1. Introduction
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The goal is to create a concise yet coherent text of about 1800 characters, exploring the content for the section “1. Introduction”, that delivers concrete, specific, factual (where needed) information relevant to the title for the section. To achieve that, you have to follow 5 equally important guidelines:
1.1. Background
The United States has faced nursing shortages for decades, but the issue has become increasingly critical in recent years. Nurses are the largest group of healthcare professionals in the US, with nearly four million registered nurses (RNs). However, hospitals of all sizes and types report difficulty in recruiting an adequate number of nurses. In the Annual National Hospital Survey conducted by the American Hospital Association, “staffing” was the top issue for 60% of the hospitals. Almost half of the hospitals reduced patient admission and 22% of the hospitals closed patient service units because of the inadequate number of nurses. Studies have shown a negative correlation between the number of hospital beds occupied by the patients and the patient-to-nurse ratios. When there are more patients per nurse, patients are more likely to die and the nurses are more likely to experience burnout and job dissatisfaction. On the other hand, when there are fewer patients per nurse, better patient outcomes are observed and the nurses are more likely to be satisfied with their jobs. As a result, the “staffing issue” in the hospitals has been the center of attention and put nurses in a distressed situation. Even worse, the aging of the US nursing workforce has resulted in the parallel retirement wave of baby boomer nurses. The wave has posed a significant challenge to the nurse staffing in America. Baby boomer nurses are seasoned and experienced professionals. When they retire, a large amount of clinical knowledge and expertise will be lost. According to the US Department of Health and Human Services, the supply of registered nurses is expected to increase by only 6% in 2020 and by 36% in 2030. Yet, the demands are estimated to increase by 40% in 2020 and 63% in 2030. This sharp increase in the nurse shortage will potentially paralyze the healthcare system of the nation. The influx of technology into the healthcare workplace has impacted the nursing workforce. The development of the electronic health record and the picture archiving and communication systems require the nurses to have a consistent level of technological competence. These systems can reduce redundancy and fragmentation in patient care, improve diagnostic and treatment decisions, and enhance the communication among the care team. However, it takes time, effort, and money to train nurses and maintain their competency. Coupled with the nurse staffing issue, some nurses are reluctant to “add on” the technological work to their responsibilities. Yet, studies have shown that with the increase in the technological work, nurses have felt more empowered because they play a greater role in the decision-making of patient care. Albeit, the technological work has somewhat become an obstacle for the older generation of nurses, it is beneficial and prepares the workforce in providing efficient and effective patient care. Last but not least, the economic recession has improved the nurse retention but also brought the decrease in nurse salary. With the scarcity of opportunities and the decrease in the spouse’s income, many nurses in the country are staying in the workforce. However, the mean RN salary has decreased by 2.72% from 2009 to 2013. Such phenomenon raises concerns about nurse’s commitment to the quality of patient care and the impact of nursing shortages on health outcomes. Although the relationship between the salary and the patient outcomes has been a controversial topic, low salary does affect the decision of nurses to seek new employment. All of these findings suggest that there are numerous dynamic and interacting factors that contribute to the nurse work environment and workforce. This study will target on uncovering the relationship between the staff nurses’ socio-demographic characteristics, job-related factors, levels of nurse staffing and the outcomes of the patients in the acute care hospitals. Also, additional analyses will be performed to examine the changing trend of the nurse staffing and assess the impact of the latest technological advancement on the nursing workforce.
