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Interprofessional Organization & System Leadership

Interprofessional Organization & System Leadership

COVID -19: Development of Organizational Policies and Practices

Introduction

In the contemporary healthcare environment, competing needs occur within organizations as the employees strive to meet set targets and the leaders strive to achieve the corporate goals. In light of the increasing competition, the costs of delivering healthcare continue to increase, whereas hard-bargaining insurers either hold the line or lower reimbursements (Dafny & Lee, 2016). Compounding the health industry’s problems, services that account for most profits, like ambulatory surgery and radiology, are most susceptible to poaching.  Thus, leaders are required to establish priorities and allocate resources effectively and efficiently. In modern healthcare settings, the workforce needs, limited resources, and patient needs are usually conflicting. Examples of common practices that trigger conflicting needs in healthcare practice range from compulsory overtime, enactment of staffing ratios, unlicensed assisting staffs, and decreases of staff educational benefits. This paper presents a detailed explanation of competing needs that are impacting the ongoing COVID-19 along with policy and practice changes that have been designed to achieve an optimal balance of the competing demands of the resources, workforce, and patients and tackling the ethical shortcomings. Also, Cuyahoga County Corrections’ relevant policies and practice that could influence COVID-19 and ethical considerations policies will be discussed in the report.

Competing Needs in Healthcare: COVID-19

The COVID-19 health pandemic is ranked as the biggest challenge of all time. Unfortunately, the majority of countries have demonstrated that they are ill-equipped to respond to health pandemic of this magnitude. This could be attributed partly to the shortages and precincts of the nursing workforce. As the coronavirus sweeps the globe, the nurses are on the front line of the health response and are transcending to maintain the health systems’ functionality. One of the competing needs is that the mentally and physically exhausted nurses work overtime to provide quality care to a growing number of patients while exposing themselves and families at high risks of COVID-19 infections. Secondly, due to shortage, the nurses have been experiencing work overload as they are forced to take on added responsibilities beyond their comfort levels. Consequently, this has translated into a high turnover in the healthcare sector. Another competing need is fewer nurses are forced to share a substantial workload, which has pushed some staff to extreme exhaustion and low job satisfaction. The final competing need is nurses being forced to work in health settings, where personal protective equipment supplies are declining. The shortage of PPE has created immense distress and anxiety for nurses as they feel pressured to care for Covid-19 patients with inadequate or reused single-use PPE. As a result, nurses have reported an increase in infection cases of COVID-19 in the health sector as they work long hours, under immense stress while risking their health to protect others.

Cuyahoga County Corrections Center: COVID-19 Policy & Best Practices

On March 18, 2020, the Cuyahoga County Corrections System issued a press release on the new policies and best practices implemented to lower the potential for COVID-19 at the facility. The policy was devised by the Cuyahoga County Jail Administration in collaboration with MetroHealth to curb the spread of the highly-contagious virus in the corrections facility. The policy highlights include establishing locations in the jail to isolate 25 symptomatic prisoners, and quarantine 48 verified COVID-19 prisoners, with a potential of increasing this by an additional 100 if looked-for. Secondly, the policy highlighted staff education on actions required to respond to COVID-19 related issues in the Corrections Center. Also, MetroHealth was sanctioned to conduct inmate screenings for coronavirus symptoms. Lastly, remote video visitations were enforced for the inmates and family, with only one free remote visit weekly. The facility’s leadership team worked closely with County judges and prosecutors to reduce the jail population. In March, Ohio courts in Cuyahoga County issued court orders and conducted special hearings to grow the number of inmates released from jails (Prison Policy Initiative, 2020). Since March 10, the Cuyahoga County jail released approximately 900 inmates, reducing its jail population by over 30%.

Policy Critique: Ethical Considerations

The COVID-19 has augmented the complexities of the modern healthcare environment; it is imperative that RNs should identify and address any ethical concerns in practice. Ethical awareness encompasses identifying ethical implications of varied nursing actions and empowering nurses to serve as moral agents in delivering safe and ethical healthcare to all patients (Milliken, 2018). The pandemic has presented challenging conditions and dilemmas, which pose dramatic risks to both nurses and patients. At Cuyahoga Corrections, the pandemic has brought forth challenges in providing quality care amid limited resources, low energy, loss of pride, and inability to offer holistic patient care. Thus, nurses face frustration, stress, and helplessness to alter their working circumstances and promote ethics. The American Nurses Association offers guidance and support to nursing practice through the formation and enactment of the Code of Ethics for Nurses applicable in a variety of settings (Epstein & Turner, 2015). Provision 6 is most applicable in the implementation of the Cuyahoga Corrections Center’s COVID-19 Policy as it encompasses the work environment, moral virtues and values, ethical obligation, and responsibility for the care environment. Through collective and individual actions, provision 6 necessitates nurses to establish, maintain, and improve the moral environment of the work settings and employment conditions conducive to quality care (American Nurses Association, 2015). The primary strengths of the policy’s implementation are to minimize the risks of exposure to the coronavirus and create open space for isolating and quarantining inmates considering the safety of all inmates and staff.

Recommendations

There are various recommendations for policies and practice changes that can aid in balancing the competing needs of healthcare resources, nurses, and patients while addressing ethical inadequacies of the implementation of COVID-19 policies. Research has demonstrated that business models that routinely undermine nurses’ professional knowledge and their ethical mandates of the provision of individualized patient care causes ethical conflicts, workplace tensions, and strains (Kelly & Porr, 2018). Accordingly, the Cuyahoga County Corrections Center administration should recognize nurses’ value as legitimate contributors to healthcare by promoting and upholding a quality working environment that fosters the delivery of ethical care. For example, similar policies have been effectively advocated by Ontario’s Registered Nurses under the Healthy Work Environments Best Practice Guidelines. The recommended policy can be implemented by educating and supporting nurses in techniques that nurture respectful and effective communications that warrant challenging and tough conversations in complex work environments. Cuyahoga County Corrections should promote the ideal atmosphere that allows nurses and other staff to speak up and voice concerns while maintaining professionalism, integrity, and accountability.

Conclusion

The Covid-19 pandemic has presented unprecedented challenges and competing needs for nurses, which has produced fresh stimuli for the examination of working practice and redesign of services. The report identified and described competing needs that have impacted the COVID-19, including the increasing COVID-19 cases, shortages, and precincts of the nursing workforce, mental and physical exhaustion of nurses. Other competing needs include working overtime, huge workload, extreme exhaustion, low job satisfaction, limited supplies of PPEs, and exposures to high risks of coronavirus infections. On 18th March 2020, Cuyahoga County Corrections Center administration and MetroHealth implemented a policy to curb the spread of the virus at the facility.  The pandemic has presented challenging conditions and dilemmas, which pose dramatic risks to both nurses and patients. These necessities ethical awareness in the policy implementation by recognizing the ethical implications of and empowering nurses to act as moral agents in delivering safe and ethical care to all patients. Lastly, the key recommendation is recognizing nurses’ value as legitimate contributors to healthcare by promoting and upholding a quality working environment.

References

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