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The effects of nurse staffing
The effects of nurse staffing
The effects of nurse staffing
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Abstract
This research proposal will analyze safe nurse staffing levels and the effect that safe nurse staffing levels have on patient satisfaction through HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores. The proposal will include six months of data from a 30-bed medical-surgical floor and a three-bed intensive care unit of a rural Upstate New York critical access community hospital, to include weekly staffing numbers and corresponding weekly HCAHPS scores. Registered nurse, (RN), staffing levels will correspond with the Nursing Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. The study will utilize SPSS, (Statistical Package for the Social Sciences), to collect and compare the data.
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This proposal will prove that safe nurse staffing ratios translate into higher patient satisfaction scores on HCAHPS surveys in the hospital setting. There is a correlation between safe nurse staffing and increased patient satisfaction. This research proposal will examine specifically that when there is safe nurse staffing ratio, patient satisfaction in the form of HCAHPS scores, will improve.
Background
It seems every hospital is concerned about patient satisfaction scores and how their facility rates. In this research proposal, the author analyze safe nurse staffing levels and the effect that this has on patient satisfaction, specifically, HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores. The author will analyze weekly staffing ratios and compare those statistics to the HCAHPS scores that correspond to those weeks.
Review of the literature
The author searched in MILO using the terms, patient satisfaction and the effects on safe staffing ratios, patient satisfaction scores and effects on nurse staffing, patient satisfaction and safe nurse staffing. The author did enlist the assistance of Amanda Calabrese, the Online Instruction and Electronic Resources Librarian of the Mildred & Louis Resnick Library at SUNY Delhi, and she searched in CINAHL, MILO, and Google Scholar, putting quotation marks around “patient satisfaction” and “nurse
Safety competency is essential for high-quality care in the medical field. Nurses play an important role in setting the bar for quality healthcare services through patient safety mediation and strategies. The QSEN definition of safety is that it “minimizes risk of harm to patients and providers through both system effectiveness and individual performance.” This papers primary purpose is to review and better understand the importance of safety knowledge, skills, and attitude within nursing education, nursing practice, and nursing research. It will provide essential information that links health care quality to overall patient safety.
According to an article in Health Services Research, safety is one of the main reasons that HCAHPS/Press Ganey surveys patients after their hospital stays (Isaac, Zaslavsky, Cleary & Landon, 2010). This positive aspect brought about by HCAHPS/Press Ganey surveys is the re-focus of patient safety, something that should be a top priority and nursing responsibility of all patient care. A direct example of this focus is that if a patient experiences a serious safety event or is harmed by a medical error, his or her overall experience will be negatively impacted. (Isaac et.al., 2010). Cohen (2015) predicts that if the focus of healthcare shifts to the delivery of safe, compassionate, high-quality care, the patient experience and satisfaction with their overall care is likely to rise. There is also evidence that increased patient satisfaction is important for improving patient adherence. How patients perceive the receptiveness of the unit’s hospital staff likely reflects the hospital 's safety culture thus promoting adherence to treatment guidelines (Isaac, Zaslavsky, Cleary & Landon, 2010). Patients are more likely to continue suggested healthy habits and be compliant with their medication if they are satisfied with their healthcare practitioners. Spence & Fida (2015) correlated in their article the relationship between a nurse 's job satisfaction, job retention, and perceived
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).
The reason for the controversy of the Hospital Consumer Assessment of Healthcare Providers & Systems, referred to as HCAHPS (pronounced “H-caps”), is the tie that the Center for Medicare and Medicaid Services (CMS) placed between the scores of the assessment and healthcare reimbursement (Westbrook, Babakus, & Grant, 2014). There are two sides to consider when addressing HCAHPS/Press Ganey surveys as they directly affect hospital reimbursement. Patient satisfaction, quality of care, and how they portray their hospital stay contributes to the reimbursement that hospital receives. The nurse-patient relationship plays a large role in influencing the quality of care than patients feel that they are receiving.
The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to transform large amounts of data into easy to read and understandable tool to be used for reporting as well as to determine areas in need of improvement. By looking at a sample dashboard for an inpatient rehab unit a greater understanding of dashboards and their benefits can be seen. The sample dashboard includes four general areas, including nurse sensitive service line/unit specific indicators, general indicators, patient satisfaction survey indicators and NDNQI data. The overall performance was found to improve over time. There were areas with greater improvement such as length of stay, than others including RN care hours and pressure ulcers. The areas of pressure ulcers and falls did worse the final quarter and can be grouped under the general heading of patient centered nursing care. The area of patient satisfaction saw a steady improvement over the first three quarters only to report the worst numbers the final quarter. A facility then takes the data gathered and uses it to form nursing plan...
The Quality and Safety Education for Nurses (QSEN’s) goal is to prepare future nurses with the knowledge, skills, and attitudes (KSAs) that are needed to continuously improve the quality and safety of the healthcare systems within which they work. QSEN focuses on six main competencies; patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As we have learned in earlier classes these competencies and their KSAs offer a base to help us and other nurses as we continue our education and become RNs. As we will learn in this class these KSAs go hand in hand with health assessment.
In most aspects of life the saying “less is always more” may ring true; however when it comes to providing quality care to patients, less only creates problems which can lead to a decrease in patient’s quality of life as well as nurse’s satisfaction with their jobs. The massive shortage of nurses throughout the United States has gotten attention from some of the most prestigious schools, news media and political leaders. Nurses are being burnt out from their jobs, they are being overworked and overlooked. New nurses are not being properly trained, and old nurses are on their way to retirement. All the while the rate of patient admissions is on the rise. Nurses are reporting lower satisfaction in their job positions and hospital retention rates are at an all-time low, conversely this is affecting all patients’ quality of care. As stated in the article Addressing The Nurse Shortage To Improve The Quality Of Patient Care “According to an Institute of Medicine report, Nurses are the largest group of health care professionals providing direct patient care in hospitals, and the quality of care for hospital patients is strongly linked to the performance of nursing staff”.
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).
O’Daniel, M., & A.H., R. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2637/
How come my nurse doesn't spend more time with me? Why is she/he always rushing to get out of my room? Staffing in nursing is probably one of the biggest issues in health care nowadays. For one, there are just too many patients and not enough nurses, which makes it unsafe for the clients and the licensed professional.
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.
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
The overall goal for the Quality and Safety Education for Nurses (QSEN) plan is to meet the challenge of educating and preparing future nurses to have the knowledge, skills and attitudes that are essential to frequently progress the quality and safety of the healthcare systems in the continuous improvement of safe practice (QSEN, 2014).Safety reduces the possibility of injury to patients and nurses. It is achieved through system efficiency and individual work performance. Organizations determine which technologies have an effective protocol with efficient practices to support quality and safety care. Guidelines are followed to reduce potential risks of harm to nurses or others. Appropriate policies
Mitchell, P. H. (2008). Defining patient safety and quality care an evidence-based handbook for nurses. Rockville,Maryland: Hughes. DOI: //www.ncbi.nlm.nih.gov/books/NBK2681/