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Nurse staffing ratio and patient outcomes
Nurse staffing ratio and patient outcomes
Nurse turnover
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Introduction Health care organizations are focused on providing high quality and safe patient care. There are numerous organizational factors that may directly affect patient care and outcomes, but one of great importance is nurse staffing. Low nurse staffing levels are a major problem that I have encountered during both my clinical and management experiences. There is a significant relationship between inadequate staffing levels and adverse patient outcomes; however, as I observed during my experiences, there may be increased awareness about this issue, but it has not been sufficiently addressed. In order to ensure patients’ safety and positive outcomes, as well as to improve nurse satisfaction, it is imperative to effectively address low staffing levels. Presentation of Data Low nurse staffing levels are an issue hospital-wide at St. Vincent Healthcare, particularly observed during my management hours with a House Supervisor. A responsibility of a House Supervisor is to ensure efficient utilization and allocation of nurses among the floors, so I have had the opportunity to thoroughly discuss and personally observe a variety of causes and consequences of low staffing with my preceptor. A primary reason for inadequate staffing appears to be due to finances; along with making patient safety a continuous priority, St. Vincent Healthcare must strive for good financial outcomes as well. There are certainly challenges that arise in maintaining a balance between providing adequate staff to deliver safe patient care and delivering services at lower costs. Other causes of low staffing are employee conflicts, management and/or leadership discrepancies, heavier patient loads/higher acuity patients, floating to other units, or decreased job ... ... middle of paper ... ...y training. This would require sufficient funding and time, as well as qualified instructors and appropriate settings. Nurses would be given the opportunity to volunteer for cross-training, and unit managers would recruit any others whom are deemed capable. Incentives and recognition could be given to nurses who have finished the program and are adequately cross-trained. Evaluation of this solution would be done through annual skill check-offs and verbal evaluations. On a bigger scale, staffing levels, nurse morale, job satisfaction/performance, patient outcomes, and costs would need to be evaluated to ensure that cross-training remains beneficial. Low nurse staffing levels at St. Vincent Healthcare must be addressed, as the nurses are key to the provision of high quality health care; a commitment to excellence would be further ensured through cross-trained nurses.
This article is a comprehensive look at staffing on hospital units. It used a survey to look at characteristics of how the units were staffed – not just ratio, but the experience and education level of the nurses. It evaluated several different categories of hospital facilities – public versus private, academic medical centers versus HMO-affiliated medical centers, and city versus rural. It is a good source because it shows what some of the staffing levels were before the status quo of the ratio legislation passed in California. It’s main limitation as a source is that it doesn’t supply any information about patient outcomes.
Without participating in a longitudinal study, it is difficult to truly assess the efficacy in mandating nurse staffing ratios. It is difficult to measure the benefits of mandated staffing due to numerous confounding variables. These confounding variables include the resources available at specific hospitals in addition to the populations that they serve. Hospital volume, RN job satisfaction and the relationship between physicians and nurses have also been shown to affect patient outcomes (Duval et al., 2007).
Needleman, J., Buerhaus, P., Pankratz, S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. England Journal of Medicine, Retrieved from http://www.nejm.org/doi/full/10.1056/nejmsa1001025
Needleman, J., Buerhaus, P., PKankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse Staffing and Inpateint Hospital Mortality. The New England Journal of Medicine , 364, 1037-1045.
INTRODUCTION There are many things that affect a student’s enrolment as a nurse the student must be competent in the many registration standards that the Nursing Midwifery Board of Australia have set. The stigmas attached to students with Impairments and or Criminal histories and the ineligibility to register. Nursing is defined by the International Council of Nursing (2014) as collaborative care of individual’s any age health or ill of all communities, groups, in all situations. Health promotion, illness prevention and the care of unwell, disabled and dying people are included in the nursing practice. Encouraging a safe environment, research, contributing to shape health policies and health systems management, and education are also key nursing
In the past two decades, there has been a push for appropriate staff to client ratios. However, measuring client needs and nursing efforts have been around since 1922 (Lewinski-Corwin, 1922, pp. 603-606). The earliest recorded effort was by the New York Academy of Medicine. Superintendents and nurses from ten training schools documented the time spent providing bedside care. From complied information, the researchers revealed each client required an average of five hours and four minutes of care in a 24-hour period. From these observations, they evaluated staffing issues in New York City. At that time, none of the hospitals were sufficiently staffed (Lewinski-Corwin, 1922, pp. 603-606).
These articles have many similarities when discussing the issue of staffing shortages. For patients, their loved ones and the general population, they don’t understand the ramifications and strain that staffing shortages have on nurses. People expect and deserve complete, competent and safe care when they are patients. These articles bring to light all the struggles that nurses have to deal with. Nurses are fearful that they will make mistakes, will harm patients, and will harm themselves. (Bae, 2012; Erlen, 2001; Martin, 2015) Overtime can be overwhelming and exhausting, which can lead to errors being made. (Bae, 2012; Erlen, 2001) These articles perceive that it may be beneficial for nurses, patients, and healthcare facilities to decrease the nurse-to-patient ratio, however, this option is not always
Poor staffing stresses every nurse and makes them despite what they once loved to do. Nurses are overworked and because of that they may not provide adequate patient care.
