Although it was identified that the measures of nursing workload does not assure efficiency, and they lack to capture the complexity of the nursing workload, it’s important to conduct such studies

Although it was identified that the measures of nursing workload does not assure efficiency, and they lack to capture the complexity of the nursing workload, it’s important to conduct such studies

Thus, there is need for people to take physical exercises seriously. Good nutrition, rest and removal of stress all play an extremely big part in the natural prevention of the condition. To prevent recurrence of stroke, aspirin and warfarin anticoagulants should be administered (Hutton, 2005). They are used in the treatment and prevention of clotting disorders. These drugs have side effects and vary in dosage from person to person, raising the issue of their nursing implications. Such implications include monitoring of laboratory results and administration of therapy. This should be exercised before and after drug administration. Finally, growing issues like dissolution of clots require the introduction of thrombolytics.

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Second, there is a notable section of the nursing workforce that is nearing retirement. According to a 2013 survey, about fifty-five percent of registered nurses are aged 50 or older (AACN, 2013). In the next decade, multiple million nurses will retire. Third, there are changes in the demographic composition that is signaling the need for additional nurses. It really is mainly due to the increasing aging population. The birthrate is reducing, which means that there will be fewer people to work as nurses as the current lot retires. Moreover, as the aged population increases, the demand for healthcare will increase. Fourth, studies have indicated there is high-stress level in the profession due to insufficient staffing, which is affecting their satisfaction. As a result, many nurses are leaving the profession. It is also characteristic for nurses to change occupations after a short period of service (AACN, 2014). The safety of patients and quality of the services that they receive is reliant on the satisfaction of the nurses. It is also reliant on the nurses’ ability to handle their workload efficiently.

When the number of nurses is not sufficient, the care and safety of patients may be compromised. At the same time, the nurses might be dissatisfied, overwhelmed and distressed. Increased nurse-patient ratio lead to frustration and job burnout, which is the key cause of turnover in the profession. When there is a shortage in the nurses’ workforces, it becomes necessary to develop strategies that will enable the rectification of the issue (AACN, 2014). It is also evident that the nurses’ shortage problem isn’t only A american problem, but also a global problem. Numerous countries are affected by the same problem, and finding the current situation is a step towards getting the solution. It is essential for the nurses operating in all institutional specialties, as well as, those in leadership and administrative positions to examine the factors contributing to the current shortage. In addition, there should be familiarization of the nurses to the situation and make a determination of what ought to be implemented in order to influence improvement strategies. Therefore, the choice of the topic will guide the study into determining the situation in the nursing profession, and the perception that the nurses have towards their roles. Additionally, there will be an investigation of the patients’ situation due to the prevailing situation. In addition, the findings can be applied in the findings of a solution.

Importance of the Project to Nursing

Nursing course requires understanding the practical and theoretical issues relating to the profession. In addition, it’s important to understand the actual environment. As the research indicates, a considerable number of nurses usually do not pursue the profession for more than two years after they start practicing (AACN, 2014). It means that they are usually unprepared for the actual work experience. Understanding how to become a nurse or the medical issues associated with it is important, but practicing is the ultimate goal. Therefore, loses its purpose to truly have a large number of qualified nurses who are not willing to practice. The project will assist in analyzing the situation from the nurses’ perspective. They will provide information that will assist students to understand the situation in the actual field and prepare for it. As the discipline entails different aspects of training, one more reinforcement to the training can assist develop high-quality nurses who are prepared for the actual work is necessary. As a nurse, the main target is to become useful in the field. In addition, the discipline may not be highlighting different issues affecting the profession. For instance, there should be preparation for the students to work under pressure. The study will make suggestions to relevant authorities on the factors affecting the profession.

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The suggestions will include actions that need to be taken in the teaching. The current procedures used for teaching in health related fields are mainly student based. Most of the courses evaluate the teachers based on the evaluations made by students. The students don’t have any field experience to understand whether whatever they learn is useful or important. The perspectives offered by the nurses will be useful in the development of curricula, which means that the students who go through it will be better prepared for their professional role. The suggestions will also provide the plight of the nurses, and through the nursing discipline, it can be possible to have relevant authorities responding to the problem. Therefore, the project is relevant to the nursing discipline as a whole.

