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GNED 250 Current Issues Question: Nursing shortage and issues patient safety,title page and reference page ,introduction of the topic and and analysis of the issues which is patient safety,Socio-cultural perspective ,economic ,and political then conclusion. Answer: Introduction: The report brings about the discussion on the assignment ‘Current Issues’ which includes the description of the nursing shortage and the issues of patient safety in the healthcare system. Nurses play a dynamic and a crucial role in the healthcare settings, as they are the first person who interacts with the patients. The heavy workload of the nurses in the hospitals is one of the major problems for the American healthcare system. Nurses in the clinical settings experience increased workloads due to several reasons, such as increase in the demand of nurses, and reduced supply of nurses, reduced staffing and high overtime, and reduction in the length of patient stay in the hospitals. Thus, the report will bring an assessment and analysis over the shortage of nurses and the increasing issues of patient safety in the healthcare. In addition, the problem will be highlighted in context to many different perspectives, including socio-cultural, economic, and the political aspects in any country (Black, 2016). Nursing Shortage In Healthcare Nurses are considered as the largest group of health professionals who aims to provide direct and effective patient care in the hospitals. The quality of care provided to the patients is dependent directly on the performance of nursing staff. The term nursing shortage is referred to the situation, where the demand for the nursing professionals or the registered nurses (RNs), exceeds the supply in the healthcare systems, at a local, national or global level. In other words, the shortage can be defined and measured in terms of the country’s historical staffing levels, resources and the estimates of the demand for the healthcare services.  Shortage has following meanings, as they are not easily quantifiable in the healthcare, and these can be stated as the professional capacity, i.e. shortage of nurse who is required to provide quality services. From the economical perspective, shortage is the unavailability of the nurses to fill the required positions in the clinical settings (Snavely, 2016). According to some authors, it has been also defined, in absolute and relative terms, in different scenarios. An absolute nursing shortage is the situation where there is lack of skilled staff or nurses for a particular vacancy whereas relative shortage discusses about the presence of the skilled people, for a position; however they are unable to fulfil some other required aspects or requirements of employment, leading to nursing shortage (Whalen & Schmidt, 2016). Discussing about the shortage, it has been evidenced that healthcare in the United States are facing a potential shortage of the nursing staff. There have been several reasons for the growing concern of nursing shortage, in several states such as California, New York and many others. Past few decades, U.S. hospitals have faced critical problem of nursing shortage, born due to increased patient loads, and the increasing pressure to treat large number of people. Some other reason, states that without the new graduate pipeline, there are few nurses available in the healthcare who can replace those who have left, or retired themselves from their jobs. Thus, from the above description it has been studied and analysed that the nursing shortage in the health care organisations, affects their each and every aspect of healthcare delivery (Vincent & Amalberti, 2016). Issue Of Patient Safety The term patient safety refers to the discipline, which puts emphasis on the safety in healthcare through prevention, reduction, reporting, assessment, and analysis of the medical errors, which leads to the adverse incidents. Patient safety has been the integral part of the effective and successful healthcare system in any country, which ensures sound health and wellbeing of the patients in the hospitals. The report highlights about the problem of nursing shortage, which leads to negative impact on the safety of the patients in the hospitals. Lack or shortage of the competent staff in the hospitals, increases the possibilities of issues of hospital-related mortality, increases in failure to rescue, and one of the major issues is increased length of the patient stay in the hospitals. Thus, shortage of nursing staff in the healthcare affects the patients, and the quality of care delivered in the long-term (Maier et al., 2016). IOM (Institute of Medicine), defined the aspects and importance of patient safety in the healthcare, stating that patient safety is the prevention of harm caused to the patients, and emphasising the system of care delivery, aimed towards preventing medical errors, learning from the occurs that occur, and ensuring patient safety which involves, healthcare professionals, organisations and the patients. It has been observed that in some of the hospitals, patient safety is the top-priority, towards helping patients recover fast from their health problems. Strong healthcare are responsible to reduce the infection rates, puts check to gather information about the mistakes which can occur due to mistakes, of the staff (Aiken, 2014). They also perform the duties to make sure that there is an open flow of communication between the nursing staff, and the senior doctors, health professionals, and the patients or their families in the healthcare. The research findings, has revealed the fact around 4,440,000 patients die every year from the hospital errors, injuries, accidents and infections, and amongst them many patients die due to the occurrence of preventable errors (Wonder & Otte, 2015). To discuss in detail about the patient safety issue, there are three main aspects such as the reasons or factors contributing to the patient safety issue, impacts of the issue and the methods to resolve such issue in the healthcare. The factor which may lead to the occurrence of increased patient safety issues includes certain human factors, environmental factors, and the technical factors. Environmental factors consists of patient’s social background, background of care; unplanned consultation from the doctors, place of care, healthcare services provided to the patients/consumers in the hospitals. The human factors are those which are linked by the patient, communication, and the relationship between the health professional and doctors. The technical factors such as equipment handling, failure, malfunction, and incorrect use of the technological systems and processes, also