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Brigitte U.


Republic of the Philippines
Ifugao State University
Main Campus, Nayon, Lamut, Ifugao

Master of Arts in Nursing

Midterm Exam
Nursing issues in the province of Ifugao

In Partial Fulfillment of the Requirements in
Foundations of Nursing Practice

Submitted By:
Brigitte U. Bumanghat

Submitted To:
Valerio F. Famorca II, RN, MAN

semester, S.Y.2013-2014

Brigitte U. Bumanghat

Unprofessional Behaviors
A lot of unreported bullying is happening in the field of nursing (evident in
our province alone). Those who make the most money and do the least work are
usually the ones who bully. This would include senior nurses, permanent co-
workers, and what not. For example in the operating room or delivery room,
because doctors are on top of the food chain, they are usually the ones who
would be disrespectful, aggressive and arrogant particularly to clinical
instructors, students and volunteer nurses. Some of them would treat these
nurses useless and not part of their team. There should be no place for them in
health care.
From experience, having a supervisor who has a bossy attitude towards
his/her subordinates is really abusive. These trait blocks an empathic concern for
the well-being of his/her subordinates. I sometimes think if he/she is beyond
miserable that his/her misery is projected towards employees and patients too. It
is always disruptive, and usually marks ineffectiveness in communication skills. It
also discourages openly discussing a patient's problems, which gives time for
those problems to worsen. So when anger and intimidation flow down,
information stops flowing up. This discourages employees to approach him/her
and discourages them to continue to work under that situation. Sometimes the
only solution is to leave, which is extremely unfortunate.
During our student years, mistreatment has also been happening regardless
of the pain and suffering inflicted on the students. I have witnessed a lot of
mistreatment during procedures and sometimes during charting too. The bully
screams or yells at the student nurse in front of others to make him or her look
bad. These interactions shame and humiliate student nurses that undermine
their confidence. In times like these, the student nurse constantly feels stressed
and fearful waiting for additional negative events. It discourages the student to
go to work and be criticized, or treated badly.
The bullying behaviors create feelings of defenselessness in the nurse and
significantly demoralize his/her right to dignity in the workplace. Despite having a
history of excellence, this will make the nurse have problems with self-esteem
and feel incompetent. The most serious consequence would be the emotional
pain suffered by the nurse which also has a secondary effect on co-workers who
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witness the situation. The nurse will suffer anxiety, depression and feelings of
The bullying situation seriously is so bad. These behaviors have great impacts
on the care of the patients. Its unprofessional, unnecessary, ill-mannered, rude,
destructive, emotionally damaging and effects the quality of care being provided
to patients. Victims fail to serve patients, themselves, or the industry by
engaging in degrading, demoralizing and destructive behaviors.
How will nurses protect themselves from these situations?
Understand the consequences of workplace violence incidents. Nurses
should know his/her rights. They should be knowledgeable of workplace policies
and procedures related to bullying and harassment. Documenting all the
incidents including the date, time and site of occurrence will also help when legal
assistance is sought.
What to do?
Confront the individual regarding the behavior in a professional manner;
make clear your expectations of the individual. Use words such as bullying,
hostile work environment, and intimidation. Make a memo of the encounter.
Document only the facts.
If nothing happens, organize a crisis management team, develop and
disseminate a workplace violence policy, identify and evaluate potential threats
of violence, and provide mechanisms for reducing or eliminating threats.
If still nothing happens, inform the management in writing, make clear
your expectations and your previous attempt to resolve the issue at the lowest
level. Notify Director or HR in writing, provide previous documentation, and
make clear your expectations.
If the situation worsens, get a lawyer, provide all documentation. Any idiot
who fails to effectively interdict before it gets to this point deserves what they
get. Be sure to above all, remain professional and do not engage the bully in any
public display of unprofessional behavior.

Brigitte U. Bumanghat

Increase in workload
The heavy workload of hospital nurses is a major problem for the health
care system. Nurses are experiencing higher workloads than ever before due
to increased demand for nurses, inadequate supply of nurses, and reduced
staffing and increased overtime.
There are several important consequences of high nursing workload.
Research shows that a heavy nursing workload adversely affects patient

