Over the past five years in the Hospice department there has been significant turnover of staff. Newly hired nurses come from a variety of background. Some have worked on the Oncology unit in the local medical center, some have worked in mother baby units in the local medical center. Some are fresh out of school and hold no acute care setting experience at all. The turnover in this unit has been associated with a combination of reasons. An example is, many of the nurses have retired or are approaching retirement age, some have expressed burnout and frustration due to the increasingly high acuity of patients and mandatory overtime expectations as the reason for leaving or retiring early, or have decreased their work hours to Per Diem part time status in attempt for better life balance. Some of the nurses that have left have decided that Hospice work is not for them as they had hoped, and leave …show more content…
Discuss your investigation of the problem or issue.
In a previous research projects completed, Hospice families and untrained caregivers were assessed regarding their comfort and skill needs associated with medication and symptom management support in end of life care. (XAP Task 1 C. Thienes) These caregivers were followed in the home environment, and different teaching areas of support were assessed to provide guidance for the caregiver’s confidence while caring for someone at end of life.
Further research through additional articles exploring mentoring of newly hired nurses (NHN) in palliative care, to support the NHN anxieties associated with provision of end of life care. These articles reflect on the education of the nurse and the lack of time spent in EOL situations. Palliative care mentorship Workload and acuity systems do not reflect adequately on the time needed to properly support patients and families in EOL care. Articles reviewed different acuity techniques used to better balance the staffing matrix in EOL care. (Article #2) Visit Based Acuity Index
There is a surge of retiring nurses and a rising number of patients. Hospitals are scrambling to fill the tens of thousands of nursing positions, therefore, asks the question as to
Nurses are both blessed and cursed to be with patients from the very first moments of life until their final breath. With those last breaths, each patient leaves someone behind. How do nurses handle the loss and grief that comes along with patients dying? How do they help the families and loved ones of deceased patients? Each person, no matter their background, must grieve the death of a loved one, but there is no right way to grieve and no two people will have the same reaction to death. It is the duty of nurses to respect the wishes and grieving process of each and every culture; of each and every individual (Verosky, 2006). This paper will address J. William Worden’s four tasks of mourning as well as the nursing implications involved – both when taking care of patients’ families and when coping with the loss of patients themselves.
Hospice focuses on end of life care. When patients are facing terminal illness and have an expected life sentence of days to six months or less of life. Care can take place in different milieu including at home, hospice care center, hospital, and skilled nursing facility. Hospice provides patients and family the tool and resources of how to come to the acceptance of death. The goal of care is to help people who are dying have peace, comfort, and dignity. A team of health care providers and volunteers are responsible for providing care. A primary care doctor and a hospice doctor or medical director will patients care. The patient is allowed to decide who their primary doctor will be while receiving hospice care. It may be a primary care physician or a hospice physician. Nurses provide care at home by vising patient at home or in a hospital setting facility. Nurses are responsible for coordination of the hospice care team. Home health aides provide support for daily and routine care ( dressing, bathing, eating and etc). Spiritual counselors, Chaplains, priests, lay ministers or other spiritual counselors can provide spiritual care and guidance for the entire family. Social workers provide counseling and support. They can also provide referrals to other support systems. Pharmacists provide medication oversight and suggestions regarding the most effective
Dealing with death on a regular basis can take a toll on a person. Being a hospice nurse will never be easy and is certainly not for the faint of heart. A hospice nurse watches patient’s health decline, often times very rapidly, and many times sit by the patient’s side as they pass away. It can be exhausting both emotionally and physically. You need to have a big heart and a strong will to help those in need for the occupation. Sara Schmidt certainly never saw herself in the profession, but discovered that she has a true love for helping people.
... end of life care. The third theme discussed in this study is the intensive care environment. Homs stated that advantages in the ICU include a higher ratio of nurses to patients leading to more available time with the ill patients and their families. The fourth theme discussed in this study is education and training. Nurses learned about end of life care in the ICU through bad experiences or by watching other co-workers make a mistake. The final theme discussed in this study was staff distress. The nurses stated that the feeling of distress was brought upon when they lacked experience or training and there was inconsistent communication. “Lack of support from other staff and managers, differences in the consultants’ End of Life Care decisions and a lack of involvement in the End of Life Care decision-making were the most common areas causing distress” (2014, p. 553).
