Reactions to Families as Hospital Caregivers. An Education Perspective

Details

• Personal Author:
  McNeese-Smith D ; Ta LL
• Description:
  Nursing is on the verge of a serious crisis as the profession faces the impending nursing shortage. The nursing profession has failed to replace the many aging registered nurses (RNs) who will be ready to retire within the next decade. Thus, as we look into the future, this shortage will continue to have an impact on the healthcare work force if extreme measures are not taken. However, caution must be exercised, for desperate measures may exacerbate the crisis. Mayer has introduced a radical proposal for a self-service model to moderate the nursing shortage. The implications for this model must be critically evaluated. Family members play a critical role in a patient's recovery. Therefore, a family-focused approach should be implemented in healthcare organizations. Family members should be included in task-oriented nursing care, such as bedside care and activities of daily living. They also should be included in major patient decisions. They should not, however, be considered as replacements for RNs. Instead, they can serve as a supplemental source of help and support to the patient. This will ease the load of the nurse and allow the nurse to allocate the time saved for care management, technical skills, teaching, and education. Despite the obvious advantages of having a family member present and assisting at the bedside, the success of this model outside the United States, as referred to in the self-service proposal, is questionable. Performing a literature search on this topic revealed limited findings to support this claim. It is unclear what "basic nursing care functions" were carried out in these countries. Therefore, to conclude that a self-service model will ease the nursing crisis does not appear to be substantiated by research and literature. More research-based studies must be conducted to evaluate possibilities. On the surface, the self-service model seems to offer assistance for the nursing shortage. The claim of increased quality and potential decreased costs appeals to administrators. However, as the model is analyzed further, the ramifications for the nursing profession are severe. The model claims, "only by decreasing the need for nurses will we ever be able to meet our need." The reality of this statement is far from true. Eliminating the need for nurses, on any level, is not an option! Replacing nurses with family members is a great liability to the organization and to the patient. We cannot expect family members with 2 or more days of training to act as surrogates for a nurse with years of education and experience in nursing. A 2-day intensive course in basic and routine nursing procedures does not provide the theoretical framework for family members to recognize, assess, and respond to potential warning signs. In fact, unlicensed assistive personnel, who assist but do not replace RNs, are already being used in most facilities to free nurses from tasks that do not require the RN's knowledge and skills. There is no guarantee that the need for nurses will decrease under any model that substitutes untrained individuals for RNs. Currently, life expectancy has increased. The baby boomer generation will live well into the seventh and eighth decades. Older people will require more hospitalization, and their illnesses will be more acute. Thus, the need for nurses will not be reduced. Rather, the demand in nursing will continue to rise. Even if the demand for nurses at the medical/surgical unit level were reduced, the need would continue to grow for nurses in other settings, including critical care, ambulatory care, home health, hospice, education, pharmaceutical firms, and insurance companies. The cycle to replace, recruit, and retain RNs still will be a challenge to nursing administrators. Unfortunately, the nursing crisis is nowhere near its end. Therefore, it is imperative that nurses, including administrators, employers, physicians, and legislators get involved. During these times, we must take extreme measures to rectify the situation. However, implementation of a self-service model of care will neither eliminate nor lessen the nursing shortage. Instead, it sends out a desperate message to decrease the need for nurses and risks losing the most humane aspect of healthcare today. It implies that nurses can be replaced with any warm body who has completed 2 days of training. Lack of understanding of the role of the RN, and his or her role in decreasing patient mortality and morbidity is one of the factors behind the current nursing shortage. Bright students will only be attracted to nursing if they understand the critical role nurses perform in healthcare. By implementing such a model, we would do a disservice to our profession and cause more harm than good. [Description provided by NIOSH]
• Subjects:
  Aging Family Health Personnel Occupational Health Safety
• Keywords:
  Aging Workforce Families Health Care Workers Nurses Nursing
• ISSN:
  0002-0443
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  459-460
• Volume:
  31
• Issue:
  10
• NIOSHTIC Number:
  nn:20058005
• Citation:
  J Nurs Adm 2001 Oct; 31(10):459-460
• Federal Fiscal Year:
  2002
• Performing Organization:
  University of California, School of Public Health, Los Angeles, CA
• Peer Reviewed:
  False
• Start Date:
  19990701
• Source Full Name:
  Journal of Nursing Administration
• End Date:
  20040630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:8af5e246cee066694477ebc4955f0e60deaf038543881dc77ea2a310148b17fed5f279211b579e041ac64dba50a883e37c5930e6af9c3f9f3ef89c503145c450
• Download URL:
  https://stacks.cdc.gov/view/cdc/215198/cdc_215198_DS1.pdf
• File Type:
  [PDF - 333.43 KB ]