Competing Needs in Nursing: Developing Policies and Practices

A nurse climbing a pyramid-shaped hierarchy of needs chart, representing professional and ethical growth in nursing practice.

A competing need conflicting with the chosen nursing staffing shortages stressor (NSS) is the patient’s expectation of outstanding and holistic wellness services. Essentially, patients believe their health service providers should provide services worth the payments they make (Kwame & Petrucka, 2021). The expectation of a superior, all-inclusive service by patients simultaneously rivals the expectations of hardworking nurses for competitive compensation. Failure to reward diligent nurses competitively can sow feelings of misuse by employers, which could dampen their motivation. Consequently, patients can notice when nurses are demotivated and question their commitment to upholding professional standards.

Another competing need conflicting with the need to sort nursing staffing shortages in health facilities is nurses’ desire to fulfill their financial obligations. Nurses want to be able to rely on their compensation to have a great standard of life and fulfill the needs of their loved ones (Wakefield et al., 2021). This need contradicts the shareholders’ and owners’ expectation to make valuable returns from their healthcare investment.

Temporary Hiring and Competing Needs in Nursing Policy

My institution has chosen an interesting approach to deal with the needs simultaneously competing with nursing staffing shortages. The nursing staff are hired on a temporary basis, and their contracts expire at the end of four years. This means the staff can either find work elsewhere once the contract expires, or they negotiate afresh with the company if they wish to keep working there. The fact that roles within the company are temporary means the employer does not pay employees any benefits. This hiring policy has been implemented to keep expenses low. The company avoids hiring workers on a permanent basis since experienced workers can ask for salary increments, unlike new recruits. However, this policy communicates an employer’s disregard and ingratitude towards nursing. Unfortunately, shorter job tenure drives attrition rates upward because it encourages nurses to actively seek work and depart once better offers arise. As a result, the organization keeps experiencing a nurse staffing shortage.

Ethical Dimensions of Competing Needs in Nursing

The ethical principles of justice, non-maleficence, and beneficence require that healthcare professionals act in the best interest of patients, prioritizing safety, timely interventions, and compassionate care. However, the widespread policy of contract-based staffing undermines these very ideals. High staff turnover leads to chronic understaffing, which in turn places excessive pressure on remaining nurses and increases the likelihood of clinical errors. Crucially, inadequate staffing compromises the timeliness and quality of patient care. For example, delays in administering medication, such as insulin, can result in serious harm or even fatal outcomes (Tariq et al., 2023).

The temporary hiring policy practice has created an ethical conflict by causing chronic understaffing, which in turn leads to inefficiencies such as delayed medication and an increased risk of patient harm, directly challenging the principles of justice and non-maleficence. Similarly, an ethical dilemma unfolds in another context in our article on Ethical Dilemmas in Neonatal Nursing, where nurses must balance institutional policies with the emotional and medical needs of families in critical care. Both instances demonstrate how structural decisions can undermine core ethical principles in nursing practice.
A professional Asian businesswoman sitting confidently in a modern office setting.Dr. Arya, Nursing & Healthcare Ethics Contributor

Short-Term Gains vs. Long-Term Harm

Nevertheless, this practice offers a very rare advantage because continuous replacement potentially reduces negative issues experienced from working with experienced workers who are reportedly less committed to upholding practice standards. The knowledge that their employers keenly monitor their adherence to healthcare standards drives them to offer outstanding services to patients and assist patients diligently. Thus, despite possible timeliness challenges, patients benefit from better services because newer recruits show increased dedication than seasoned staff. In the long run, higher staff turnover weakens the quality of services and therefore disadvantages patients.

Recommendations for Balancing Competing Needs in Nursing

The organization needs an urgent policy change in recruitment and policy to address the perpetual nursing staffing shortage issue, which has negative implications on services. The current policy is chiefly responsible for increased turnover that subsequently overburdens workers. The organization needs to rehire employees who have over four years of experience for permanent roles with benefits. Additionally, the organization should offer junior nurses the possibility of being hired permanently after completing their initial four-year contract. These adjustments would save the organization the increased costs of constant recruitment. Also, the organization should consider improving the skills of nurses on the job and periodic evaluation to match their compensation to experience. Incentivizing employees encourages higher job retention. Possible training opportunities include training employees on the use of medical equipment, which the organization can facilitate by inviting the manufacturers of various equipment to offer training.

References

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00684-2

Tariq, R., Vashisht, R., Sinha, A., & Scherbak, Y. (2023, May 2). Medication dispensing errors and prevention – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK519065/

Wakefield, M. K., Williams, D. R., Menestrel, S. L., & Flaubert, J. L. (2021, May 11). Supporting the health and professional well-being of nurses – The future of nursing 2020-2030 – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK573902/

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💡 Final Thoughts & How We Can Help

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