Week 2 Interactive Case Study Journal
Narrator: It is high census season for the hospital. The nurses are concerned because they have been working extra shifts for a month and they are tired. See Nurses Schedule.
Grace: Just look at this schedule. The Lead Nurse has placed mandatory overtime for this month again! I just can’t do it again. I’m so tired, and I made a medication error last month. I’m afraid that I may hurt a patient and could never forgive myself.
Nancy: Oh no! I have a wedding I’ve already RSVP’d to on that Saturday. That’s three Saturdays in a row! And each weekend I work, I’m always the senior nurse, with all new grads or nurses with less than a year’s experience.
Narrator: Uh oh, it looks like the nurse are unhappy with their schedule.
Susie: What’s going on?
Nancy: We were all scheduled an extra day each week.
Susie: Oh great, an extra day each week! What are you frustrated about? I’ll take an extra one from one of you ladies, or I’ll let the Lead know I can work another day.
Nancy: Susie, are you sure you want to do that? I think that’s unsafe. We are already on notice from the infection control nurse about the increase of central line infections on the unit. And you were just complaining earlier about having to work short most of the time.
Grace: I can’t work her mandatory extra shifts. Besides, is it legal for her to do that? Isn’t it against the law to schedule overtime? I’m going to have to see our union representative. And let’s not forget about mandatory staffing routes.
Susie: Ladies, stop whining. I’m saving for a car, so what if I’m a little tired. I get the job done. They just want a warm body here and I provide that.
Nancy: I just read this article earlier, and it points out that nurse understaffing and nurse fatigue are the two prominent issues that negatively impact the quality of care delivered to patients.
According to the article in JAMA pediatrics- a national study found that very few neonatal intensive care units provide sufficient numbers of nurses to meet national guidelines and that units caring for the most vulnerable babies are also the most understaffed, putting the health of critically ill newborns at risk. We need more nurses.
Please see attached article.
Grace: You know I don’t even know the staffing ratio requirements for this unit. Yesterday I cared for five babies, one who was really sick and required transferring to Count General!
Nancy: Grace, the ratio is 1:4 on this unit for lower-risk babies and 1:1 in the NICU (neonatal ICU).
Susie: You know, there is a nursing shortage at the bedside and with the implementation of the new computer charting and the implementation of the affordable care act health care costs are soaring. Let’s check out the guidelines for mandatory staffing again, and speak with the director. I know that nurse fatigue is a factor when mistakes are made, and we are taking care of very sick babies. The hospital does not actually use acuity guidelines in real time
Nancy: There are classification tools that measure the requirement needed for each patient. Sometimes a stated mandatory ratio does not always meet the requirement for staffing or mean that we are unsafe. I think this might be something we could bring to management during the next staff meeting. You know, become a part of the solution.
Susie: We need to get together at the next union meeting and talk about this mandatory
staffing issue. I can’t work five days a week anymore. I could really hurt my patients.
Nancy: I do believe an employer can ask us to work as much overtime as needed to Cover shifts. But we might want to check our union contract again, and always put the patient safety first.
Narrator: For more information, click the link on the screen.
Narrator: Yes, understaffing does impact the quality of care and may lead to increased
rates of infection. As registered professional nurses, we must ensure that we are all practicing safely and are not fatigued, because understaffing goes hand-in-hand
with nurse fatigue. According to the Nursing Staffing Strategy, 69 percent of health care
professionals surveyed said that fatigue caused them to feel concern over their ability
to perform during work hours. Additionally, nearly 65 percent of participants reported
they had almost made an error at work because of fatigue. The aging nurse population and nursing work shifts that are longer than eight hours can also have an impact on errors and fatigue. When discussing the aging nurse, according to Reese the director of Kronos (K. Brimmer 2013) in “2008. the average age of nurses was 45.5. The average age is probably closer to 52 now and we’ve found that the aging workforce tires easy and working extra shifts doesn’t help. These highly skilled workers have to make critical
decisions related to patient care and if doing it in a fatigued state, will only increase the risk for errors and injuries” , said Reese. We can only hope that we continue to discuss these sensitive issues including mandatory staffing.