affect or lead to issues of patient safety. The factor which can help in preventing the impact of the errors in the healthcare, on the patient safety is the patient himself. Thus, it states that the participation of the patients in the issues of safety contributes in ensuring their health care to a great extent. The errors which affect the safety of the patients can be improved by a number of changes made in the healthcare (Vaismoradi, Jordan & Kangasniemi, 2015). Face-to-face interactions or communication between health professionals and patients. A determined time and place for the occurrence of handovers. Minimised interruption in work. Use if structured content Sufficient time to clarify issues and doubts in the processes, such as overlap in the shift or schedules. Presence of the supervisor, to overlook the problems or queries in the healthcare system. Thus, these changes will at first reduce the occurrence of errors, in the hospital or clinical settings, which will reduce the possibilities of negative influence on the safety of the patients. In addition, it will also resolve the issues, minimising their impact on the patient health and safety in the longer period (Braithwaite, Wears & Hollnagel, 2015).  Analysis Of Patient-Safety Issue From Different Perspectives The patient safety has been identified as the major concern for the delivery of quality care to the admitted patients in the hospitals, from a number of different perspectives. These perspectives, socio-cultural, economic and the aspects from the political environment affecting the quality of care and patient safety. The diagram given below describes about the patient safety plan in context to the patient safety issue observed in the hospitals across Canada (Aiken et al., 2017).                                                                                                                          ce: Canadian Patient safety Institute, 2018) Socio-Cultural Perspective  Patient safety is one of the major concerns in the contemporary health organisations, therefore safety must be ensured to achieve positive health outcomes. The socio-cultural factors which may affect health or impact the safety of the patients include religion, family, wealth, drug, poverty, working conditions, unemployment, social support, and the availability of the food to the patients. Discussing about the socio-cultural aspects of the patient safety, it has been analysed that wealth and the unemployment is one of the major factor that affect the safety. If a person is unemployed, then he/she will not be able to avail the basic or necessary healthcare services, or ensure that they are provided proper treatment in the hospitals (Wonder & Otte, 2015). The working conditions of the patients along with their families, determines the response towards their illness or disease. Social factors such as literacy and education also affect the patient safety in the healthcare. It is thus described, when the health professionals, doctors or the nurses in the hospitals, are aware of the treatment or methods to ensure patient safety. In addition, it also depends on the patients’ education and awareness towards participating in ensuring their health and safety. Education, income, housing, and access to healthcare are some of the major factors from the socio-cultural perspective which affects the patient safety and health in the longer period (Waring, 2017). For an instance, the factor of housing states that people who live in poor conditions, or do not have proper housing facilities, are exposed to a number of risks which develops health problems in their future. This affects their access to the health services, and it leads to the negative impact on their safety, and wellbeing. Also, to view the healthcare and issue of patient safety, the social factors, also states that providing services or treatment at the minimum possible costs to the patients so that they can ensure safety at their own cost (Werner et al., 2016). The socio-cultural perspective is more described in terms of the factors which affect patients in the health care organisations. Patients with their elderly or family members are able to seek social support which helps the patients or consumers to enhance the quality of care delivered to them in the hospitals. Socio-cultural factors or perspective play an important in affecting the patient safety either in a negative or positive manner, like family, peers and social media affect health to a major extent. The religious, cultural values, affects the individual’s choices, regarding food and the diet of the patient, leading to effective results for the health care services (Ulrich & Kear, 2014). Economic Perspective Patient safety is considered as the critical policy issue, and remains a vital challenge for the OECD health systems and processes. Many adverse events, leading to the harm to the patients, can thus be prevented by the implementation of appropriate safety protocols, and the clinical guidelines. The economics or economic perspectives describes the patient health includes estimating the cost of failure and reduction of the harm effectively and efficiently. It explains that by comparing the costs of safety failure, as well as the cost and influence of various alternatives applied to prevent these failures, it helps to inform the policy makers, with an idea of then burden on the economic system. The patient safety in a healthcare system in any country requires adequate investment and human capital. As there are many systems or technologies which needs to be used in the hospitals to improve patient health while giving them treatment. Thus, the economic perspectives to the emerging issue of patient safety are thus understood from both, patient, and the healthcare system in the country. The economic perspective of the healthcare systems which describes safety of the patient as major element or aspect, as it states that the financial impact of safety failure is considerable, and it must be managed by the health care organisations, and the health managers. According to the research findings, approximately 15% of the total hospital activity and the expenditure have been the direct results of the adverse clinical events in the healthcare settings (Mardis et al., 2016). Limited financial resources in the healthcare mean that the health service managers have to cut their costs in all the areas which also consist of human resources. For an instance reducing the overall number of different positions, and increasing the part-time and causal employees leads to the problem of staff turnover. It means that nurses leave their work or healthcare organisations due to increase in workload and overtime (Carayon et al., 2014).  