Introduction
Nurses are an integral part of the healthcare system and are crucial in supporting patients’ well-being. While nurses’ primal focus is taking care of patients, they also encounter multiple demands from their colleagues and hospital management (Haahr et al., 2019). Nurses face challenges related to pressure at work, bullying, and the current pandemic, which requires them to continuously work on improving their competencies to ensure the delivery of high-quality care.
Challenges of Nurses
The challenges of nurses come from various areas and can be based on ethical, legal, financial, or social aspects. While nurses need to overcome obstacles, they also have to manage work overload in a limited time, which can cause burnout and compromise their everyday duties (Haahr et al., 2019). In addition to experiencing pressure due to heavy workloads, nurses may encounter bullying from their colleagues (Edmonson & Zelonka, 2019). Furthermore, the spread of COVID-19 has endangered nurses’ health, which can affect their work and patient care negatively (Morley et al., 2020). All the challenges that nurses face are interconnected, and some of the most common include pressure at work, bullying, and personal safety during the pandemic.
Pressure at Work
Nurses often experience ethical dilemmas, which result in a heavy workload. A recent study shows that despite nurses’ desire to provide patients with high-quality care, they have to balance between patients and other duties (Haahr et al., 2019). On the one hand, nurses have to provide care to a greater number of patients within a limited time due to staff shortages (Haahr et al., 2019). On the other hand, nurses have to handle disagreements with physicians and patients’ families. For instance, some relatives may have preferences for patients’ care that conflict with nurses’ professional responsibilities (Haahr et al., 2019). Meanwhile, some physicians’ treatment plans may contradict nursing values (Haahr et al., 2019). Moreover, nurses are pushed to take on additional roles, starting from setting up viral communication platforms and up to cleaning rooms and emptying bins (Morley et al., 2020). Therefore, nurses are pressured to work under stress with a lack of time, having to choose between their moral beliefs, patients’ well-being, and colleagues’ decisions.
Bullying
Nurses are often involved in disagreements with physicians in relation to patient care, but many of them also experience bullying. Bullying is more likely to happen in already stressful settings with work overloads (Edmonson & Zelonka, 2019). Research shows that more than 50% of nurses leave their first jobs within the initial half-year because of their colleagues’ behavior (Edmonson & Zelonka, 2019). While bullying is typically meant to offend or humiliate another person, it can include physical violence and death threats (Edmonson & Zelonka, 2019). Edmonson and Zelonka (2019) state that bullying transcends age, gender, and experience, coming from the younger and older male and female healthcare workers and patients. However, nurses usually get bullied by other nurses, which begins in the classroom and can continue through the bedside and until the boardroom (Edmonson & Zelonka, 2019). Bullying is a major challenge for today’s nurses as it starts at the early stages of the profession and adds more stress, forcing people to leave healthcare.
Safety of Nurses
Nurses directly participate in the resistance to the virus, and one of the major challenges they face today is endangering their own health. Although healthcare workers are constantly exposed to infectious diseases, little knowledge of COVID-19 and its unpredictability makes the situation dangerous, especially for those professionals who are more vulnerable to the virus (Morley et al., 2020). Providing care for patients is the core duty of a nurse; however, having to work in critical settings with a lack of proper personal protective equipment (PPE) threatens their safety and the health of their loved ones (Morley et al., 2020). Moreover, Morley et al. (2020) state that according to the Code of Ethics of the American Nurses Association, one of the nurses’ duties is to promote their own health and safety, which has become difficult recently. Until society finds a way of defeating COVID-19 and its variations, a conflict between nurses’ responsibilities is expected to remain, putting their well-being at risk and increasing the transmission of the virus to those around them.
Overcoming Challenges
Several ways can be helpful in overcoming the mentioned above challenges. First, to reduce pressure at work, organizational norms and administrative directives should be changed to prevent the heavy workload related to the number of patients (Haahr et al., 2019). Since disagreements with physicians are associated with differences in competencies, they are harder to resolve, but research proposes integrating nurses into decision-making by developing new policies (Haahr et al., 2019; Morley et al., 2020). Second, Edmonson and Zelonka (2019) suggest that addressing bullying should start by admitting the problem, as it will prosper until no one speaks about it. Preventing and stopping bullying has to begin with leaders who must have strong communication skills and continue with other employees who need to commit to a zero-tolerance policy against bullies (Edmonson & Zelonka, 2019). Third, to increase nurses’ safety when dealing with the virus, employers must provide the staff with adequate PPE and guidance on how to use it (Morley et al., 2020). Overall, overcoming nurses’ challenges does not depend solely on the nurses but rather on the upper management.
