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Journal of Nursing

The Forgotten Arm of Care

Hilda Pritchard Ming PhD Director Nursing Staff Development Division University Hospital of the West Indies Jamaica [email protected]

“Yes, you inform us about the patient, but you did not tell us that this patient might need a ventilator and where I am going to get the staff from?” According to Giovanpetti (1978), “Staffing is related to, the numbers and kinds of personnel required to provide care to the patient or client” (p. 13). But, is there a solution to this ‘staffing’ tension or at least an approach that will lead to an amicable end? One point is obvious; there are unique variables peculiar to the nursing profession that is leading more and more nurses to utilize what could be regarded as the solution to the staffing issue: The Patient Classification Systems (PCS). Marquis and Huston (2015) pointed out that “A Patient Classification System groups patients according to specific characteristics that measure acuity of illness in an effort to determine both the number and mix of the staff needed to adequately care for those patients” (p. 397). Basically, PCS are tools or frameworks with at least two common groupings: the area of needs/care needed e.g. hygienic, treatments, and categories (e.g.1-4 grade) or what is commonly referred to as acuity levels and graded according to the amount of care required for each need. According to Harper and McCully (2007), “Patient Classification Systems (PCS) assist nurse managers in controlling cost and improving patient care while appropriately using financial resources” (p. 1). Patient Classification Systems themselves have inadequacies so it is well to note that as there are many dynamics in a health institution any classification system adopted must be adjusted to suit the specific organization. So, perhaps the panacea we all seek could be a continual refinement of PCS to make them internationally and culturally relevant to both Nursing standards and the financial controllers’ budget. But, still there is yet another element that is not considered in PCS or the general routine nursing activities which is creating tension and impacting care delivery.

Looming in the background is a pivotal need: working in a healthy work environment/building a healthy working relationship. Manion (2009) noted that without this solid foundation “the rest of the structure is weak and likely destined for an early demise or at least significant problems” (p. 1). It is quite obvious that there is such a need when one considers that the nursing profession is people-focused in nature. There are countless interactions and resultant emotions that flow in medical institutions. On one side there are the patients and their relatives with their constant demands and the other side the vast interplay of the varying demands of the network of medical teams on the nurses who are the implementers of care. With the dynamics of these care environs, the activity of building a healthy work environment is now calling for factored time in the daily routines of patient care. According to McCauley (2005), “The creation of healthy work environments is imperative to ensure patient safety, enhance staff recruitment and retention, and maintain an organization’s financial viability” (p. 9).

First, to achieve a healthy environment it must not be seen as a one off venture. Managers need to have a commitment to empower their staff to create a healthy work environ for themselves and others. In a study of Nurse-to-Nurse-Relations, Moore et al. (2013) found that 40 participants (56%) believed their nurse managers did a great deal to promote positive nurse relations. Also, the managers’ behaviours believed to foster nurse relations included encouraging staff, confronting conflicts, and providing an inclusive environment. Unfortunately, 31 participants (44%) perceived their nurse managers did little to promote positive relations. They also noted that one participant pointed out “The nurse manager holds the key to a positive, healthy unit”. Moore et al. said that new managers should have organizational resources available to learn managerial skills, including how to handle conflict and foster healthy work environments. To build such environments will call for activities that involve team building, giving recognition or awards, mentoring, affirming, accepting cultural differences, sharing, displaying positive attitude, bearing equal workload, and much more. On the surface, these activities may appear purely social but by daily practice and monitoring, the working environment will evolve into one that has high productivity, satisfied customers, and staff with high morale. What must not be ignored is that, like the PCS, it too will take commitment. It is well for organizations to invest in this arm of care since the outcome of their business is dependent on healthy caregivers.


Giovanpetti, P. (1978). ERIC- Patient classification systems in nursing: A ... Retrieved from
Harper, K., & McCully, C. (2007). Acuity systems dialogue and patient classification system essentials. Retrieved from

McCauley, K. M. (2005). American Association of Critical-Care Nurses standards for establishing and sustaining healthy work environments: A journey to excellence by AACN. Retrieved from

Manion, J. (2009). Building a healthy workplace: Start with the foundation of positive working relationships. Retrieved from

Marquis B., & Huston, C. (2015). Leadership roles and management functions in nursing: Theory and applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Moore, L., Leahy C., Sublett, C., & Laing, H. (2013). Understanding nurse-to-nurse relationships and their impact on work environments. Retrieved from

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