Furthermore, it negatively affects nursing job satisfaction and, as a
result, contributes to errors.
Heavy nursing workload results to stress, increases burnout and job
dissatisfaction. It also leads to anger and emotional exhaustion. Nurses
experiencing stress and burnout may not be able to perform efficiently and
effectively because their physical and cognitive resources may be reduced.
Under a heavy workload, nurses may not have sufficient time to perform
tasks that can have a direct effect on patient safety. A heavy nursing
workload can influence the care providers decision to perform various care
and procedures. It also reduces the time spent by nurses collaborating and
communicating with patients.
This condition is affected by low nurse to patient ratio and patients
condition. It arises when a nurse is expected to care for twenty to forty
patients in a shift. Eight hours would not be enough for the nurse to execute
physicians orders and quality care. Interruption is also one factor for increase
in workload. It is true that nurses need to be responsive but not all
interruptions are equally important.
How to manage increase in workload?
Nurses can also apply the five minute rule. If a job can be done in five
minutes or less then do it.
If I will experience extra work or activity, it will really be overwhelming so
having a plan will help me finish my job. I will always make time to plan my
day, my week or whatever interval I need to organize.
Brigitte U. Bumanghat

Breaking down an entire problem will also help. This gives focus for the
next step for finishing a work.
When managing actions, setting priorities is the best to take. The most
important work is the first to be done. When things begin to pile up, its easy
to react to the urgent and let everything go somewhere in a hand cart. An
investment of time in planning and using my systems will keep me from
being overwhelmed.

Other tips for reducing overload by Judi C. Casey and Jacquelyn Boone
Regularly analyze the tasks that you perform and distinguish between
the vital and the disposable
Make adjustments that will ease work pressure without significant
sacrifice of quality
Take vacations; take sick time if needed
Assess the best fit between your work and personal life
Set firm boundaries between work and non-work time
Take care of your health exercise, eat healthy, sleep
Minimize interruptions and distractions
Expect recognition and rewards from co-workers and managers
Insist that you are treated with respect and fairness.

Brigitte U. Bumanghat

Limited nursing personnel
It is already known that hospitals in the Philippines have limited employed
nurses. It is obviously evident in our province. Nurses are the largest
deliverer of health care in the health care system. The scarcity of nurses is a
major challenge for hospitals because it impacts not only their ability to
provide nursing coverage for patient care, but also provide adequate nursing
resources such as quality improvement.
Nursing care is a major reason why patients go to hospitals but in our
situation, limited nurses are there, thus there is also limited care. Nurses
working in these conditions are often presented with complex nursing
decisions, long hours and shift work. For example, a registered nurse looks
after more than fifteen patients on a ward. Nurse to patient ratios in
provincial and district hospitals are now one nurse to between 40 and 60
patients, which is a striking deterioration from the ratios of one nurse to
between 15 and 20 patients that prevailed in the 1990s (Galvez-Tan 2005).
While previous ratios were not ideal, the current ratios have become
dangerous even for the nurses, adding to the loss of morale and desire to
migrate for those still employed in our province.
Elderly, chronically ill, and physiologically unstable patients, as well as
those undergoing lengthy or complex treatment, are at much greater risk of
experiencing various types of adverse events in care. Every patient needs
different kind of care and compassion but due to certain situations, the nurse
cannot provide quality and compassionate care to the patients.
To help the hospital continue to provide high-quality care and support for
nurses in areas where patient volume has increased, hospital management
needs to adjust staffing levels in some units. For instance, medical ward has
forty patients and one nurse. The surgical ward has six patients and two
nurses. The management can move the other nurse to the medical ward to
help the other nurse.
Flexibility is one of the answers when it comes to limited personnel in the
hospital. Flexibility is needed to perform everyday activities with relative ease.
Our activities or work would be easier to perform.
Brigitte U. Bumanghat

A nurse should be able to adjust to the environment to avoid stress.
Working hours, instead of being repetitive and fixed, should involve changes
and variations to help the nurse accomplish his/her work on time.
An ability to think widely is also a big factor in helping to address limited
personnel. Be alert in your work and be prepared as well.
During difficult situations, lets love our work and think of three positive
things for every negative one. Replace negative thoughts with positive ones.
Look for a bright side in every situation. There are both positive and negative
aspects to most situations. We get to choose which ones we will focus on. We
can try to catch ourselves when we're being negative and try thinking the
opposite. We will find that there are surprising benefits within them. If we do
this long enough, it will become habitual, and it will make a tremendous
difference in improving our positive thinking skills. Say I can more than I
can't. Remember, everything can be framed positively; make a relentless
effort to do so.
And lastly, dont forget to smile. We are nurses who give care to patients
even in the most difficult situation. Smiling will help give a good working
environment between nurses and patients. Smiling is a reward, not a risk.
The only thing we risk when smiling is a giving ourselves a little more
happiness. Many studies have demonstrated that even a forced smile can lift
one's mood! We may also share positivity with others by flashing them with a
brilliant smile.

