The two main driving forces of the economy are supply and demand. Understanding the basic concepts of supply and demand can help an organization focus on the bottom line. According to Gretzen (2007), demand is the relationship between price and quantity. Supply refers to the amount of a good or service available at any particular price. The principle of supply and demand describes a balance that develops between the supply of an item or service and the demand for it (Kleinman, 2009). Economics plays a major role in the health care industry. As a resource, the health care workforce is a determinant of the balance between supply and demand. The health care workforce consists of nurses, physicians, and other ancillary health care workers such as certified nurses’ aides (CNA’s) and patient care associates (PCA’s). The supply of health care workers directly impacts the demand of quality care rendered to patients.
SERVICE OR PRODUCT
Health care organizations have specific stated missions and visions to map out their fundamental way of operation. In health care, the workforce is instrumental in assisting with the organizational delivery of services to consumers (patients). The primary issue for all health care workforce personnel is that of inadequate staffing. This paper focuses on the staffing effectiveness of supplemental staffing of health care personnel within the inpatient setting.
Nursing managers formulate staffing patterns on a daily basis. The staffing of inpatient units requires a knowledge of unit census (total bed capacity), consideration of patient acuity (level of care required for the patient), and skill mix (nursing hours per patient per day and nurse patient ratio) (U. S. Department of Health and Human Services, 2002). Often times, inadequate staffing is due to a high rate of call outs of sickness or other emergencies. Inadequate staffing directly impacts patient safety and quality of care. All health care titles render supplemental staffing coverage in one of two ways, overtime and through per-diem agencies. Overtime employment provides regular full time employees with monies set at a rate of time and half for any extra work completed over the prescribed 40 hours a week.
Per-diem agencies are outside contractors capable of providing their own qualified titled personnel to fill vacancies with monies defined at a set rate. Patients are admitted to inpatient setting with varied co-morbidities may or may not indirectly increase the necessity of staff. Patients are often admitted for diagnoses of altered mental status, agitation / combativeness, risk for falls, suicidal ideation, and alcohol or drug intoxication. Many patients require a higher level of skilled care, such as turning and repositioning, and assistance with activities of daily living such as toileting and eating. It requires a higher staff to patient ratio to provide safe, effective quality care.
PERSPECTIVE AND RATIONALE
According to published reports there are key factors affecting the adequacy of the health care workforce. Some key factors include an aging workforce of where 40 percent of practicing physicians are older than 55, and one-third of the nursing workforce is over 50 with a majority of both professionals seeking to retire within the next 10 years (Alliance for Health Reform, 2011). The largest groups of health professionals in the United States are composed of Registered Nurses. Statistically, there is a huge decline in the numbers of nurses within all regions of the U.S. An estimated 118,000 FTE RNs will exit the workforce within the next five years (Staiger, Auerbac, & Buerhaus, 2012). This potentially leaves a major void in terms of numbers of bodies needed to fill vacated positions. Low staffing levels are associated with higher rates of adverse outcomes that are directly sensitive to nursing attention, such as urinary tract infections, pneumonia, pressure ulcers, and falls (American Federation of Teachers, 2012).
Unintended additional costs associated with the development of complications in patients are greater than labor savings when units are understaffed. Acquiring pressure ulcers are estimated to cost the health care industry $8.5 billion per year (Kleinman, 2009) Overtime costs and per-diem agency costs can’t stand alone to solve the issues of staffing shortage. Their combined usage enables institutions to deliver optimal health care services to consumers/ patients. The supply of overtime and per-diem staff meets the increased demands of patients. It also assists in the delivery of quality care through services rendered. In terms of patient safety, the potentiality of the risk of injury to patients via falls, medication errors, and or sentinel events decreases.
The United States is a great consumer demand for health care services. The supply of such services is affected by varied factors. These factors directly influence the financial stability of health care organizations. Recessional times cause delays in career and retirement plans for health care professionals. In recessional times, there are noted changes in the supply and demand of the health care workforce. The shortage of registered nurses and providers in the workforce may inadvertently lead to a reduction in health care access for consumers. Inadequate staffing levels place heavy burdens on the nursing staff. Adverse events such as falls, hospital acquired infections and medication errors are potentially painful and life threatening events. Adverse events can result in considerable costs to be paid by the understaffed institution.
For this reason alone, supplemental staffing via agency and overtime personnel provides a measure of increased patient safety. The future is trending towards the assistance in the recovery of the health care workforce shortage. It will rely heavily on the provisions made by the Affordable Care Act of 2010 (Alliance for health reform, 2011). Recruitment and reinvestment in health care professions especially nurses and physicians will assure sufficient supply of workforce personnel to meet the increased demands of health care economy and its’ consumers( Kaiser Foundation (2012). The Joint Commission bolsters workforce infrastructure through in-service and continuing education, supporting nursing education, and the adoption of set staffing levels based on competency and skill mix relative to patient mix and acuity (Stanton, 2012). It also supports the establishment of financial incentives for health care organizations investing in nursing and workforce services.
Alliance for Health Reform. (April, 2011). Health care workforce: Future Supply vs. Demand. Retrieved from http://www.allhealth.org/publications/medicare / health_care_workforce.
American Federation of Teachers. (2012). Issues: Healthcare Staffing. Retrieved from http://www.aft.org/issues/healthcare/staffing/index.cfm
Changes in Health Care Financing & Organization. (August, 2009). Issue brief: Impact of the economy on health care. Retrieved from http://www.academyhealth.org /files/hvfo/findings0809.pdf
Getzen, T.E. (2007). Health economics and financing. (3rd ed.). John Wiley and Sons, Inc., Hoboken, NJ.
Kleinman, C. (2009). Health care supply & demand. Retrieved from http://www.community.advanceweb.com
Staiger, D. O., Auerbach, D. I., & Buerhaus, P. I. (2012, April). Registered nurse labor supply and the recession- Are we in a bubble? New England Journal of Medicine, (366), 1463-1465.
Stanton, M. (2012). Hospital nurse staffing and quality of care. Retrieved from http://www.ahrq.gov/research/nursestaffing/nursestaff.htm
U.S. Department of Health and Human Services. (July, 2002). Projected supply, demand, and shortages of registered nurses: 2000- 2020. Retrieved from http://hrsa.gov.
The Kaiser Foundation. (2012). Nursing workforce: Background brief. Retrieved from http://www.kaiseredu.org/Issues-Modules