Problem Statement

Problem Outline

In the modern times, there has been an increase in the demand for healthcare and nursing services. It has also attracted increased demand. It offers become important to understand the workload that health providers have, as well as its impact on their delivery of service. Consequently, the closer examination of the issues has led to the need to examine the characteristics of the caregivers, as well as, the care provided. Increased pressure on the nurses due to their workload translates to low output or lower quality of service. As the current population of people ages, the demand for healthcare services will increase. It means that it is necessary to have more nurses attending to the patients. Additionally, the general population in America, which is a developed country, is increasing at a slow pace. Therefore, there will be fewer people to take the current positions as nurses. The pressure is increasing as time moves, and it has become necessary to gather information regarding the perception of the nurses. While studying, nurses are trained to work under pressure. Nonetheless, it really is uncertain whether they can handle the pressure they get due to increased workload.

When working under pressure, human beings tend to produce low-quality results. When the nurses have to work extra hours, or attend to a larger number of patients, it means that there are getting immense pressure both physically and psychologically. Studying the human being factors relating to nursing workload is vital, rather than considering the simple factors, such as, task performance, time needed for the accomplishment of roles, and skill competency. In addition, although other researchers have focused on the matter, it is essential to recognize the nurses’ perspective. If the workload increases, the nurses experience stress. The occupational stress will lead to decreased efficiency and increased hazardous within and without the hospitals. On the list of different factors leading to absenteeism, job stress is ranked high. It also leads to absenteeism (Adib-Hajbagheri, Khamechian & Alavi, 2012). With the influence of other factors, having a large workload can affect the nurses negatively when at the place of work, besides, their private lives. Consequently, the services provided to the patients are of lower quality. The problem relates to the identification of the perception that the nurses have towards patient workload, as well as, its effect on delivery of service. It is essential to understand these aspects in order to develop suggestions and suggestions that would promote the improvement of the situation.

Due to the increased workload, there is a lack of sufficient time for a nurse to tackle various tasks. It has a direct impact on the patients. It can also impact negatively on the nurses’ decisions on the performance of various procedures. Nurse-patient communication can be affected by the time insufficiency. Increased workload has also led to decreased motivation for the nurses. Thus, the nurses’ turnover and absenteeism increase. There was also poor performance and reduced morale. It also leads to stress in the workplace, violation of rules and errors.


Over the past two decades, there have been numerous changes in the health service delivery. Different parties have made changes in relation to new sets of regulations by the government (Scott, Matthews & Kirwan, 2014). Consequently, the approach through which the nursing care is provided has changed. Earlier studies have focused on the concern of patient workload centering on different variables. Such variables include staffing patterns, perception of patients, pattern of communication between different occupations, and demands from the environment (Scott, Matthews & Kirwan, 2014). Such demands include the availability of supplies, which contribute the outcomes of the patients and quality of services. Nonetheless, other aspects, such as, intellectual capital, contribution of nursing knowledge, and psychological workload should also be considered. Although it was identified that the measures of nursing workload does not assure efficiency, and they lack to capture the complexity of the nursing workload, it’s important to conduct such studies. The work environment variables have received little focus from studies relating to nursing workload (Scott, Matthews & Kirwan, 2014). Nonetheless, that has been give attention to factors including the relationships of between employees and colleagues, in addition to, their managers. It is often identified that work relationships have higher impact on the satisfaction of the nurses than economic variables. The effects of the workload on nurses have been witnessed not only in USA, but also in other countries throughout the globe.