1.2. Scope of the Study
The investigators are hoping to acquire a superior comprehension of the effect of clinic budgetary assets on the nursing labor force consistently and during COVID-19 explicitly. This incorporates assessing if changes in clinic financials expect changes in the nursing labor force, deciding if there are more prominent odds of enlisting and holding medical caretakers when monetary assets are extended versus when they are more limited, choosing how the composition of the nursing labor force contrasts under public and not-revenue driven clinic monetary settings and surveying whether the effect of clinic financials on the nursing labor force contrasts to some degree during a worldwide pandemic when clinical assets are extended, for example, during COVID-19. This is expected to distinguish potential systems and strategies that clinic emergency clinic pioneers and managers can use to successfully react to changes in the nursing labor force and monetary assets. The data acquired by the examination may likewise assist with illuminating choices and changes the board practices embraced by clinic pioneers and managers across various hospitals and clinical settings and give proof based experiences to clinical and medical services arrangement producers. Such proof based experiences can advise better approaches to enhance and remain clinically and monetarily practical under restricted and testing conditions like a worldwide pandemic. To accomplish this general point and to address the particular examination goals illustrated above, the investigation will zero in on all clinics in a specific express that utilize an affirmed nursing labor force, including medical caretakers, nurture associates and qualified medical attendants, and clinical staff that convey direct patient consideration benefits in 24-hour patient care administrations. This will incorporate yet not be confined to general intense consideration clinics and basic access emergency clinics, which give focus care administrations in rustic areas under a U.S. governmentally assigned program. In such provincial regions, bone fide basic access emergency clinics arilikses exceptions and adaptability in case rate installment terms from the Centers for Medicare and Medicaid Services under the program. By zeroing in on the state level, a more granular and point by point investigation of clinic level information, for example, the yearly money related expense reports submitted to the Centers for Medicare and Medicaid Services in the USA.
1.3. Objectives
The longitudinal nature of the analysis, coupled with the incorporation of contemporary qualitative data that was captured after the impact of COVID-19, holds promise in helping to identify and understand the complex and evolving relationships between healthcare financial systems, workforce composition and resiliency in the face of large-scale emergent health events – such as the recent and ongoing challenges posed by the global COVID-19 pandemic.
On the other hand, the qualitative aspect of the study will serve to contextualize the quantitative findings and offer potential explanations for observed trends, through a practice-based understanding of the pressures and challenges management faced both before and during the pandemic. As well, because there are a limited number of studies that have sought to measure the impact of hospital financial resources on nursing workforce resilience, and no known studies that explore trends after the widespread changes caused by COVID-19, the findings of this research will help to address important gaps in knowledge and provide a valuable evidence base to inform health policy and workforce planning. The implications for nursing management and health policy could be profound, such as providing empirical support for the allocation of resources to frontline nursing services, and for new workforce development technologies or strategies that may help to build a more robust workforce, better able to respond to public health crises.
These three objectives will be achieved through a mixed-methods study design comprised of longitudinal quantitative analysis of large secondary datasets from 2012-2019, and qualitative interviews and focus groups that were conducted with nursing leadership in 2021, after the initial COVID-19 surge. Specifically, the quantitative analysis will aim to determine whether and to what extent measures of hospital financial resources (such as operating margins and capital expenditure) are associated with changes in nurse employment and staffing levels over time, and how the strength and direction of these associations may have been modified by the COVID-19 pandemic. In particular, it is expected that lower financial resources will be related to workforce downsizing and more severe nursing shortages in the context of COVID-19, and that these relationships will be stronger during 2020 and 2021 than in previous years.
Based on these gaps in knowledge, this study has the following objectives: 1. To examine the relationship between hospital financial resources and the size and composition of the nursing workforce, both before and during COVID-19. 2. To investigate the potential for hospital financial resources to impact the resilience of the nursing workforce to persistent public health crises such as COVID-19. 3. To explore how hospital finances and nursing workforce composition may have affected the quality of patient care both before and during COVID-19.
2. Literature Review
2.1. Nursing Workforce
2.2. Hospital Financial Resources
2.3. Impact of COVID-19
3. Methodology
3.1. Research Design
3.2. Data Collection
3.3. Data Analysis
4. Findings
4.1. Pre-COVID-19 Nursing Workforce
4.1.1. Staffing Levels
4.1.2. Skill Mix
4.1.3. Workload
4.2. Pre-COVID-19 Hospital Financial Resources
4.2.1. Budget Allocation
4.2.2. Revenue Sources
4.2.3. Financial Stability
4.3. Changes in Nursing Workforce during COVID-19
4.3.1. Staffing Adjustments
4.3.2. Training and Education
4.3.3. Workforce Well-being
5. Discussion
5.1. Impact of Hospital Financial Resources on Nursing Workforce
5.2. Effect of COVID-19 on Nursing Workforce
5.3. Strategies for Adapting to Changes
6. Conclusion
6.1. Summary of Findings
6.2. Implications for Practice
6.3. Recommendations for Future Research
Examining changes in the nursing workforce in response to hospital financial resources before and during COVID-19
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