Brigitte U. Bumanghat

Nurse migration
Our province is a job-scarce environment and, even for those with jobs in
the health care sector, poor working conditions often motivate nurses to seek
employment overseas. The province has too few jobs for its population. The
unemployment rate has been steadily increasing. Even for those with jobs,
conditions are too difficult. Nurses are underemployed, underpaid, or
employed below their full potential. For instance, applying for a job order in
hospitals give nurses limited chances for long-term employment. Therefore,
employment abroad provides chances for nurses to gain job satisfaction. This
also applies to the whole country.
Although working abroad provided nurses good benefits, the province
have been losing trained and skilled nursing workforce much faster than it
can replace them. When there was international shortage of nurses years
ago, experienced nurses went abroad in search for professional development,
better quality of life and personal safety. This results to the danger of
integrity and quality of Philippine health services. For example, nurses who
want to go abroad have been taking a lot of trainings, not to mention
specializations, to help them with their employment abroad. The province
doesnt benefit at all from the specialization of these nurses who go abroad.
Therefore, due to this reason the integrity and quality of the health care
system in our province is degrading.
There are a variety of reasons for migrating to other countries. This
includes low salary, no overtime or hazard pay, poor health insurance
coverage, work overload or stressful working environment, slow promotion,
limited opportunities for employment, decrease health budget, socio-political
and economic instability of our province and the whole country.
Other countries might provide higher income, better benefits,
compensation package, lower nurse to patient ratio, more options in working
hours, chances to upgrade nursing skills, opportunity for family to migrate,
opportunity to travel and learn other cultures, influence from peers and
relatives, advance technology and better socio-political and economic
Nowadays, demand for nurses in hospitals are requiring at least 3 years of
experience or more. Thus, newly graduated nurses have no choice but to
apply as volunteers or go to Middle East where some clinics/ hospitals dont
require years of experience. Analyzing this situation makes me think that if all
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hospitals in the Philippines are alike, then nurses will not be able to have a
job. And since our province cannot provide enough job for all the nurses,
applying abroad will help rather than being unemployed.
Our government should give priority to the health care system of our
province and country. They should provide career advancement for nurses
now and in the future.
If this situation will never be changed then this statement will forever be
applied to the health care system of our province and country. We are the
one in need of better service yet we are the losers; those countries with
better facilities enjoy better care from health professionals (Lorenzo et al.

Brigitte U. Bumanghat

Closed-minded individuals in nursing hinders development or improvement
and a barrier to continuing nursing education
Gradual development or improvement is a better way to solve problems in
nursing. But Close-minded people are famous for forming negative opinions
of things theyve never even tried. Though being close-minded doesnt
necessarily equate with being negative, many close-minded people tend to
look at most things at the world as being negative or threatening and tend to
stick to the things they know. Close-minded people tend to do the same thing
every day because theyre convinced that they wouldnt be happy if they did
something different, had a different breakfast, or took a different route to
work. So, do just that.
I have experienced this when I was working with older people who were
pretending to be know-it-all. They wont listen to our opinions and even if
updates are being introduced, they do not care at all. They just stick to what
they have learned years ago from their education when technology was not
yet advanced. Even if there are seminars introduced and they even attend,
they still stick to what they know.
This situation is an example of a barrier to continuing education in nursing
This situation hinders improvement and development of health care.
Therefore, health care loses its quality.
Continuing nursing education is essential to the health care system. It is
also essential in staff development. It helps in assessment of clinical
competence, and promotes communication and collaboration among the
nurses. We should let the elders understand that continuing education to
introduce new equipment, to teach new procedures, to assess competency of
nurses in responding to specific clinical situations, to assess adherence to
specific protocols and to promote teamwork.
What to do when we encounter this kind of people:
It is really difficult to deal with the kind of attitudes that my example
portray. However, providing them with reading materials will help them to
understand better.
Reading more and sticking to what is acceptable at present then sharing it
to them will be of help too.
Approaching and teaching them the correct procedures in a nice way.
Although its hard for them to accept the fact that they are wrong and their
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knowledge is already obsolete, helping them to understand what is at the
present moment will help them to accept facts.
Another successful method that is being used is to introduce simulation in
trainings. This is an effective way to let elders understand what is being
taught. Through patient simulation scenarios, essential elements of patient
safety can be emphasized, such as prevention of medication errors,
promotion of effective communication, and the importance of teamwork.
Learners can be exposed to critical care scenarios and have the opportunity
to respond without fear of harming a live patient.
Be creative and think widely in finding ways to deal with this kind of