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The present trepidations regarding the effect of nurse staffing on the quality and safety of the patient services emanate from the merging of different factors. They include recurring shortages in the nurses’ workforce, measures to contain the costs in the 1990s, and increased concern by the public regarding the safety of the patients (AACN, 2014). Fewer patients per nurse increase the quality of care and safety of the patients. The clear presence of medical as a cause of deaths in the hospitals has also elicited pressure to understand whether staffing has an impact of the safety of the patients. It could be attributed to the nurses’ pressure or lack of concentration while offering services due to burnout. Nurses have also aired their perceptions regarding the re-engineering and redesign of their work. The concern of nurses relates to the increasing ratios of this patients to nurses, its impact on the welfare of the patients, and the substitution of unlicensed personnel.

Possible Causes of the Problem

The working population is aging at a high rate than the general population. Consequently, when nurses retire, there are no replacements available. a significant area of the current nurses in the workforce are nearing the retirement age, whereas few nurses are being employed. There is also a decrease in the nursing school faculty, which restricts the enrollment of nurses. It really is mainly due to classroom space, clinical preceptors, and clinical sites. As the general population increases, there is an increased demand for the nursing services. Consequently, the pressure increases on the current workforce. The increased pressure and stress in the workforce have led to job dissatisfaction, and most of the nurses leave the vocation. As a result, the remaining nurses have to attend to a higher number of patients.

Research Questions

  1. Is there an increased workload in the profession according to the nurses?
  2. What is the impact of the current workload on the ability of nurses to offer services?
  3. What is the effect of the workload on the patients?

Literature Review

Impact of the Workload

There are different aspects relating to the dissatisfaction of patients as a result of high workload on the nurses. Aalto, Karhe, Koivisto, & Valimaki (2009) study the connection between the nurse’s workload and the dissatisfaction of the patients. They found that the workload of the nurses varies depending on the flow and condition of the patients. They found a connection between high workload and dissatisfaction of the patient. Blay, Duffield & Gallagher (2012) focus on the transfer of patients due to workload on the nurses. When the patients have short stays, there was increased work to be done by the nurses. Additionally, there was increased risk of health-care acquired infections and incidents of medication. Bogossian, Winters-Chang, & Tuckett (2014) focus on the perception of nurses in relation to its contribution to abrasion in the nursing vocation. They found out that various factors including workload affect the perception of the practicing nurses towards the profession. Duffield et al. (2010) conduct a study on the different factors relating to the workforce and workload of the nurses. It became evident that the models of care are varied according to the circumstances in each of the wards, as well as, the levels of staffing.

Myny et al. (2011) conduct research and identify that there are different causes and effects of the impact level of workload pressure. They suggested that nursing workload has a multi-causal etiology, and the influencing factors can be integrated to for a workload measurement tool. A report conducted by Palese (2013) sought to conceptualize the impact of the daily intervention by nurses for the Italian patients. They found out that the nursing system has positive impacts on the safety of the patients, in addition to, other multidisciplinary outcomes. The impact is in different levels including national and international. Donovan, Doody & Lyons (2013) centering on stress as a important factor in the nursing profession. It offers undesirable impacts on both physical and emotional aspects of the nurses. Consequently, it reduces individuals’ power to work as required. In the nursing profession, it offers adversarial effects on the patients.

Measurement of the Workload

The assessment of the nursing workload requires the use of electronic sources of information. Baumberger & Hunstein (2009) focus on the use of data available in the electronic sources so as to assess the link between the nursing workload and the outcomes. They state that it increases the explanatory power of nursing data. Brito & Guirardello (2011) conducted study relating to the workload on nurses relating to inpatients. They found out that the use of Nursing Activities Score (NAS) can assist in the evaluation of the workload of the nurses. Debergh et al. (2012) conduct a study on the measurement of workload in the intensive care unit. They found that the nursing activities score had been influenced by the characteristics of patients and shift type. Therefore, you’ll be able to measure the workload per shift. Fasoli & Haddock (2010) discuss the issues relating to systems of patient classification. They suggest that approaches used to predict staffing should be parsimonious and should minimize workload. They should also include the indicators used to measure the complexity of patients, resources available and organizational features. Hoi et al. (2010) advised that in a rapidly changing nursing working environment, it’s important to have frequent reviews of the workload measurement systems.

