Scholarly Paper Improving working conditions in the acute care units

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Scholarly Paper – Improving working conditions in the acute care units
Heather A. Ryan, RN
University of Central Florida
November 16, 2013
NUR 3805 - Dimensions of Professional Nursing Practice

Results from research studies are inconclusive on the most effective ways to improve the working conditions in an acute care unit. The objective of this paper is to explore various ways to improve the working conditions in an acute care unit. Below we discuss the various nursing implications and recommendations for improvement.

This research paper will delve into the issue of improving the working conditions of nurses in the acute care units. Recently, one of the charge nurses on my unit posed a question to the nursing staff. She called for the staff nurses to think of ways to improve the conditions on our unit by approaching it like we were writing a paper for school. My research was tailored specifically to brainstorm ways to address the issue of improving the working conditions. I have narrowed down my focus to include a few things that I feel impact the working conditions and shape the nurses perception. Job dissatisfaction is one of the main reasons for low morale and an increase in the nursing shortage. Another concern is nurse workload, patient acuity and nurse to patient ratios have become more intense and demanding.
As an acute care nurse, we face challenges daily. Specifically, the patient population has changed over the years. Through the years, there have been research studies done on nurse staffing and patient outcomes based on the care they received. Many studies show conflicting results. But with the increase in patient acuity, acute care nurses see patients that are sicker than they once were. Hospitals are still required to maintain a minimum staffing requirement across the board despite the different types and acuity of patients. With that in mind, we are seeing hospitals having to increase the staffing levels without receiving additional reimbursements for the patient care. (Welton, 2007) Unfortunately, the downside is more patients and fewer nurses to care for them. For example on the unit that I work on, when this happens the increase in the acute care nurses’ workload can negatively impact patient safety and decrease the unit morale.
Nursing Implications
To get to the heart of the matter, we need to categorize the nursing workload. One article I read organized the nurses’ workload into four levels: unit level, job level, patient level and situational level. Unit level focuses on the nurse to patient ratio. The job level focuses on the nurses’ stress level and job dissatisfaction. Patient level focuses on the clinical condition or acuity level of the patient. On a unit level, sometimes budget constraints and lack of nurses negatively affect the ability of units to staff acute care units with the recommended 2-1 ratio. Currently, we are seeing an average 3-1 ratio despite the increase of higher acuity patients.
When we look at the job level, we focus on the impact of the workload and how it affects the acute care nurse directly. At this level, we see burnout from stress, job dissatisfaction, and decline in job performance due to a heavy workload. Another aspect is looking at the clinical condition or the acuity level of the patients. This can impact the nurses’ workload dramatically when there is a change in condition. Lastly, we can address the situational level. This is where we look at the condition of the work environment, the availability of the supplies needed to care for the patient, needs of the family members, communication issues between staff, and the distance between patient rooms. This looks at the variables that can affect the work load. (Carayon & Gurses)
Incidental overtime is another area that I identified as an area of concern. Due to the increase in patient acuity and necessary charting, sometimes nurses end up staying after