One of the major concepts presented by the Theory of Bureaucratic Nursing is the dilemma faced by nurses to meet patient care needs while balancing the often equally stressful and taxing corporate demands of the healthcare organization. As an ER/Trauma nurse for 5 years now, I can say that I have had first-hand experience when managerial decisions do not necessarily translate to better, if not good, patient care.
Staffing remains to be the biggest challenge that every manager meets on a day-to-day basis. Quite a global phenomenon since time immemorial, shortage of staff is addressed by various shifting methods to ensure that the number of nurses is adequate at various times of the day. Here in UAE, it is expected that the hours 7-11AM and 3Am-7AM are lull times. That is, patient census is controlled at a minimum; hence, staffing is decreased to 13 nurses instead of the full rota of 17. Such a staffing method is efficient in controlling the need to call for overtime and is therefore beneficial for the healthcare organization.
However, in the Emergency Department, we cannot say definitively that there are as they say "lull times." In my perspective, the concept of Emergency Nursing is being prepared for all cases at all times, meaning at whatever part of the day. True is the case where an ER unit may have ZERO census for 2 hours. But it is also true that a 30-bed capacity ER unit can also become full in 30 minutes, most especially in cases of trauma cases or disasters. In such a scenario, shortage in staff will definitely pose as a problem to meet the high demand for patient care.
Another idea presented by the theory is the concept of "opportunity cost" where the healthcare institution should realize that nurses are vital resources of the hospital that can translate to revenue if appropriately managed. In Tawam Hospital, several programs for staff have been initiated to uplift the standard of living of all members of the healthcare team. A bus shuttle has been provided to transport staff from hospital accomodations to and around the hospital vicinity. Several light fixtures have been installed to ensure safety of staff who are coming or going to the hospital at awkward times (I myself have a shift that ends at 3AM) and most recently, night shift allowance has been raised to a competitive rate.
All the previously mentioned efforts are all geared towards increasing staff satisfaction. Putting the theory into perspective, an increase in staff satisfaction will elevate standards of patient care and furthermore staff retention as evidenced by studies looking at the cost of training new staff versus the cost of retaining a staff.
Simply put: the happier the healthcare staff (better patient care), the happier the patients (increased patient satisfaction and patronization), and ultimately, the happier the healthcare organizations (increased revenues).
– Julius G. Lejarde, RN
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