In addition, there is another reason, as when on the introduction of advanced technologies in the healthcare, systems are improved, but the staff training has not kept pace with all these changes. Thus, it increases the economic burden on the health organisations, ad with the advancement of technologies and heavier workloads, few nurses are found working on part-time or casual basis, therefore there are fewer opportunities to attend for the orientation and in-service education for new processes and technology in healthcare. The issue of fewer nurses who work in full-time positions leads to a negative influence on the patient safety, as the continuity of care gets reduced, due to limited financial resources and increased economic burden (Jiang et al., 2016). Political Perspectives Discussing about the political aspects or perspectives of patient safety, it can be stated that there are certain rules, regulations or the governmental authorities which govern the healthcare system in any country. The term political perspective is used to refer to the government policies, rules, and programmes to ensure effective operation of the systems in healthcare. It has been examined that there is major contribution of the healthcare regulatory agencies, as they monitor the practitioners, and the facilities provided to the patients in the hospitals. It can be stated that the role of accreditation and the regulation leads to patient safety, as it enlist some of the standards which every hospital needs to accomplish, directing towards attaining effective treatment and patient safety (Wager, Lee & Glaser, 2017). The basic standards states that the unsafe practices must be omitted in the hospitals by the health professionals in their treatment, so that it may not hamper the safety and health of the patients. Accreditation has been observed to be more effective in promoting good safety practices, than the error reporting or public awareness. On the grounds of political perspectives, in most of the hospitals accreditation serves as the primary driver for the patient safety. Accreditations in healthcare are considered significant and beneficial as it provides the organisations to receive payment, from the federally funded Medicare programs.  From the perspective of politics or governmental accreditations it has been analysed that it helps the healthcare settings to enhance their performance through delivering safe and quality care services to the patients. Thus, every healthcare setting or hospitals serving the requirements of their customers must comply with the rules, policies or the governmental aspects to ensure delivery of care as per the mentioned health standards (Cho et al., 2015). Conclusion: To conclude the above discussion it has been analysed that nursing is a dynamic and complex activity or services which aim at providing quality care to the patients in the healthcare. Patient safety is considered as the corner-stone of the high-quality healthcare, and the nurses play a critical role in ensuring the patient safety, as they perform the duties of identifying the errors, or mistakes in the treatment of the patients, and reducing the impacts there on. The report above mentioned about the lack or shortage of nursing staff which is one major issue or concern found in the United States, Canada and many other countries. The shortage of nursing staff also led to the occurrence of problem of patient safety in the hospitals. Hence, these issues must be resolved in any healthcare system considering the different socio-cultural, economic and the political perspectives and their influence on the effectiveness of care delivered to patients in the healthcare. References: Wonder, A. H. & Otte, J. L. (2015). Active learning strategies to teach undergraduate nursing statistics: Connecting class and clinical to prepare students for evidence?based practice. Worldviews on Evidence?Based Nursing, 12(2), 126-127. Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R. & McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824-1830. Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M. & Sermeus, W. (2017). Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Qual Saf, 26(7), 559-568. Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. United States: Elsevier Health Sciences. Braithwaite, J., Wears, R. L. & Hollnagel, E. (2015). Resilient health care: turning patient safety on its head. International Journal for Quality in Health Care, 27(5), 418-420. Canadian Patient Safety Institute. (2018). Integrated patient safety plan. Retrieved from: Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R.& Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied ergonomics,  45(1), 14-25. Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, I. Y. & Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: an observational study. International journal of nursing studies, 52(2), 535-542. Jiang, H. J., Boutwell, A. E., Maxwell, J., Bourgoin, A., Regenstein, M., & Andres, E. (2016). Understanding patient, provider, and system factors related to Medicaid readmissions. The Joint Commission Journal on Quality and Patient Safety, 42(3), 115-121. Maier, C. B., Barnes, H., Aiken, L. H. & Busse, R. (2016). Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: size, growth, physician substitution potential. BMJ open,  6(9), 011901. Mardis, T., Mardis, M., Davis, J., Justice, E. M., Holdinsky, S. R., Donnelly, J. & Riesenberg, L. A. (2016). Bedside shift-to-shift handoffs: a systematic review of the literature. Journal of nursing care quality, 31(1), 54-60. Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economics, 34(2), 98. Ulrich, B. &  Kear, T. (2014). Patient safety and patient safety culture: Foundations of ex – cellent health care delivery. Nephrology Nursing Journal, 41(5), 447-456. Vaismoradi, M., Jordan, S. & Kangasniemi, M. (2015). Patient participation in patient safety and nursing input–a systematic review. Journal of clinical nursing,  24(5-6), 627-639. Vincent, C. & Amalberti, R. (2016). Safety strategies in hospitals. In Safer Healthcare (pp. 73-91). Berlin: Springer. Wager, K. A., Lee, F.W. & Glaser, J. P. (2017). Health care information systems: a practical approach for health care management. United States: John Wiley & Sons. Waring, J. (2017). A socio-cultural perspective on patient safety. United States: CRC Press. Werner, N. E., Gurses, A. P., Leff, B. & Arbaje, A. I. (2016). Improving care transitions across healthcare settings through a human factors approach. Journal for Healthcare Quality, 38(6), 328-343. Whalen, H. & Schmidt, G. (2016). The women who remain behind: challenges in the LDC lifestyle. Rural Society, 25(1), 1-14.

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