VPT Task 2: Data-Driven Decision Making
Assessment Code: VPT
Kyle Cluff
000505604
02/08/2016
Nelda Turner
A-
The real world business situation I presented in the task 1 of this paper is as follows: I addressed a concern that a hospital would have by collecting and analyzing a set of data, specifically that of the hospital staff and the patient safety interaction. This situation which is relevant to a Hospital business that I will continue to answer in this paper by collecting and analyzing a set of data is: Is there a relationship to the number of hours a Registered Nurse (RN) works and patient safety? RNs are the main caregivers to the patient. They continually monitor, provide medication, take vitals, and assess the overall health of each patient in their care. With such a demanding job and many job duties, a deeper look at how they perform under not only stress but fatigue will allow us to see what type of care they are able to provide to their patients. The data we collect will allow us to answer if patients are safe with an RN working prolonged hours.
B-
1
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Data from logbooks were summarized using frequency tables.
The data collected was the duration of scheduled and actual work hours per shift which was calculated and aggregated per nurse and per week. A shift a RN worked was classified as an overtime shift if the actual working hours were longer than the scheduled hours. We also analyzed the associations between errors (or near errors), work hours, and overtime. Regression models were performed to assess if working more than twelve hour shifts would increase the probability of making one or more errors (or near errors) in a week long period.
2 Column1 Column2 Shifts with one or more errors Column3 Column4 Shifts with one or more near errors Column5 Column6 Column7 Work duration (hours) Number of shifts Number Percent OR Number Percent OR Up to 8.5 771 12 1.6 1 20 2.6 1 8.5–12.5 2,484 77 3.1 1.85 (.06) 94 3.8 1.44 (.18) 12.5 or more 2,057 103 5 3.29 (.001) 97 4.7 1.80 (.04) Total 5,312 192 3.5 211 4 3 The gathering methodology I used was to collect the pertinent data was the logbook method. This method was put in place in order to have the RNs log their individual information for the span of the study and respond specifically with what I was asking and what they found as important. It also allowed me to separate each log to that specific individual, which made it possible to have the opportunity to clarify their responses if needed. Another key benefit is it was very low cost and I did not have to pay the individuals for their corporation in this study. A disadvantage to this gathering methodology was not always having consistent and continuous entries. This was difficult to regularly obtain from every RN who enlisted for this study. C 1 I chose to use regression analysis as the tool to analyze the data I collected in which to answer the question “Is there a relationship to the number of hours a Registered Nurse (RN) works and patient safety?” 2 Our analysis showed that the RNs work duration, overtime, and number of hours worked per week had significant effects on their errors. The likelihood of making an error increased with longer work hours and was three times higher when nurses worked shifts lasting of 12.5 hours or more (odds ratio = 3.29, p = .001) 3 I chose to utilize the regression analysis as it was very favorable for studies to predict the value of the dependent variable based on the value of multiple independent variables. This technique will allow for proper forecasting for the new recommended hours a RN can work in order to mitigate putting the patients or themselves at any risk. 4 The main advantage of this technique is that fact it was very conducive to accurately predicting the value of a dependent variable in a study that has multiple independent variables to account for. This was very advantageous for the large variety of data I gathered for this study. The main disadvantage of this technique was that the regression analysis looks at the relationship between the mean of the dependent variable and the independent variables. This is all well and good, but it does not look at the extremes of the dependent variable, which in this case could be very beneficial. D 1 My findings confirm that the specific work schedules of hospital RNs are unpredictably prolonged. This could be due to the shortage of RNs that the healthcare industry is currently seeing. Because of this shortage, RNs are required to work longer shifts, with more overtime then the average hospital employee. This analysis showed that work duration, overtime, and number of hours worked per day had significant effects on errors performed by the RNs. The potential of making an error increased with longer work hours, and was three times higher when RNs worked shifts lasting of 12.5 hours or more. In addition, working overtime increased the odds of making at least one error, regardless of how long the shift was originally scheduled was. These finding brought about a light of information that the hospital can utilize in order to decrease the likelihood of errors. 2 The main limitations of our data analysis was geographical. We utilized a small sample size, which was only applicable to the Ogden, Utah region. Because of this, it is hard to make the statement that all RNs are working longer hours and a higher volume of overtime then should be worked. In addition, this study took place in a hospital. RNs work in multiple industries, for example, urgent cares, hospice, homecare, nursing homes, etc. By not taking data that link the RNs in all of their potential working environments, it limits the ultimate results we can incur on the absolute working relationship RNs have in correlation to their hours and patient safety. 3 Based on the finding of this study, the recommended course of action is as follows: Hospital RNs who work long hours may have a strong correlation to adverse effects on patient care. We found that both errors and near errors are more likely to occur when the RNs work twelve or more hours. Because of this, my recommendation would be to not schedule an RN for more than a twelve hour shift. In addition overtime, especially which associated with twelve hour shifts should be eliminated. RNs should only be eligible for overtime if they have not worked twelve hours, and the total amount of overtime plus their original shift does not equal over the twelve hour threshold. By doing this I believe we will be able to produce a safer work environment for our RNs and their patients, while at the same time increasing the relationship that the hospital has with their RNs, as we are not requiring them to work unreasonable hours any longer. Bibliography G., R. (2007). Using Statisitics: A gentile introduction. Berkshire, England: McGraw-Hill.
