Numerous nursing theories review various aspects of medical practice to ensure the provision of high-quality care. Among them, it is significant to point out the Adaptation Model by Callista Roy that perceives the patient as an individual, recognizing his/her personal and social characteristics (Smith & Parker, 2015). According to the model, both physiological and psychological systems of a person have to exist in the state of relative equilibrium, in order to provide a range within which people can adequately cope with their experiences. However, for each human being, this range is unique (Smith & Parker, 2015). The application of the theories, including the one presented above, to the issues encountered by nurses in the course of their work, may provide an insight into the possible solutions. Moreover, as it will be demonstrated further, the use of theories is not limited to the problems of the patients. The following work focuses on the identification of an issue relevant to the nursing practice and its comprehensive analysis. Additionally, it proposes an effective strategy to solve the problem that stems from the application of the provided nursing theory and describes the mechanism of its implementation while identifying the unresolved aspects.
Nursing Theory: Description of the Issue
Currently, the health system of the U.S. experiences a wide array of problems and challenges, many of which are related to the provision of high-quality care under the conditions of scarce resources. Among the most pressing issues in the implementation of mandatory overtime by healthcare management. Recently, this practice has become a relatively common staffing tool due to the shortage of healthcare specialists, especially nurses, and the high inflow of patients (Yoder-Wise, 2014). However, the desire of the employers to optimize the organization of work through the implementation of such methods may have a negative impact on the quality of the provided care.
The problem of mandatory overtime must attract the attention of the nursing staff in any given healthcare facility due to its contradictory and dangerous nature. On the one hand, from the economic point of view, by implementing such a strategy, the clinic does not require additional personnel and is able to cope with challenges by using the existing staff. Moreover, in some cases, the employees may be interested in performing additional work for appropriate compensation, thus become more motivated (Yoder-Wise, 2014). One cannot deny that such flexibility and motivation have a positive effect, providing the conditions for efficient adaptation to changes in the external environment of the facility. However, such practice can be detrimental to the health of nurses, as the mandatory overtime forces them to ignore such mental and physical signals as fatigue and various functional disorders. Additionally, overtime is usually performed at the expense of family and personal life, which also has a negative effect on the nurses’ state of mind and concentration (Huston, 2014). Thus, overly frequent use of mandatory overtime as a staffing tool can cause occupational stress, as well as various illnesses and accidents at work, and ultimately lower the quality of the provided care.
The problem of mandatory overtime has also attracted the attention of scholars, who constantly refer to this topic in the nursing literature. In particular, despite the fact that the nursing organizations, such as the American Nurses Association, oppose this practice and are relatively successful in banning it at the legislative level, many healthcare specialists are still required to stay on duty after the end of their shifts. The researchers also indicate the presence of a connection between the mandatory overtime and the hospital-related mortality, a 1.3% increase for each additional 10% of overtime hours (Yoder-Wise, 2014). Moreover, the lack of rest has an equivalent effect to alcohol intoxication, up to 0.10% of alcohol level in the blood after 24 hours without sleep (Huston, 2014). However, despite these facts, mandatory overtime has become a standard staffing tool instead of the emergency measure, which contributes to the relevance of the problem.
By using the information provided above, it is possible to point out the following stakeholders affected by the problem. First, the nursing staff of the healthcare facilities directly experiences the negative effects in the form of occupational stress and fatigue (Huston, 2014). The next group includes the patients, since, as was mentioned before, mandatory overtime is stressful for the nurses, increasing the chances of them making mistakes in the course of treatment. As a result, the risks for those receiving the treatment become higher, which may contribute to the negative outcomes in a form of a wide array of chronic and acute conditions that could have been avoided under different circumstances (Rigolosi, 2013). Thus, the mandatory overtime puts the patients at risk of developing complications, comorbidities, and disability, which do not contribute to the overall health condition of the nation, as well as the satisfaction of the particular clients with the hospital or clinic.
The final group of stakeholders includes the healthcare facilities in general. The private nature of the American health system makes it dependent on such factors as quality, supply, and demand. The mandatory overtime has a negative effect on the provision of care, meaning that the credibility of a clinic lowers. Moreover, given the fact that after the reform, the majority of hospitals operate based on a pay-for-performance model, their staff does not receive incentives and may consider changing the place of work (Kronenfeld & Kronenfeld, 2015). Such turn of events may hinder the survivability of a facility in the long-term perspective.
Application of the Theory to the Issue
Despite being caused by the objective reasons (shortage of nurses and an increase in the number of patients), the presented issue can be solved through the application of the nursing theories, namely the Roy Adaptation Model. It is based on the presence of a certain range of possibilities, which patients adapt in unfamiliar conditions (Smith & Parker, 2015). Moreover, each of them has a unique range of comfortable adaptation both physiological and psychological (Smith & Parker, 2015). However, it is possible to say that this statement can be applied not only to the patients but also to the nurses. In particular, the mandatory overtime disrupts the normal daily routine of a nurse, resulting in the need for adaptation to the new work conditions. As was mentioned before, the ability of individuals to do so is not uniform, i.e. it differs from one person to another. In other words, in some cases, even the motivation mentioned above is unlikely to stimulate the process of coping with the altered environment. Therefore, the strategy has to be based on the use of a personalized approach. In other words, the management should replace the mandatory overtime with a voluntary one.
