Top Issues Staff Nurses Face on the Job

Nursing is a field where art meets science. From psychology to physiology to microbiology, a nurse’s educational background and practical experience cover a broad gamut of skills needed to facilitate a patient’s physical healing and emotional well-being.

With the many duties and areas of background knowledge involved, a staff nurse can expect to meet many challenges on the job. Here are some of the more prevalent issues that staff nurses often encounter while on the shift.

Occupational Hazards

One of the primary concerns for staff nurses is having a safe work environment. While some issues are easier to cope with, or even avoid than others, the practices needed to maintain workplace safety are complex and always evolving. Nonetheless, safety measures are vital to the smooth operation of a floor or department.

Some of the hazards that nurses face on a daily basis include:

• The spread of influenza or pneumonia
• Workplace violence
• Bio-hazards
• Chemical hazards
• Patient handling

Many of the cases that nurses deal with involve influenza or pneumonia, especially if they work in the emergency room since these illnesses and their related complications tend to bring in some of the largest numbers of patients. However, with consistent preventative measures, like hand-washing and administer masks to patients with fever, the risk for contracting these illness can be greatly reduced.

Additionally, workplace violence is a problem that also requires a constant re-examination of policy since there are so many unpredictable (if not uncontrollable) factors—from unruly staff, patients and visitors to active shooters and bomb threats. Working in close partnership with hospital security and law enforcement officers along with regular training is imperative.

Along with violence and the flu, staff nurses also have to be wary of environmental hazards, whether they are biological or chemical in nature. Coming in close contact with bodily fluids poses the risk of exposure to Hepatitis, HIV, and other pathogens. Likewise, the varieties of chemicals that one might find in a healthcare facility, such as cleaners, pesticides, and dangerous waste products, heighten the risk as well. Again, vigilance and regular training helps to keep the area safer for all employees and patients.

Finally, one of the main reasons for absences from work stem from injuries suffered on the job. Staff nurses are at very high risk for back injuries from the handling of patients. Adequate numbers of staff covering a shift, improved ergonomics, more access to assistive equipment, and training can help staff nurses to avoid injuries.

Mandatory Overtime

Nationwide, a shortage of nurses has impacted the scheduling of staff and even the quality of care. Not only does mandatory overtime damage morale and increases burnout, it makes for an unsafe situation. When staff nurses have not had enough rest or sustenance, they are in danger of committing serious errors that can easily be avoided otherwise. Some facilities, due to lack of funding, cannot offer sufficient compensation for overtime. This directly affects stress levels which consequently lead to health issues.

Adequate Staffing Levels

This issue also relates back to widespread shortage of staff nurses and even to economic policies of some healthcare facilities who are trying to deal with a budget crunch. Either way, workplace and patient safety are both on the line.

Longer hours and not enough staff nurses to fulfill all duties during their shift can lead to more complicated care for the patient and more fatigue for the employee. Thus, many organizations, like the ANA, conduct research and surveys and encourage legislation that would do away with inadequate staffing levels.

Fair Compensation

Along with scheduling issues, staff nurses, specifically females, face a gender gap in regard to salary. According to an article published in JAMA, male RN’s, on average, earn $5,000 more than their female co-workers.

In relation to specialty areas of practice, male nurses, who specialize in chronic care, get paid $3,792 more than their female counterparts, and the largest gap falls into the area of cardiology with males earning $6,034 more than female RN’s. Again organizations that represent nurses can help to bring about change as awareness of this issue increases.

In addition to the inequality of salaries between the two genders, staff nurses also have to look carefully at the region where they live. Oftentimes, differences in salaries from one region to another depend on the cost of living in that area. So for example, RN’s on the Pacific Coast make $18,000 more than they would in most other parts of the U.S. The second highest paying region is the Mid-Atlantic region with nurses making $14,800 than nurses located in other areas; whereas in the East South Central part of the U.S., nurses make $4,300 less. Interestingly enough, these regional gaps in salary might account somewhat for shortages in nurses.

Ethical Dilemmas

And if gaps in pay, occupational hazards, and scheduling and staffing issues weren’t already challenging enough, nurses also face various ethical dilemmas.

According to the International Council of Nurses’ ICN Code of Ethics, aside from the central responsibilities of providing quality patient care and preventing illness and easing suffering, nurses must also “respect human rights, including cultural rights, the rights to life and choice” and “to dignity.” This respect extends to not only the patient, but also the families and to the community. Consider the diversity of any given place, this is a very high expectation that staff nurses must face on a daily basis.

Some of the ethical dilemmas that staff nurses deal with entail:

• Reproductive Rights: whether one is pro-life or pro-choice, a nurse faces the situation of a patient’s option to continue with a pregnancy or not.
• Patient Freedom versus Nurse Control: a nurse would have to handle a situation when the patient refuses suggested treatment or even refuses even basic self-care like eating or practicing person hygiene.  This can be quite a challenge when a nurse knows that rejecting certain healthcare practices and/or treatments would result in the possible worsening of the patient’s condition.
• Parental Notification in the treatment of minors: a firm knowledge of the law and a hospital’s policy would be extremely helpful in what can be a very tough situation. Often a nurse might have to deal with disclosing information to the parents of a minor that the youth would not want revealed. While minor patients have basic rights to privacy, nurses still have to notify parents of certain information as required by law.
• Honesty versus Information: this situation usually relates to a terminal illness or other severe condition and/or the age and mental capability of the patient. The nurse would have to weigh the decision of giving out all information to the patient or withholding some for the sake of less stressful final days.
• Resource Management: when a patient is in a vegetative state, a nurse faces the dilemma of managing resources to some extent; however the wishes of the patient’s family takes precedence over all.
• Beliefs versus Treatment Options: this is another challenge for a nurse whose first instinct is to provide life-saving treatment, but it goes against the cultural or religious beliefs of a patient and his or her family. For instance, some religions do not allow blood transfusions.

Although these situations are quite daunting, there are many sources of information available through professional organizations and through the ethics departments of colleges and universities. Gaining more knowledge and expressing concerns are both quite important in this field.

While this profession certainly has its own brand of challenges to face, it can still be one of the most rewarding.