Inequality In Nursing Care

One of the issues within the organization I for work that remains unresolved is assigning patients to nurses based on acuity. This issue has been ongoing within the hospital and no one has been able to come up with a reasonable solution. The hospital has been faced several challenges due to the unsolved problem of unfair assignments by the charge nurse.
Favoritism has been identified as the major cause of this ongoing problem whereby the charge nurse favors some staff by assigning them to lower acuity patients than other staff. Some charge nurses target some nurses anytime they work with them on their unit. This practice creates problems on a daily basis, such as difficulty with staffing on different shifts and units, conflict among staff
members, increases in budget due to overtime and mostly unsafe environments for the patient and staff. I work in a psychiatric hospital where safety is on the organization’s top priority. The hospital form of leadership can be considered part of this ongoing problem because subordinate ideas or opinions are often not considered during decision making. Since the authoritarian style of leadership is mostly practiced within the organization, the majority of managers and charge nurse practice authoritarian leadership whereby they dictate what goes on the unit regardless of what their subordinates have to contribute. Within the company I work for, subordinate ideas are not considered during decision making and the supervisor makes choices based on their own ideas and judgement and rarely take feedback from their subordinates. In a situation where a charge nurse assigns a nurse with high acuity patients, the nurse is not supposed to question the assignment. If she does, it will be considered an insubordinate act towards the charge nurse. Nurses are expected to accept their assignments with no complaints. If a nurse disagrees or refuses to accept an assignment that particular nurse is often assigned to a high acuity patient in retaliation. In the event the complaint about the assignment gets to the director of nursing or manager, the nurse does not get an opportunity to explain his or her side of the story. The process of lodging a complaint is automatically considered as patient abandonment due to a refusal of unfair assignment. If the case ever makes it to the disciplinary committee meeting at all, the manger usually represents the charge nurse during the meeting and in most cases it is the charge nurse’s word against the nurse due to the authoritarian type of leadership within the company. This creates great enmity between the charge nurse and the nurse because there was no one-on-one remediation between the charge nurse and the nurse to find out where the mistakes were made so that they can be corrected for future reference. Due to this ongoing problem of inappropriate assignment and authoritarian leadership style a lot employees have been dismissed or punished when they speak up about the assignments given to them.
Another area where nurse-patient acuity ratio has been a problem is when a nurse gets floated to a different unit other than his or her regular unit. Anytime a nurse gets floated to another unit they get assigned to the highest acuity patient in that unit with other duties like first admission, group leading, and narcotic count during the end shift.
This inequality of assignments among nurses has caused staff shortages within the hospital due to the fact that nurses do not want to work on certain units and certain shifts because of unfair assignment practices.
In a situation where the unit is short on staff, the charge nurse will be hesitant to ask a nurse from the previous shift if they will be willing to stay for an extra shift. The charge nurse knows the manager will question their decision because of overtime without considering the safety of the staff and patients. I work in a psychiatric hospital where safety is one of the company priorities. The majority of the decision-making in the facility where I work is controlled by the director of nursing who speaks to the manager who communicates the charge nurses; there is little or no input from the nurses on the floor even though they spend the most time with the patients.

Incident report
One of the most frequent incidents that occur in my work place is assault. During any assault incident, whether the assault is patient to staff or patient to patient, an incident report must be filed. The charge nurse and the nurse assigned to the perpetrator conduct the initial investigation. They both evaluate the situation to find out what happened prior to the incident.
Was the perpetrator agitated or showing any sign of aggressive behavior?
Does the perpetrator have a history of
aggression?
Was the patient on routine medication or given any prn medication prior to the incident?
Did anyone incur injury during the assault?
Was anyone else involved in the assault?
How did staff intervene during the incident?
What could staff have done differently to prevent the incident? The victim is given an opportunity to decide if they want to press charges against the perpetrator.
If the victim decides to press charges, the police are called to obtain reports, but perpetual perpetrator will not be arrested until they are mentally cleared. The police will be notified when the perpetrator is discharged for follow up on the pending charges brought against him or her.
An incident report is filed electronically that goes to different departments including the manager, risk management department, and harm reduction department.
Each of these department looks at the incident to determine what caused it and what can be done to prevent future assaults if possible. The manager does his or her investigation by having a one-to-one conversation with the charge nurse, reviewing the patient’s care plan and reviewing records of the patient’s past visits, if any. The manager also reviews intervention steps taken by the staff after the incident and reviews with staff what was missed during the incident. The risk management department uses a graph to evaluate the frequency of assault within the entire unit, how many times the perpetrator attacks people per visit and causative factor(s) of the incident. The harm reduction teams are part of the safety team that responds to the unit any time the safety alarm is activated in response to any aggressive behavior on the unit. They investigate the incident at the scene and even though they still receive the electronic incident report. All data are collected and analyzed among departments to determine how aggressive and assaultive behavior can be reduced or prevented on the unit. The safety team comes up with a safety reduction method that eventually get passed down to the nurses during unit in-services and annually as
well.