The purpose of this paper is to address the issue of nursing staffing ratios in the healthcare industry. This has always been a primary issue, and it continues to grow as the population rate increases throughout the years. According to Shakelle (2013), in an early study of 232,432 surgical discharges from several Pennsylvania hospitals, 4,535 patients (2%) died within 30 days of hospitalization. Shakelle (2014) also noted that during the study, there was a difference between 4:1 and 8:1 patient to nurse ratios which translates to approximately 1000 deaths for a group of that size. This issue can be significantly affected in a positive manner by increasing the nurse to patient ratio, which would result in more nurses to spread the work load of the nurses more evenly to provide better coverage and in turn result in better care of patients and a decrease in the mortality rates.
In spite of the shortage among nurses, there are number of options and recommendations that can better help to maintain an adequate staff level and provide greater strategies needed to increase nursing. The choices open to cover for insufficient staff range from reallocating and postponing work, relocating staff within unit or from other units, to employing temporary additional nurses according to Buchan and Seccombe (1995). In health care, some of these options may not be available because ...
Evidence shows that nurse to patient ratios impacts patient safety. The analysis titled "Nurse-to-Patient Ratios Must Increase to Improve Safety" was chosen for review as possible research material for my chosen health care topic of nurse to patient ratios (Duffin, 2012). The analysis is a concise glimpse of the problems that occur with high patient loads and those that suffer because of it. However, the analysis is just that, a glimpse. It is too short to provide any substantial new evidence or add to any existing research on this topic. This essay will evaluate the targeted audience or discourse community as well as the author's relevance or kairos in the writing of this brief analysis.
Patient’s safety will be compromised because increase of patient to nurse ratio will lead to mistakes in delivering quality care. In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a metanalysis and found that “shortage of registered nurses, in combination with increased workload, poses a potential threat to the quality of care… increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stay.” Intense workload, stress, and dissatisfaction in one’s profession can lead to health problems. Researchers found that maintaining and improving a healthy work environment will facilitate safety, quality healthcare and promote a desirable professional avenue.
Factors such as, heavy workloads, stress, job dissatisfaction, frequent medical errors, and intention of leaving the job are all common for nurses to experience, especially during the nursing shortage crisis. Not only do the nurses suffer during a shortage, but the patients ' health outcomes suffer even more. For instance, there are higher rates of infectious diseases and adverse patient outcomes, such as urinary tract infections (UTIs), upper gastrointestinal bleeding, shock, pneumonia, prolonged hospital stays, failure to rescue, and mortality. As a result, this leads to higher re-admission rates for patients. Furthermore, high patient-to-nurse ratios cause heavy workloads due to an inadequate supply of nurses, an increased demand for nurses, a reduction in staffing and an increase in overtime, and a shortened length of stay for patients. Without the heavy workloads that nurses have to endure on a daily basis, there would more time for nurses to communicate more effectively with physicians, insurance companies, and patients and their families. Those heavy workloads are the result of hospitals reducing the nursing staff and implementing mandatory overtime policies just to meet unexpectedly high demands. Unfortunately, the nursing shortage has affected nurses ' mental and physical health. For example, the most common health concerns for nurses include cardiovascular health, occupational injuries and illnesses, and emotional and physical exhaustion. Therefore, safe-staffing ratios/levels have to become the main
Bedside nurses want to change staffing levels to assure that they have enough time to both keep up with the constantly evolving health care and to provide safe patient care. Yet, healthcare employers consider that reducing nurse patient ratio is an unnecessary expense that has not been proven to improve quality of patient care (Unruh, 2008). Employers emphasize that raising nursing staffing level is not cost-effective. In fact, in accordance with ANA’s report (2013), a study, in the Journal of Health Care Finance, confirmed that reducing patient-nurse ratios increased hospital costs, but did not lower their profitability. Higher hospital costs were attributed to wages and benefits allocated to newly hired nurses. Yet, according to Cimiotti et.al (20112), it is more costly for hospitals to not invest money on nursing.
Nurse staffing is perceived as a major issue due to its effect on the safety and quality of patient care (Hinno, Partanen and Vehvilainen-Julkunen, 2011). Inadequate patient care could result in readmission. Readmission and emergency department visits by patients within 30 days of their discharge exhibits avoidable and costly outcomes (Weiss, Yakusheva and Bobay, 2011). The Affordable Care Act (ACA) has developed a financial penalty refusing the Centers for Medicare and Medicaid services for hospital reimbursement due to readmission (Berenson, Paulus and Kalman, 2012). Hospitals are now seeking to reduce patient readmission. The pertinence of this literature review is to unfold the effect of nurse staffing on patient readmission.