Nursing: How Do Nursing Cutbacks Affect Patient Care?

A life or death situation: Nursing cutbacks and patient care

When there are pending nursing cutbacks with respect to professional registered nurses, an alarm should be triggered in the medical world immediately, because patient's lives must be the first priority. This could catapult into a critical life or death situation for numerous patients, if a major shortage of registered nurses should occur due to lack of government funding and drastic nursing cutbacks.

Budget planning with nursing cutbacks is just one possible option with regard to a "deficit elimination plan" (1) for the global economy. Cutting the budget by cutting professional registered nurses affects patient nursing care adversely. Nursing cutbacks affect every other level of patient care as well, whether this involves nursing care in a hospital, another health care facility or a home nursing care setting.

Look at what may happen if this occurs, in each of these different scenarios:

Nursing cutbacks in hospitals

What do nursing cutbacks signify for hospitals? It may be less than an ideal situation for patients, if the numbers of registered nurses are cut back, in acute care, hospital settings. Both acute care beds and critical care beds may have to be reduced or eliminated. A shortage of available beds in large city hospitals may result in serious problems for that area. For instance, nursing cutbacks may mean that there are fewer beds available for emergency admissions. Patients may have to be sent home instead of being admitted after visiting the emergency department. Those who are admitted into the hospital may not have beds and may be forced to spend their time on stretchers in hospital hallways or in other areas that are not set up for nursing care. There may be a reduction in beds for incoming surgical patients, as well. Surgery for some patients may have to be postponed, booked elsewhere or cancelled. Professional, post-surgical nursing care may be diminished with non-professional caregivers administering post-surgical nursing care.

Specialty areas like orthopedics, cardiology and neurology may have to be closed. Long term medical care beds may be cut. This might include geriatric, palliative care and psychiatric beds. Patients may have to be discharged, moved to long term facilities or sent home prematurely. This could prove to have serious consequences. Maternity wards and delivery room facilities may have their nursing care levels diminished or they may have to be shut down completely, too. Newborn nurseries and pediatric wards may have to be reduced in size or closed. In this kind of a scenario, home nursing care demands may increase for infants and children.

Patients admitted to hospital may receive fewer hours of professional nursing care from registered nurses. Increased numbers of patients may have to be cared for, by non-professionals. They may receive only minimal care at times, even though they still need professional level nursing care.

Many essential in-hospital tests, procedures and treatments may have to be postponed and re-scheduled on an out-patient basis in doctor's offices or cancelled entirely.

Registered nurses in hospital settings may have marked increases in their workloads and added responsibilities. This may add to their frustration level, which could affect their personal lives. They may have increased anxiety or concern about their own job security. Nursing cutbacks may affect their benefits and pension plans. Union issues may arise. All of these factors affect the relationships between registered nurses and their patients, even though this should not affect their nursing care.

Increased work loads for registered nurses may put numerous patients at risk, as patient safety in hospitals may become a serious concern, if there are not enough registered nurses to supervise them or care for them properly.

A reduction in the number of registered nurses may cause the quality of patient nursing care to suffer. Non-professional health care givers may have to assume added responsibility, in spite of the fact that they require appropriate training and supervision by professionals, in order to maintain high standards of nursing care.

Cutbacks in other health care facilities: Can patients expect to receive proper medical care in other health care facilities when there are major cutbacks with regard to registered nurses? Many long term health care facilities function with a lower ratio of registered nurses and a higher ratio of non-professional health care givers than one finds in hospital settings. Nursing cutbacks may affect this ratio further, as the number of registered nurses may be diminished and the ratio of non-professional caregivers may be increased accordingly.

Major cutbacks of registered nurses could lead to serious, health related issues, concerns and problems in many health care facilities. Non-professional health care givers must be properly oriented, trained and supervised. Nursing cutbacks may lead to a lower quality of patient care, for many patients. The number of long term care patients is normally high in these kinds of health care facilities. These numbers may have to be reduced with the discharge of numerous, long term patients.

Nursing cutbacks may result is a lower level of quantity care administered en masse, as opposed to a higher quality of professional nursing care for patients, as individuals. This may also result in an immediate increase in the work load for non- professional health care workers. This may lead to major staffing issues and in turn, various nursing care concerns.

Health and safety issues have to be taken into consideration for both staff and patients. Cutbacks may lead to an increase in the number of injured workers, as well as patient injuries. Sick time for workers may increase. The number of sick patients may increase.