The nurse becomes the confidant, the guide through the darkness, a source of comfort for those experiencing the trauma of losing a child. To successfully fulfill these nursing roles, in addition to roles that must be fulfilled to meet other patient’s needs, one must acknowledge their own definition of death and educate themselves on cultural and societal norms associated with death and dying. It is important to identify one’s own definition of death and dying but also understand that one’s preference does not define the death experience for others. The individuality and uniqueness of each death experience means that one definition of death may be hard for one to accomplish. It is important to maintain an open mind, nonjudgmental spirit, and impartiality for the cultures and practices of others surrounding death and dying. A culturally competent nurse is not only responsible for acknowledging the cultural norms of others but also respecting and educating themselves about the death rituals of their patient’s culture and providing the family with as many resources to safely and effectively fulfill their cultural practices. Education is empowering for the nurse who is navigating the death and dying process. Education often supplements ones credibility with the dying patient and their family which can ease overall anxiety and further promote ones role as a patient advocate and provider of
However, upon securing a job, they find that things on the ground are not as they had expected them to be and this results in some of them deciding to leave the profession early. Research shows that turnovers within the nursing fraternity target person below the age of 30 (Erickson & Grove, 2011). The high turnover within the nursing fraternity results in a massive nurse shortage. This means that the nurses who decide to stay have to work for many hours resulting in exhaustion. A significant percent of nurses quitting their job sites exhaustion and discouragement as the reason that contributed to their decision. In one of the studies conducted on the issue of nurse turnover, 50% of the nurses leaving the profession argued that they felt saddened and discouraged by what they were unable to do for their patients (Erickson & Grove, 2011). When a nurse witness his/her patients suffering but cannot do anything because of the prevailing conditions he/she feels as if he/she is not realizing the reason that prompted him/her to join the nursing profession. The higher rate of nursing turnover is also affecting the quality of care nurses provide to
middle of paper ... ... qualified nurses diminishes. Based on this study, administrators should recruit nurses who understand that health care is at its best when health care professionals work collaboratively as members of a team, committed to providing the best possible patient care. References Aiken, L.H., Clarke, S.P, Sloane, D.M., Sochalski, J., & Silber, J.H. (2000). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.
In addition to concerns about the adequacy of the supply of nurses the financial impact of high turnover was startling. According to Jones (2005) Using the updated Nursing Turnover Cost Calculation Methodology, the per RN true cost of nurse turnover is calculated to be 1.2–1.3 times the RN annual salary. That estimate is derived from a retrospective, descriptive study of external RN turnover cost data at an acute care hospital with over 600 beds. The findings indicate that the three highest cost categories were vacancy, orientation and training and newly hired RN productivity. (as cited in Kooker & Kamikawa, C. 2011). For example, At the Queen’s Medical Center, the annual salary of an experienced RN is currently $91,520. Therefore, using the
After reading the different stories in the book “Final Gifts”, I believe I have a better understanding of the nurse’s role in caring for the needs of the dying patient and how their families need to be guided through this experience. The different stories in this book provide insight into the experiences of the dying as well as how their loved ones cope with their loss. The authors Maggie Callahan and Patrician Kelly, experienced hospice nurses who have extensive exposure to dying patients and their families, through their shared stories, paint a picture of what the dying want. To many, death is a difficult concept.
The prolonged shortage of skilled nursing personnel has been a serious concern to the healthcare industry, and this shortage has impacted the quality of care delivery. In addition, nursing turnover has also exacerbated the problem of nursing shortage. Nursing shortage has been blamed on many nurses retiring and less younger nurses joining the occupation. There is also an increase in life expectancy (baby boomers) leading an increase in both physical and mental ailment with subsequent demand in nursing care. Nurses are also leaving nursing profession because of inadequate staffing, tense work environment, negative press about the profession, and inflexible work schedules. Even though nursing is a promising career and offers job security, the
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
Hodge, M. B., Romano, P. S., Harvey, D., Samuels, S. J., Olson, V. A., Sauve, M., & Kravitz, R. K. (2004). Licensed Caregiver Characteristics and Staffing in California Acute Care Hospital Units [Electronic version]. The Journal of Nursing Administration, 34(3), 125-133.
Registered Nurse turnover is a continuous problem in the nursing profession. Turnover in this context is simply defined as “someone leaving a job” (Kovner, Brewer, Fatehi, & Jun, 2014). Some aspects of nurse turnover can be viewed as positive, however, most circumstances of turnover are seen negatively and can be referred to as functional versus dysfunctional. The difference between the two is a “functional turnover, a poorly functioning employee leaves, as opposed to a dysfunctional turnover, when well-performing employees leave” (“One in Five nurses leave First job within a year,” 2014). The nursing profession’s recommendation for improvement focuses on dysfunctional turnover of Registered Nurses. Nurses choose to leave their jobs to explore
“Persons intentionally choose to become nurses to help patients meet their health needs,” even when the patient is actively dying. (Wu & Volker, 2012) Hospice nursing and palliative care nursing are both considered end of life care. However, hospice nursing is typically given to patients with a terminal illness and who have less than six months to live. Palliative care is typically given to patients with a life threatening illness, and is used to increase the patient’s quality of life. Choosing a nursing career in either hospice or palliative care can be extremely difficult, but will provide an opportunity for great personal growth. At times, an end-of-life caregiver may feel responsible for their patient’s death, or they may feel isolated due to a lack of support. Nurses new to this field should “feel that their unit acknowledges death as a difficult event and that discussion of death is acceptable in the workplace.” (Lewis, 2013) The most rewarding, and also most difficult, part of being a hospice or palliative care nurse is the ability to be a part of your patient and their family’s life, including their loss, grief, and death. (Wu & Volker, 2012)