Since overcoming challenges requires more effort from leaders in healthcare and can be time-consuming, employers have to begin by offering additional support to employees. For instance, more organizations should integrate clinical ethics consultations to help nurses deal with moral distress and prevent burnout (Morley et al., 2020). Furthermore, there is a need for more employee assistance programs, clinical psychologists, and hotlines that would provide healthcare workers with consultation on certain questions (Morley et al., 2020). With that being said, one should recognize that the mentioned challenges and related issues are interconnected and need to be addressed altogether.
Key Message
As ways to overcome challenges that nurses face depend on healthcare leaders, there is a need for more leaders in the nursing profession. In the Institute of Medicine’s (IOM) Future of Nursing report, the third message is related to transforming leadership and redesigning the healthcare system (Institute of Medicine, 2011). The report states that leaders in nursing have to be full partners with physicians and work collaboratively with other leaders in healthcare (Institute of Medicine, 2011). To be leaders, nurses are required to have certain competencies that include but are not limited to teamwork, effective collaboration, knowledge of theories of innovation, and skills to decrease medication errors (Institute of Medicine, 2011). Nurses have to be leaders in both community and home settings, where they work more autonomously with patients and their families (Institute of Medicine, 2011). The report provides information on leadership programs for nurses, such as those that prepare leaders to operate on the governing board of a healthcare organization (Institute of Medicine, 2011). Overall, IOM suggests that leaders in nursing should complete training to acquire competencies that would help in the reformation of healthcare.
The Institute of Medicine’s report emphasizes the importance of nurses becoming leaders. Healthcare professionals, including nurses, tend to work independently, so they have to be full partners to identify problems and find solutions (Institute of Medicine, 2011). As leaders, nurses would be more involved in decision-making and positively affect patient outcomes, prevent medical errors, and decrease staff turnover (Institute of Medicine, 2011). An increased number of leaders in the nursing profession is important to change the healthcare system so that patients would receive better care.
Core Competencies
IOM has stated that all health clinicians should obtain five core competencies. The first competence requires professionals to provide patient-centered care and refers to identifying, respecting, and addressing each patient’s uniqueness, values, and needs (Institute of Medicine, 2003). Nursing practice can meet this competence as nurses directly affect patient care, providing most assessments and evaluations to people (Institute of Medicine, 2010). Despite that, due to obstacles created by outdated regulations and biases, nurses get restricted from practicing to the full extent of their skills (Institute of Medicine, 2010). The second core competence encourages healthcare professionals to work in interdisciplinary teams to ensure continuous and reliable care through cooperation and communication (Institute of Medicine, 2003). Being a member of an interdisciplinary team is one of the registered nurses’ responsibilities, but they are often denied influence and are considered “functional doers” (Institute of Medicine, 2010, p. 252). Overcoming the two competencies’ obstacles requires a transformation of the healthcare system that would allow nurses to make more decisions in care delivery (Institute of Medicine, 2010). Society needs to understand the significance of nurses for better delivery of care.
Following that, three more competencies are expected of healthcare professionals. The third core competence requires specialists to employ evidence-based practice to incorporate research with clinical expertise, which is one of the fundamentals of nursing (Institute of Medicine, 2003, 2011). However, nursing practice is typically not captured in research, but the Nurse-Family Partnership, an evidence-based program, can be helpful for practitioners to access information (Institute of Medicine, 2003, 2011). The fourth competence refers to applying quality improvement to increase the likelihood of desired health outcomes, which is one of the responsibilities of clinical nurse specialists (Institute of Medicine, 2003, 2011). Despite that, quality improvement lacks leadership and enthusiasm and requires more effort from the organizational structure (Institute of Medicine, 2003, 2011). The fifth core competence encourages professionals to utilize informatics to reduce errors, manage information, and make decisions, such as nurses using online registries to keep in contact with patients (Institute of Medicine, 2003). Although some obstacles are related to patients’ privacy, they can be overcome with specific regulatory requirements (Institute of Medicine, 2003). The core competencies are meant to improve care delivery, but they face certain barriers.
Conclusion
Nurses are important in providing care for patients, but they face ethical and social challenges in the workplace. While nurses should be able to focus on patients’ well-being, they are pushed to balance various responsibilities under pressure, experience bullying, and risk their lives without adequate protection during the response to the pandemic. Nurses can meet core competencies for healthcare workers, but several barriers prevent them from fully doing so. Therefore, there is a need to prepare more leaders in the nursing profession to promote changes in the healthcare system and enhance care delivery.
References
Edmonson, C., & Zelonka, C. (2019). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly, 43(3), 274-279. Web.
Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2019). Nurses experiences of ethical dilemmas: A review. Nursing Ethics, 27(1), 258-272. Web.
Institute of Medicine. (2003). Health professions education: A bridge to quality. The National Academies Press
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. The National Academies Press.
Morley, G., Grady, C., McCarthy, J., & Ulrich, C. M. (2020). Covid‐19: Ethical challenges for nurses. Hastings Center Report, 50(3), 35-39. Web.