Homework Lance
During your practicum, determine what clinical problem or issue the organization is facing. Discuss two implications for nursing.
I work in the Corrections setting for a local county jail. That being said, our nurse to inmate ratio is 1:150 on a good day. We stay busy not only caring for injured, critically ill, and often psychiatric patients, but monitoring and regulating vaccinations through national standards. It is required through the National Commission on Correctional Health Care (2016), that every inmate be TB skin tested within 7 days of entry into the facility. According to the CDC (2015), 44 cases of TB were diagnosed in the corrections setting in Arizona alone. TB skin testing is mandatory for inmates due to overcrowded conditions, closeness of inmates, and inmate level of contact. Many of the facilities are old and lack ventilation, contributing to the spread of communicable diseases such as TB.
TB skin testing becomes a problem when inmates try to refuse a TB skin test. This happens often and many times it’s the tattoo-covered inmate who is “scared of needles”. Understand, that the jail is not a prison. Jail is the holding facility from the time they are charged with a crime, until they are sentenced and sent to a prison. In order for an inmate to be sent to prison, they must have a current TB skin test. When an inmate refuses to get a TB skin test, one nursing implication we instill is trying to talk them into it peacefully. Occasionally this works, but there are times it doesn’t. At this point, the inmate is isolated in a lock down unit. Sounds cruel but sometimes just mentioning it works very well. Inmates in the jail don’t like to be locked down if it’s not necessary. For the occasion when even that doesn’t work, necessary means have be taken to administer the TB injection. This means placing them in a restraint chair. I personally don’t like doing this, however it is sometimes necessary in order to meet federal regulations.
Prisons are not obliging when they recieve an inmate who hasn’t had a TB skin test, and the inmate is locked down for 3 days after they get there in order to have enough time to administer the test and for it to be read. Having the ability to talk the inmate in to getting the test done prevents the prison from having to find room for the inmate in lock down at their facility, and helps prevent the spread of communicable diseases. It is unfortunate that sometimes measures of force have to be taken, but in the long run, we are helping keep the spread of TB down. This not only helps the inmates in prison to stay healthier, but prevents the spread of TB once they re-enter the community.
Resources:
NCCHC (2016). Federal clinical guidelines. Retrieved from
CDC (2015). TB in correctional facilities. Retrieved from
https://www.cdc.gov/tb/topic/populations/correctional/
ANSWER 2
Insufficient training/turnovers is an issue that plagues the organization. Which has led to increase absenteeism and the inability of the organization to retain qualified nurses as valuable resources to incoming nurses. According to Mudaly&Nkosi “employees were absent from work due to stress, depression and anxiety due to work (2015).” Thus, causing massive nursing turnovers that have contributed to deterioration of care. Let’s be honest here, lack of training which led to stress, decrease workforce, endangerment of patients, complaints and loss of revenue or decrease organizational financial stability. These costs include loss of talent and organizational knowledge and need to use fill-in outsourced nurses and train new incoming ones with whatever staff is available as a resource.
Job satisfaction is demised causing those who have decided to stay to act in a manner of unkindness, lacking support for each other and are disrespectful to patients and other staff member. This can penetrate in any nurse mind, body and spirit causing emotional, physical and mental harm. According to Liu, Zhang, Ye et al, “job satisfaction has been identified as a key factor to nurses’ intention to leave and turnover (2012).”
The organization is now realizing the enormous affect this has on productivity now. Hint, conducting surveys and having talkbacks with management and executives to problem solve and develop solutions. Of course, incentive pay for those “lean” days but still lagging behind when it comes to the proper training in current areas. Some of the nurses have teamed up together to share whatever knowledge they have gained. There is a review of where resources can be located on the computer system such as P&P and online training classes within the organization. Providing support and leadership to each other. This is not a replacement or a solid solution to the problem of training and turnovers but it is a start.
Reference
Liu, C., Zhang, L., Ye, W., Zhu, J., Cao, J., Lu, X., & Li, F. (2012). Job satisfaction and intention to leave: a questionnaire survey of hospital nurses in Shanghai of China. Journal Of Clinical Nursing, 21(1/2), 255-263. doi:10.1111/j.1365-2702.2011.03766.x
Mudaly, P., &Nkosi, Z. Z. (2015). Factors influencing nurse absenteeism in a general hospital in Durban, South Africa. Journal Of Nursing Management, 23(5), 623-631. doi:10.1111/jonm.12189
ANSWER 3
One issue I have noticed in the hospital I work in, nursing shortage and hiring freezes. All units are short on nursing staff, resulting in nurses have to take care of more patient with higher acuity. The hospital is now on a hiring freeze due to budgeting issues. patient’s care and safety is compromised when nurses are expected to do more with less. Nurses are forced to do the bare minimum for patients and become tasked oriented. Things can be overlooked or unintentionally dismissed, resulting i harm to the patient. “In a 2002 national survey of physicians and the public, nurse understaffing was ranked as one of the greatest threats to patient safety in hospitals within the United States”. (Jianghua, H., Staggs, V. S., Bergquist-Beringer, S., &Dunton, N. (2016).
Jianghua, H., Staggs, V. S., Bergquist-Beringer, S., &Dunton, N. (2016). Nurse staffing and patient outcomes: a longitudinal study on trend and seasonality. BMC Nursing, 1-10. doi:10.1186/s12912-016-0181-3
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