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The implementation of such a measure will take into account a range of possibilities of each particular healthcare specialist. For example, the majority of nurses are capable of assessing their fatigue level to make a conclusion regarding their ability to perform nursing duties safely and efficiently (Huston, 2014). In particular, in accordance with the Roy Adaptation Model, each nurse has four ways of adapting to the challenging conditions (e.g. overtime). The first of them is the human reaction to such external factors as temperature, humidity, atmospheric pressure, and other sensory stimuli. The ability to cope with new and unusual physiological factors is not only affected by external factors but also depends on the capabilities of one’s physiology. The second way is the desire to understand oneself both spiritually and physically. It also has the boundaries, within which a person can deal with changes within their psychological and physical selves. Another factor is related to the change of an individual’s role in certain circumstances; for example, a nurse that has to neglect her role as a mother in favor of work. However, in this case, a person can go beyond their capacity to adapt. The final component is interdependence, which implies the people’s desire to attain a state of relative balance in the relationship, namely with family members and colleagues (Smith & Parker, 2015). Thus, the managerial staff of the clinic should be mindful of the limitations of adaptation in such situations as overtime work, when a nurse tends to experience a feeling of pressure, contempt or loneliness.
Being familiar with the concepts presented above, as well as the conditions in a particular healthcare facility, helps the nurses perform a procedure of self-assessment, which allows them to decide whether to accept or decline the overtime hours. Given the fact that the primary factor that increases the risk of causing harm to patients is the prolonged workday (Huston, 2014), this approach identifies only those healthcare specialists who are capable of adapting to such conditions and provide treatment during the most stressful shifts. In turn, the quality of care will remain constant, without being lowered significantly.
At the same time, the implementation of the presented strategy has to occur on the organizational level. Despite the presence of the legislation that curbs mandatory overtime, one cannot solely rely on the measures taken by the federal and local governments, as they cannot completely address the issue. In particular, the clinic is to maintain adequate staffing, which can be achieved in several ways. For example, managers can make retention efforts, improve the effectiveness of new personnel recruitment, and utilize the services of the temporary staffing agencies (Yoder-Wise, 2014). These measures are to be carried out directly after the introduction of the new strategy. The primary reason for that is the fact that at its initial stage, the elimination of mandatory overtime is likely to leave a void, which may be difficult to fill with the available human resources at the clinic.
Additionally, in the long-term perspective, healthcare providers have to reduce the need for overtime, which can be achieved by increasing the availability of the nursing staff. Such a goal can be achieved through the strategic planning of the staffing needs based on the objectives of the clinic. Moreover, it is imperative to implement such measures by organizing training programs in the hospital, recruiting nurses from other states and countries, using temporary personnel, and establishing contacts with the nursing associations and organizations to ensure the inflow of graduates (Mason, Leavitt, & Chaffee, 2014). At the same time, the elimination of overtime, in general, should not be the primary goal of the strategy, as the voluntary overtime ensures the continuity of care while providing the healthcare specialists with incentives in the form of additional income (Rigolosi, 2013). However, it is important that prolonged shifts are limited to prevent burnout.
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At the same time, the provided strategy is only a single step towards the creation of a friendly environment both for the patients and for the nurses. To ensure the success of its implementation, it is necessary to address the primary cause of the reviewed issue, which requires additional studies and research. In particular, it is imperative to find the things that make people consider nursing as their field of activity, and identify the factors that make the healthcare specialists stay at their place of work (Rigolosi, 2013). Additionally, it is desirable to uncover the root causes of each factor, which affecting human resources and address them without interrupting the processes that occur within the facility. For example, it is possible to conduct a survey to point out the most satisfying and dissatisfying aspects of the nursing profession and take measures to eliminate all the negative features (Yoder-Wise, 2014). In turn, it will be possible to resolve the issue of staff shortage in the long-term perspective, eventually eliminating the need for overtime and improving the overall quality of the provided care.
The problem of mandatory overtime remains one of the realities of contemporary nursing practice despite the fact that it is being curbed at the state level. However, the application of the nursing theory to the problem, namely the Adaptation Model by Roy, has allowed identifying a solution to the issue. By perceiving each nurse as an individual with a unique ability to cope with stress and changes in the environment, it is possible to reform the system of staffing using the personalized approach. In turn, the mandatory overtimes are replaced with the voluntary one, letting the nurses that have passed the procedure of self-assessment and can provide high-quality care to the patients work additional hours for extra income. At the same time, the implementation of this strategy presents the need for the creation of the staff reserve and strategic planning for staffing needs. Moreover, the proposed solution is not final, since to address the problem completely, one is required to identify the root causes of the shortage of nurses and take measures to reduce the negative effects. As a result, it is possible to state that the presented strategy provides the basis for further research and must be improved and expanded constantly.