Jenkins & Welton (2014) indicate the standard measurement of the nursing cost for each patient. It could be benchmarked in all the hospitals so as to pass the information to all nursing administrators regarding the care delivery decisions. Kirby & Hurst (2014) indicated the importance of using a complex audit tool during the measuring of the workload, staffing, and quality of services in nursing facilities. It is a measure enable comparison of the factors, and their impact. Kohr, Hickey & Curley (2012) conduct research on different aspects of the synergy model during the making of nurse-patient assignments. They concluded that the synergy model is a prospective conceptual framework for a nursing productivity system. It may capture the researchers’ capacity to quantify the allocated resources. Kwiecien, Wujtewicz & Medrzycka-Dabrowska (2012) discuss the importance of the measurement of the workload. As one of the most frequently quoted factor in customer dissatisfaction, it’s important to measure it and respond accordingly. Mueller et al. (2010) conduct study on the functioning of the patients as a predictor of the workload of the nurses. They found out that the in patients who suffered from cardiovascular and cardiopulmonary conditions selected similar responses, while those with muscular skeletal conditions gave different response. Therefore, they concluded that selected categories of scores could be used to measure workload in relation to different rehabilitative needs of patients.

Rossetti, Gaidzinski & Bracco (2014), conduct study to spot the different indicators of the needed nursing workload in the emergency department for pediatric patients. They found a nurse – patient ratio of 1:2.6. They concluded that the application of a standard classification instrument was satisfactory. Sawatzky-Dickson & Bodnaryk (2009) studied the dependability and legitimacy of the Winnipeg Assessment of Neonatal Nursing Needs Tool. They concluded that it provided a reliable estimation regarding the number of nurses needed for a certain collection of patients so as to provide quality care. They recommended that nurse managers should incorporate it to determine the extra drivers that ought to be considered for the nurses in regard to time.

Solutions to the Workload Problem

Brann & Gustavson (2013) conduct study on the issues relating to the problem of workload in the nursing profession. They suggest that controlling the workload will depend on maintenance of fiscal responsibility. In addition requires the analysis of the work environment to ensure that nurses receive adequate support from other staff and they have a good relationship. Ellis (2013) conducted study relating to the policies relating to the workload in the nursing faculty. The results indicated that about 12 credit hours are given to the concept of the workload per semester. They advised that an increase on the time and components should be considered. Garcia (2013), suggest some features that ought to be included in the acuity system. The features include reliability and objectivity, validity, patient-centered, inclusive, efficiency, alignment, predictive, informative, actionable, and outcome driven. Keleher et al. (2009) focus on the importance of focusing on issues affecting the nurses. They state that nurses are effective in care giving in different roles. Therefore, their condition ought to be considered and improved.

Sundaramoorthi et al. (2010) suggest the use of two policies to make the nurse – patient assignments during the admission of new patients. They are the heuristic (HEU) policy and the partially-optimized (OPT) policy. The HEU policy assigns a new patient to a nurse who may have performed least direct care among available nurses. The OPT policy seeks to lessen the variation among nurses for an entire shift through the estimation of assigned direct care. Welton (2014) suggest issues relating to the importance of the development of an advanced nursing care delivery system. He suggests the application of information acquired in the management of businesses. Therefore, hospitals should use electronic approaches in scheduling, staffing and setting of assignments. It will assist in the minimization of the heavy workloads and pressure on nurses; hence, improving their output. Measures that will lead to a minimization in the number of patients that all nurse should serve ought to be applied. In study conducted by Magalhaes, Dall’Agnol & Marck (2013), they found a link between the safety of patients and the workload on nurses. Fewer patients per nurse ought to be the target as it improves restorative thinking. It also allows communication and personal relationships between the nurses and the patients.

