-Interprof Org & Sys Leadership


Organizational Policies and Practices to Support Healthcare Issues

Quite often, nurse leaders are faced with ethical dilemmas, such as those associated with choices between competing needs and limited resources. Resources are finite, and competition for those resources occurs daily in all organizations.

For example, the use of 12-hour shifts has been a strategy to retain nurses. However, evidence suggests that as nurses work more hours in a shift, they commit more errors. How do effective leaders find a balance between the needs of the organization and the needs of ensuring quality, effective, and safe patient care?

In this Discussion, you will reflect on a national healthcare issue and examine how competing needs may impact the development of polices to address that issue.

 Post an explanation of how competing needs, such as the needs of the workforce, resources, and patients, may impact the development of policy. Then, describe any specific competing needs that may impact the national healthcare issue/stressor you selected. What are the impacts, and how might policy address these competing needs? Be specific and provide examples. 

Respond to this post. Post 1 JI

Nurses are considered the largest group of health professionals. Per the American Nurses Association, there will be far more registered nurse jobs available than any other professional healthcare by 2022 (Nursing Workforce, n.d.). Because of this shortage, there is a competing need for needing nurses due to nursing shortage and the high volume of patients requiring care. One of the causes of the nursing shortage is the result of the aging population. Currently, there are about 40.3 million people in the United States that are age 65 or older (Older Population and Aging, n.d.).  As these babyboomers age, they are requiring higher acuity/patient needs in the hospitals (Haddad et al., 2020).

This high acuity of patients and nursing shortage causes organizations to develop policies that ensure a safe patient to nurse ratio. These policies ensure there is safe staffing of nurses and patient safety. An appropriate nurse-patient ratio allows the best and safer care of patients and prevents nursing burnout (The Importance of the Optimal Nurse-to-patient Ration, 2016). 

The Healthcare issue selected is nursing burnout which is greatly impacted by patient acuity level and not having appropriate staff to take care of patients. This sometimes results in nurses taking care of more patients than the recommended safe nurse to patient ratio. Nurses having to work in a high-stress environment also impacts patient safety (Nursing Workforce, n.d.).

The way policies would be able to address this current issue would be to have organizations be fined if nurses are given an assignment that requires taking care of patients more than the nurse-patient ratio allows. Currently, California is the only state that legally has a defined nurse to patient ratio (The Importance of the Optimal Nurse-to-patient Ration, 2016).


Haddad, L. M., Annamaraju, P., & Toney-Butler., T. J. (2020, July 25). Nursing shortage. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK493175/

Nursing Workforce. (n.d.). American Nurses Association. Retrieved September 14, 2020, from https://www.nursingworld.org/practice-policy/workforce/

Older population and aging. (n.d.). The United States Census Bureau. Retrieved September 14, 2020, from https://www.census.gov/topics/population/older-aging.html

The importance of the optimal nurse-to-patient ratio. (2016, November 11). Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/the-importance-of-the-optimal-nursetopatient-ratio


A competing need, when it comes to having a 2020-BSN prepared workforce, would be hiring non-BSNs or making exceptions for staff not to achieve a BSN degree.  This goal allows for some wiggle room by being 80% and not 100% of the nurses having a BSN.  Making exceptions is ok, but too many exceptions and the hospital may not meet this goal on time.  The policy impacted would be policies that mandate hiring BSN nurses and the requirement of non-BSN nurses getting their BSN.  The policy should remain, but the exceptions should be vetted through higher management to allow for exceptions.

The problem this goal imposes is balance.  Patient safety remains the top concern.  Immediately firing all nurses without BSNs and replacing them with BSN nurses can leave a hospital stripped of experience in nursing and policy, leaving patient safety compromised.  This problem is why this goal must be measured, and fortunately, it allows for an extended time frame (Gerardi et al., 2018). 

Not achieving this goal is the compromise that may be needed to ensure a safe balance of nurses that are familiar with the hospital and have adequate experience.  This compromise would be the impact of relaxing policies on hiring BSN nurses.  The nurses with experience with ADNs feel like the BSN nurses are no better than they are at bedside nursing (Matthias & Kim-Godwin, 2016).  Although they think they are the same, the higher ratio of BSN nurses in the workforce has many benefits (Straka et al., 2019).  Regardless, this goal has been set, and the competing needs are manageable.

In the hospital where I work, we have not achieved this goal but have been trying to.  I have seen days in the ICU where the most experienced nurse, including the charge and ANM, has three years of nursing experience.  This situation is where this goal, and other factors, has compromised patient safety.  We did not meet the goal by 2020 but are still trying to safely.  I have seen new hires come in with plenty of ICU experience that do not have BSNs, but they plan on getting it.


Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared 

workforce goal. AJN, American Journal of Nursing, 118(2), 43–45. 


Matthias, A. D., & Kim-Godwin, Y. (2016). RN-BSN students’ perceptions of the differences in 

practice of the ADN- and BSN-prepared RN. Nurse Educator, 41(4), 208–211. 


Straka, K. L., Hupp, D. S., Ambrose, H. L., & Christy, L. (2019). Reaching beyond 80% 

BSN-prepared nurses. Nursing Management (Springhouse), 50(5), 52–54.