The High-Quality Care in the US Hospitals

Brief explanation or description of the issue

Health care which is defined as the prevention and treatment of the various ailments and injuries that affect man’s physical and mental well being plays a very significant role in modern society. The US has invested heavily in the health sectors in a bid to ensure that its citizens enjoy quality health care. Some of the key players in health care provision are nurses and their contribution cannot be understated. However, there has been a troubling phenomenon in the form of the rising shortage of nursing staff in the acute and critical care setting. This issue has been articulated by Stechmiller (2002) in her article “The Nursing shortage in Acute and Critical Care Settings.

In particular, the author notes that there has been a significant drop in the number of registered nurses (RN) in intensive care units while the demand for the same has continued to rise. What makes this issue even bleaker is the high rate of turnover and job dissatisfaction among the RNs in America. As such, there is need to come up with solutions to ensure that more young people are attracted to the nursing field and at the same time, the high turnover rates currently experienced are curbed.

Summary of the Article

The article by Stechmiller (2002) begins by noting that while hospitals in the US continue to strive to provide high quality care, this goal is jeopardized by the marked decrease in the number supply of registered nurses (RNs). This decrease has resulted in a severe shortage in the number of nurses in US hospitals and especially in the critical care section. This shortages is attributed to a number of factors most of which are related to growing discontent among nurses with their jobs.

The author suggests that the root cause of the problem can be traced to the dramatic restructuring of US hospitals from the mid 1990s which was aimed at reducing costs. This reengineering resulted in the reduction of personnel and especially the nurse force. As a result of the restructuring, nurses became overworked and therefore unable to provide quality patient care. This combined with the decreasing morale has resulted in high turnover rates among the nurses. As a result of this, fewer young people are choosing nursing as their career of choice opting to engage in other professions which have not only better work satisfaction and superior work conditions but also better pay.

Stechmiller (2002) also documents that job strain and emotional exhaustion is commonplace in nursing. The high levels of stress that nurses experience is blamed on the high mortality rates experienced in ICUs, the frequent ethical dilemmas that nurses face, lack of mentoring experience as well as poor relationships between nurses and other health care professions such as physicians. The article also notes that nurses are unable to provide routine nursing care as a result of the structure of nurses’ work changing. Nurses have been forced to perform non-nursing tasks leading to burnouts and dissatisfaction with their job which translates to nurses discouraging others from joining the profession as well as practicing nurses making plans to change careers.

Another factor that the author highlights as contributing to the nursing shortage is the rapid aging of the RN workforce. This compounded with the lack of young entrants into the nursing field will result in even further shortages of RNs. The decline in the number of young entrants is blamed on the availability of more career opportunities for women who typically make up the bulk of RNs. Also, the decrease in the US birth rates starting from the 1970s means that nursing programs have an even less pool of students from which to draw.

A potential solution that is proposed by the article is the “Magnet Hospital Program”. This is a program in which hospitals which are successful in recruiting and retaining professional nurses are designated magnet hospitals. Stechmillers (2002) declares that hospitals which had this designation had superior nursing care and better patient outcome compared to the other hospitals. A significant feature of a magnet hospital is its involvement of nurses in the decision making process about patient care, hospital governance and working conditions. The article also recommends the creation of a work environment that promotes job satisfaction and provides for career development for young graduate nurses. The article also highlights the need for positive mentorship of new graduates so as to build confidence.

My perspective on the content

I agree with most of the issues that Stechmiller raises through her article. The first issue that I feel that the author has articulated in a very impressive manner is the lack of work satisfaction owing to the isolation of nurses in policy decisions. Nurses are not involved in the policy making activity since in most hospitals, policy decisions are left to the hospital management. Owing to this, nurses feel do not feel appreciated as professional since they have no say in the patient’s care despite them being the primary care givers.

Another issue that I agree with is the overworking of nurses. In most hospitals, there is an unsatisfactory nurse to patient ration leading to the increase in the amount of workload of the available nurses. This combined with the allocation of non-nursing tasks to the nurses’ results in a reduction in the amount of time that the nurse can spend providing the kind of care to patients which he/she was trained to offer. This not only leads to burnouts but also professional dissatisfaction.


One of the major considerations when choosing a career is the financial benefits that one will acquire from the job. While the article does note that salaries for registered nurses are above the minimum wage, it goes on to show that they are not high enough to act as incentives for one to remain fully committed to the profession. This is a factor that I agree with since remunerations are an important aspect in a persons work life and attractive pay is necessary to retain staff.