question archive  Organizational Policies and Practices to Support Healthcare Issues Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources

 Organizational Policies and Practices to Support Healthcare Issues Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources

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 Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

Respond to at least two of your colleagues post by providing additional thoughts about competing needs that may impact your colleagues’ selected issues, or additional ideas for applying policy to address the impacts described.


 How competing needs impact policy development

Effective leadership can balance the organization's needs and still ensure quality, effective and safe patient care using the transformational leadership style. Transformational leadership inspires others through effective communication(Walden University,2018). Transformational leadership is a style of leadership where leaders in an organization work with the team to identify the areas that need changes, create a vision to guide the changes, and execute them (Lyons &Schneider,2009). The United States healthcare system is experiencing difficulty in delivering quality healthcare and cost control, healthcare organizations shifted from the treat-heal-care model to a corporate or business paradigm with an emphasis on efficiency and cost outcomes as opposed to patient outcomes (kelly & Purr, 2018). The healthcare needs are growing because of the increase of the aging population, as a result of a nurse shortage, nurses are not able to provide quality patient care due to high nurse-patient ratio, leading to medication errors, neglect falls and prolonged hospitalization,

                                Specific Competing Need

     Nurses are supposed to deliver quality care to patients because of the professional goal and ethical responsibility however, nurses experience subordination and displacement of professional nursing judgment despite patient’s needs. Nurse shortage is one of the problems in healthcare that compromises patient care and the answer to this problem is to employ more nurses and develop a staffing float pool and staffing agencies to supplement staffing needs ( Sikka et al., 2015). Burnout affects every aspect of patient care negatively and the effect impact healthcare workers and the patient, so department policymakers need to emphasize on nursing staffing and the organization can reduce nurse turnover by offering competitive pay rate and benefits.

                                            How Policy  Impact Competing Needs

      The policy is made to improve the quality of care and reduce healthcare costs. The competing need has so much impact on how decisions are made and policies are developed to address some of these needs. The policy developer can come up with a method that can deliver quality care with affordable cost and with appropriate policies, barriers to quality patient care and nursing high patient ratio can be addressed so that job dissatisfaction and turnover rate can be eradicated.


In 2010 the Affordable Care Act was enacted providing healthcare insurance to those who were either underinsured or uninsured. This increased the volume of individuals seeking access to care through primary care only to discover long wait times to see a provider. One cause of the delay in care is related to a shortage of primary care physicians. The height of primary care residency programs for medical students was 53.2 percent in 1998 and has been steadily declining since (MacArthur et al., 2018). This decline in primary care providers has caused providers to rethink how care can be delivered using a team approach to care versus working independently to provide care. Utilizing non-physician healthcare members with a patient-centered approach to care reduces the strain on the provider with the delivery of care and patient access improves.    

Working in a large primary care office at the VA, managing patient care access is challenging daily. This clinic has 20 primary care teams, with each team consisting of a provider, RN, LPN, and administrative staff. Using a new medical records system, the providers see an average of 10-12 Veterans a day. This number may appear small compared to the private sector, however, Veteran health care is complex with chronic diseases mixed with health care issues resulting from experiences and hazardous exposures from military services. The LPN clinical role is focused on clinical patient flow with the provider. RN's role is Nurse Care Manager. This role manages telephone messages (on average 50 per day), nurse clinic seeing at minimum 4 patients daily for chronic disease management, managing chronic disease registry program, hospital discharge follow-ups, and reviewing urgent care visits. The volume of care daily is challenging most of the time. On average the clinic will have 20-30 Veterans walk into the clinic requesting to speak to the RN with their provider. Last year, management put together an RN resource team that can triage the walk-ins and direct care of the Veterans to our float provider team to be seen, send a message to the Veteran’s provider team or direct the Veteran to our urgent care. Prior to having this resource team, RNs were having to manage the walk-ins during the clinic, and this caused disruptions in care for the Veterans who were scheduled that day. This practice change made a big difference in the provider teams’ ability to continue to provide quality care for the scheduled Veterans and the walk-in Veterans were able to have their needs met.


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