Literature Conclusion

The literature has provided essential information relating to previous studies on the research topic. The topic relates to the identification of the perspective of nurses on pressure emanating from the heavy workload, as well as its impact on patients. The literature review has provided possible impacts of the problem, measurement procedures and possible solutions. All the information is essential in the conduction of the research. It sets the foundation of what to be expected during the study. The measurements suggested by different authors will be essential in the collection of information for the project. In addition, the literature will assist in the analysis of the findings. It will act as a basis for comparison between the current issues and what is available in literature.

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Primary Concepts of Johnson’s Behavioral System Model

Johnson’s Behavioral System Model is the model of nursing care that “presents the view of the client as a living open system” (Alligood, 2014). This model is developed on the understanding of common human needs like comfort, care, and reduction of stress and tension. It advocates the stipulation and fostering of effective behavioral functioning of the patient for the prevention of various illnesses. The patient’s behavior is considered as the mix of seven subsystems: “affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement” (Alligood, 2014).

Propositions of Johnson’s Behavioral System Model

It is recommended for health care providers (especially nurses) to perform a systematic report on the patient’s behavior (Alligood, 2014). They should pay attention to the assessment of the patient’s subsystems for understanding behavior of the patient, proper determination of existing problems, and application of treatment methodologies, which can lead to the improvement associated with the patient’s condition.

Dorothy Johnson made the proposition to maintain, restore, or attain balance “in the behavioral system or in the system as a whole” (Alligood, 2014). The role of health care providers is the modification of the structure of those subsystems or their components for the improvement of the health condition of the patient. The modification is completed in the form of reparing of damaged structural units. Health care providers play the role of regulators or controllers in this technique. Besides, they can help the patient to develop or increase the strength of those substructures. Additional attention should be paid to the fact that health care providers should have sufficient knowledge and skills for proper determination of existing damaged structural units of behavior, performance of the effective repairing process, and prediction of outcomes of the treatment.

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Structure of Johnson’s Behavioral System Model

As it has been stated above, behavior of the patient consists of seven various subsystems. Affiliation subsystem serves for the security of the individual through intimacy and social inclusion. Dependency subsystem is necessary for obtaining recognition, attention, and assistance from other individuals. Ingestive subsystem serves for the fulfillment of the need to cover biological requirements of the organism. Eliminative subsystem serves for the excretion of wastes. Such functions as procreation and reproduction are regulated by sexual subsystem. The individual’s preservation and social protection are granted by aggressive subsystem. The last behavioral subsystem is achievement. It really is necessary for self-control.

It really is notable that there are various characteristics of patient’s behavior, which have a considerable influence on the patient’s condition. These characteristics are the following: repetitiveness, regularity, predictability, and direction at reaching particular goals (Alligood, 2014). These characteristics should be strived to be brought into the balanced condition with the help of health care providers (Alligood, 2014).

Each of these subsystems has the goal that is based on the following factors: “universal drive, set, choice, and action” (Alligood, 2014). The universal drive represents the background of the goal of the subsystem. Different individuals have various goals, which depend on their values. The set represents “the tendency to act in a certain way in a given situation” (Alligood, 2014). This relatively stable formation is influenced greatly by social norms, culture, family, perceptions, etc. The set of alternative behaviors considered by the individual in any situation is known as the choice. The last factor is action. It reflects the observable behavior of the patient. Most of these factors have the direct contribution to the activity of the individual.

