Navigating Challenges in Nursing: Overcoming Staffing Shortages and Ethical Dilemmas in High-Acuity Care

In the nursing profession, overcoming challenges and adversities have become a major part of it. During my new grad nurse residency we were expected to attend classes, seminars, labs, as well dedicate three days to work on the floor with our preceptors. Once you completed the first part of the residency in four months, you were expected to be on your own. I worked on a surgical ICU unit where the patients were considered to be the highest acuity in the hospital. They were very ill and needed a variety of interventions completed such as titrating drips, and use of continuous renal replacement therapy (CRRT) which is a temporary dialysis machine. Patients on CRRT are considered to be a one to one nurse to patient ratio due to the acuity of the patient while on the machine. Most of these patients were also intubated and on the ventilator as well. As a new grad nurse, they advised all managers and supervisors that we shall not care for these patients until the residency was fully complete to ensure we were prepared. On my first independent shift, I was assigned two patients; one was an intubated CRRT patient and another was a post op kidney transplant patient. I knew the assignment was unethical and decided to advocate for myself to the charge nurse who stated they are short staffed and didn’t have anyone else to take the patient. I advocated for myself and also the patient stating it was not a safe assignment for the patient or myself. I was not trained on CRRT at the time therefore the patient would not receive the care they needed. However, the charge nurse continued to insist that I accept the assignment in spite of that. I felt very uncomfortable and unprepared to accept this assignment because I knew that this patient was very ill and deserved care from a nurse who was well prepared to attend to the CRRT machine and any troubleshooting it may need. I also felt that I did not have an adequate support system from my team leaders. It seemed as if they only cared about numbers rather than the safety of the patient and their best interest.

The underlying nursing issue in that situation is nursing shortage. According to Haddad, nursing shortage can be described as not having enough essential workers on a unit to provide care to patients due to a variety of reasons such as nurse burnout, underpay, or lack of support (Haddad, 2023). Lack of support is a major issue in the nursing profession. Most nurses are afraid to advocate for themselves in fear of retaliation from the leadership team. Major hospitals pride themselves on patient satisfaction, however employee satisfaction leads to higher percentages in patient satisfaction. According to Jacobs, most institutions will create values but they are centered on the hospital rather than the nursing profession (Jacobs, 2013). Jacobs then continued by examining each model and elaborating on how they were built and what their focus is based on. The nursing profession will continue to face adversities until practice models are incorporated to truly improve satisfaction rather than trying to keep the name of a Magnet status.

Reflecting on past experiences, as a practitioner I want to be the support that my nurses need in any shape or form. There are things that I will not be able to control such as nursing shortages, however being a patient and nurse advocate is something within my control.  As a member of leadership, providers are expected to always have the patients best interest as a priority. Carper’s Pattern of knowing was very insightful. Breaking down the different approaches and elaborating on each one causes you to identify previous practices that can be improved while also allowing for new practices to be formed. I am interested in focusing on the ethical knowing in my future practice. Carper explained this by simply stating that codes cannot determine the plan or outcome of how a patient situation should be handled, it places boundaries on what the patient wants and what true happiness is defined as (Jacobs, 2013). My goal as a future nurse practitioner is to get to know my patients as a whole and establish goals with them. Establishing and building rapport with my patients will allow them to trust me and see the passion for nursing that I have so that we can work together to accomplish future goals.

References:

Haddad LM, Annamaraju P, Toney-Butler TJ. Nursing Shortage. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493175/

Jacobs, B. B. (2013). An Innovative Professional Practice Model. Advances in Nursing Science, 36 (4), 271-288. doi: 10.1097/ANS.0000000000000002.