The assistance of volunteers, family members and friends may be required to meet basic patient care needs. These people require proper orientation and training. An increased number of educators for untrained caregivers may be needed.

Cutbacks in patient's homes: What do nursing cutbacks mean with regard to professional nursing care in patient's homes? In home nursing care settings, cutbacks with regards to the numbers of registered nurses may mean that there are fewer registered nurses in their communities, as well as in patient's homes. Registered nurses may have to seek employment in other locations or find employment in other areas of interest. Nursing cutbacks may result in an increase in the length of hospitalization for many patients, particularly when the nursing care required is on the level of registered nurses, rather than on the level of non-professional care givers. Patients cannot be discharged to their own homes unless they receive the level of nursing care that they require.

There may be a marked reduction in the quality of nursing care that patients receive at home, as those who are sent home may receive fewer hours of professional nursing care, even in instances when more professional nursing care is needed. They may have to be cared for by non-professionals, their family members or friends. Non-professional care in patients' homes must be supervised, but with fewer registered nurses, there may be less teaching, training and supervision available for them. Health related issues, like infection control and patient safety, may become serious concerns.

"Study: Nursing cutbacks affect patient survival" (2) questions whether or not a seriously ill patient can survive, if he or she is sent home. This will depend upon the quality of care that the patient receives. Some seriously ill patients may not survive, while others may thrive, because their caregivers are able to look after them appropriately, even though they are not qualified health care professionals.

An increased financial burden may fall upon family members, who have to take care of each other. But, are family members willing and able to accept this financial burden? Can family members be expected to accept the responsibility for the nursing care of other family members? Should they have to accept the responsibility for the survival of these family members?

Obviously, all three nursing care scenarios including hospitals, other health care facilities and home nursing care settings, may be adversely affected by cutbacks in the numbers of registered nurses.

One must ask, "What is the real issue, with regard to cutbacks of registered nurses?"

In the year 2009, because of the worldwide, economic downturn, there are major cutbacks happening with 

regard to the numbers of professional registered nurses. Paralleling that is a growing level of concern about the quality of nursing care, as well as the health and safety of patients. The problem already exists in many parts of the world. This is not merely an issue that has to be dealt with, at some future date. There is a degree of urgency. This must be addressed now.

There is always a very fine line between the amount of health care funding available from the government of a country, for registered nurses and the number of registered nurses needed to maintain adequate nursing care for patients. In every country, this is something that has to be continually assessed, evaluated and addressed.

One might ask if patients need quantity or quality care. In other words, should a larger number of people receive a lower quality of care? That may be what happens in the future, if there are nursing cutbacks, because of the ever increasing population of the world.

Common sense tells us that quality care should always be "a top priority" (3) everywhere in the world.

Maintaining an appropriate balance between government funding for nursing and the ever increasing demand for high quality patient care, is critical.

Factors to consider:

The salary for registered nurses is an important issue, but as salaries increase in any setting, there may be a reduction in the number of registered nurses. The designated level of government funding for the education and training of registered nurses is important, as the high cost of educating registered nurses must be taken into consideration. As the cost of education for training registered nurses rises, there may be a reduction in the number of registered nurses who can be trained. As a result, there may be fewer registered nurses available for nursing care. The population of a country is an important factor to consider, with regard to the number of registered nurses needed to maintain a high level of quality care.

Are there x-number of registered nurses allowed to be trained and funded, on a per capita basis? Does a minus-x-number of professional registered nurses, suggest quantity care instead of quality care?

The current health care status of a country must be taken into consideration. Countries with high populations and low levels of health care need to have an increased number of professional registered nurses. Are they available?

One must suggest that the more registered nurses there are per capita in a country, the better the health care of a country should be.

The bottom line, in terms of the global economy in relation to nursing cutbacks, may come down to a question of patients surviving versus thriving.

A realistic solution is needed with regard to nursing cutbacks immediately, in light of the major economic decline, on a global level. In terms of nursing cutbacks, including the cutbacks of professional registered nurses, what is required is a valid solution, not a denial of the reality of the seriousness of the situation at hand, regardless of which country, in the world, is under scrutiny at the moment. Patients' lives are at stake. Bare survival is not enough. Ideally, patients should thrive, not merely survive, in every part of the world, because of the high quality of professional nursing care that they receive from registered nurses and others.

1. http://www.rnao.org/Page.asp?PageID=122&ContentID=2359&SiteNodeID=403

2. http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1024896840586_20306040/

3. http://www.wctv.tv/news/headlines/9361076.html