Evidence-based Application of Johnson’s Behavioral System Model

Nurses, which apply Johnson’s Behavioral System Model, usually direct their efforts to the decrease of human sufferings by the change of existing behaviors or facilitation of the development of the new ones. An example of successful implementation of psychological intervention is used for supporting women to stop smoking during pregnancy. This particular case is considered to be the evidence-based example of the described model because it shows the analysis of health care providers of the described subsystems (for the determination of reasons of smoking) and taking a dynamic role in the smoking abstinence. The research described in the article on psychosocial interventions used for supporting women to stop smoking during pregnancy involved over 29,000 pregnant women who stopped smoking in late pregnancy (Chamberlain et al., 2013). The emphasis was made on the application of various interventive strategies like counselling. Health care providers assessed their understanding of patient’s perceptions and needs (like social inclusion, attention, preservation, etc.). As it was mentioned in the article, “issues around smoking in pregnancy are complicated by the intersection of gender, where a woman’s role is seen primarily as a ‘reproducer’” (Chamberlain et al., 2013). Hence, women feel that they lack control in their lives. Besides, much attention should be paid to the fact that various stresses are considered as the major cause of smoking of pregnant women during these studies. That is why, the intervention was directed on the minimization of the feelings of the lack of control and stresses. Some psychological interventions used in this study were self-help exercises, individual behavior councelling, motivational interventions, nursing and physician advices, interventions to reduce non-cigarette tobacco use, etc. (Chamberlain et al., 2013). According to the outcomes of this research, counselling has a considerable positive effect on women who smoked during pregnancy (about 55% stopped smoking) (Chamberlain et al., 2013). According to additional studies provided in the article “Facilitators and Barriers to Effective Smoking Cessation: Counselling Services for Inpatients from Nurse-Counsellors’ Perspectives — A Qualitative Study”, during the realization of the smoking cessation program additional attention should be paid to specific needs of each patient and environment: “an effective smoking cessation program should be patient-centered and provide a supportive environment” (Li et al., 2014). It should also be noted that this methodology is successful for the facilitation of smoking cessation for patients with various illnesses like lung cancer (Nishihara et al., 2013).


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Student-Developed Clinical Application in Autonomous Nursing Practice

The current work will show how Johnson’s Behavioral System Model can be applied by students in the nursing practice autonomously. It means that these individuals should have enough professional knowledge and skills to make correct decisions freely. They should plainly understand that the nursing profession is rapidly changing because of the development and realization of new methods of treatment. Also, they should apply various treatment methodologies to different patients because each patient has unique needs. The work “The meaning of autonomy in nursing practice” describes the process of exploring education and work qualification of nursing students who intend to become professionals in these fields. This work is based on the application of “the qualitative hermeneutic approach, inspired by Ghadames’s philosophy, guided the research process and the analysis and interpretation of the transcribed interview-texts” (Skar, 2010). The outcomes of this work show that students should “have a holistic view, to know the patient, you know that you know and to dare” (Skar, 2010). John Rowe (2010) provided the following understanding of the concept “to know what you know”: “knowledge about the patient’s medical condition and the confidence about the assessment and interventions”. This knowledge provides an power to make correct decisions, freely make clinical judgements, and establish friendly professional relationships with patients that facilitate improvement of their health condition.

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Reflection on the Impact of Johnson’s Behavioral System Model

Application of Johnson’s Behavioral System Model features a considerable positive impact on quality and effectiveness of treatment. It helps to understand patients’ needs and problems correctly, determine medical issues and their causes, and apply appropriate methodologies of treatment for gaining the most effective possible result. The stated example of smoking abstinence of pregnant women shows the success of the use of this method in the development and support of preventive behavior. Besides, Johnson’s Behavioral System Model is extremely beneficial for students who want to be professionals in nursing. It helps them to understand patients’ needs and perform effective treatment.

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Staff Attitude

Basol et al (2009) indicates a thin line between staff who felt that it would be better if only family members with health education were allowed to be present during such procedures instead of having any kind of family. In fact, both sides of the argument had equal members. Further, 41.1% of the respondents indicated that family members interfered with the nurses’ work. In study conducted by Gunes and Zaybak (2009), the nurses’ view of the presence of family members during a code situation was negative. The nurses pointed out that their presence led to interference with the code process, increased litigation and the sight of a loved one in a traumatic situation. In order to eliminate this negative perception, it was recommended that the nurses be educated on the same. Additionally, the incorporation of such organizations as Emergency Nurses Association was advised.

In study conducted by Oman and Duran (2010), the findings indicated something contrary to the many views of the staff relating to the clear presence of family members.