The nursing shortage and the associated competing needs have impacted the development of policy. The ANA (American Nurses Association) has developed a code of ethics to guide nurses and supplied interpretive statements to assist with understanding (ANA, 2015). Provision Six states that a nurse or a group of nurses are to assess the ethics of delivery and quality of care (ANA, 2015). This translates to nurses maintaining ethical care, including the safe delivery of care with appropriate staffing and voicing concern if ethical care is not being delivered or improvement is needed. As stated in Provision Two, the patient is the primary concern (ANA, 2015). Nurses have an obligation to advocate, including policymaking, for the patient’s interest which is Provision Seven (ANA, 2015).
The Nursing Shortage and Competing Needs
Nursing is the largest group of health professionals (Haddad et al., 2022). Many factors influence the cost of nursing, including training, recruitment, overtime, and retention. One of the largest competing needs is the cost of recruiting and maintaining a robust nursing staff. Staffing is challenging to predict as staffing is also influenced by acuity and economic downturns (Parsons, 2019). Lower staffing ratios are less expensive but result in overtime, increased errors, and potential nursing dissatisfaction (Haddad et al., 2022). Additionally, the use of agency nurses is more expensive than a traditionally employed nurse. Including nurses’ viewpoints on safe staffing and ethical care will improve nursing satisfaction even in a cost-containment environment (Kelly & Poor, 2018). In summary, a competing need is financial constraints and reducing medical costs
Policy to Address Competing Needs
California, with Bill 394, instituted mandatory staffing ratios and other states have introduced bills with a similar goal (Tevington, 2011). Several other states have laws requiring staffing ratios to be published (Davidson, 2022). The laws surrounding mandatory staffing ratios do not allow for the nurse’s level of experience, insight, education, and acuity, and have yet to be validated by research (Tevington, 2011). Even without the mandate of staffing ratios, many studies have found an increased RN staffing ratio improves outcomes, quality of care, and staffing turnover rate (Tevington, 2011). The Registered Nurse Safe Staffing Act of 2015 mandates that hospitals provide safe staffing and have committees that include nurses, thereby incorporating nursing insight in the decision of what is considered safe staffing (Congress, 2016). These committees give a platform for nurses to advocate for quality of care and ethical delivery of care illustrating Provision 6 and Provision 7 of the Code of Ethics.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. https://www.nursingworld.org/coe-view-onlyLinks to an external site.
Congress. (2016). Summary: S. 1132-114th Congress (2015-2016). https://www.congress.gov/bill/114th-congress/senate-Links to an external site. bill/1132#:~:text=Requires%20the%20plan%20to%20require,of%20safe%2C%20quality%20patient%20careLinks to an external site.
Davidson, Alexa. (2022). Nurse-to-staffing ratio laws and regulation by state. https://nursejournal.org/articles/nurse-to-patient-staffing-ratio-laws-by-state/Links to an external site.
Haddad LM, Annamaraju P, Toney-Butler TJ. (2022). Nursing Shortage. Stat Pearls. https://www.ncbi.nlm.nih.gov/books/NBK493175/
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.htmlLinks to an external site.
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