Human factors are derived from construction and adapted to a system of development in health care by carefully examining the relationship between people, environment, and technology. The consideration of human factors acknowledges the capability or inability to perform a precise task while executing multiple functions at once. Human factors provide an organized method to prevent errors and create exceptional efficiency. Careful attention must be exercised in all levels of care such as the physical, social, and external environment. It is also vital to carefully consider the type of work completed and the quality of performance. Applying human factors to the structure of healthcare can help reduce risks and improve outcomes for patients. This includes physical, behavioral, and cognitive performance which is important to a successful health care system that can prevent errors. A well-designed health care system can anticipate errors before they occur and not after the mistake has been committed. A culture of safety in nursing demands strong leadership that pays attention to variations in workloads, preventing interruptions at work, promotes communication and courtesy for everyone involved. Implementing a structure of human factors will guide research and provide a better understanding of a nurse’s complicated work environment. Nurses today are face challenges that affect patient safety such as heavy workloads, distractions, multiple tasks, and inadequate staffing. Poor communication and failure to comply with proper protocols can also adversely affect patient safety. Understanding human factors can help nurses prevent errors and improve quality of care. In order to standardize care the crew resource management program was
A considerable amount of literature has been published on the impact of working hours (8 vs. 12 hour shifts) on fatigue among the nurses. These studies revealed that twelve-hour shifts increase the risk of fatigue, reduce the level of alertness and performance, and therefore reduce the safety aspect compared to eight-hour shifts (Mitchell and Williamson, 1997; Dorrian et al., 2006; Dembe et al., 2009; Tasto et al., 1978). Mills et al. (1982) found that the risk of fatigues and performance errors are associated with the 12-hour shifts. Beside this, Jostone et al. (2002) revealed that nurses who are working for long hours are providing hasty performance with increased possibility of errors.
Harrington, J. M. (2001). Health Effects of Shift Work and Extended Hours of Work. OEM Education. Retrieved on December 3, 2013, from http://oem.bmj.com/content/58/1/68.full. doi: 10.1136.oem.58.1.68
This is directly related to my nursing major and current practice as an RN. I have a personal interest in making sure I am practicing in a way that is safe for my patients. What exactly is the problem? The problem, as defined in my argument research paper, is that to cut costs, hospitals have been steadily increasing the number of patients nurses must care for. In many areas, it's not uncommon for one nurse to have to assess, give medications to, and manage the care of as many as 12 patients.
Nurses. They are such a vital part of any hospital and in any medical offices. Their main focus is on the care of individuals, families, and communities so they can recover to perfect health. But with the constant demand, shortage staff and need for nursing, help or hurting them. During my research, I found that some people agree that overworking nurses is okay because the hospital still thrives and that an overworked is just collateral damage. Other think that overworking nurses is wrong and something should be done to change the problem. In this paper, I will discuss effects of nurses being overworked back by research.
...hological preparation. After a nurse is done working their regular shift being forced to work overtime can out them a greater right of medical mistake in part due to fatigue and tiredness consequently putting the patient at high risk of complications.
Witkoski Stimpfel, Amy , Douglas M. Sloane, and Linda H. Aiken. "The Loger the shifts for hosital nurses, the higher the levels of burnout and patient disstisfaction." Health Affairs 31.11 (2012): 2501-2509. Proquest. Web. 11 Mar. 2014.
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
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
An activity report can provide operational statistics such as occupancy rate, average daily census, and average length of stay (Finkler, Jones & Krover, 2013). Though these numbers are important and have a great influence on the operational budget, a nurse leader needs more information in order to justify staffing. Nurse leaders can obtain additional information from workload reports. Patient classification system measure workload by assigning each patient a classification level based on his or her unique care needs and then determine the number of care hours required per patient per day. Many organizations express this in hours per patient day (HPPD) or relative value units (RVU) (Finkler et al., 2013). Workload reports are useful because they can identify changes in patient mix that can increase or decrease the need for nursing personnel. Bi-weekly fulltime equivalent (FTE) reports are also useful because they convey to nurse leaders exactly how many man-hours were used by each FTE (Liberty University, 2015). Furthermore, the report provides a breakdown of productive time; contract hours, paid time off (PTO), and overtime. It also accounts for nonproductive time such as time spent on education, training, and orientation (Liberty University,
Patients Safety is the most crucial about healthcare sector around the world. It is defined as ‘the prevention of patients harm’ (Kohn et al. 2000). Even thou patient safety is shared among organization members, Nurses play a key role, as they are liable for direct and continuous patients care. Nurses should be capable of recognizing the risk of patients and address it to the other multi disciplinary on time.
Notably, having higher proportions of nurses working shorter shifts—8–9 hours or 10–11 hours—resulted in decreases in patient dissatisfaction” (Stimpfel et al.). This is essentially saying that the longer the shift length, the more negative outcomes result. This study proves that eight to nine-hour shifts are more effective, and should, in turn, be worked more than longer shifts. This is a problem because hospitals are likely to continue to schedule nurses for twelve hours shifts out of
Working in a fast-paced environment and being on their feet can really take a toll on a person. In addition they have to be prepared for anything to happen during their shift. A study of overworked and stressed nurses found that nurses are overworked suffered from physical sickness like type two diabetes (Stress and overworked 2006). For most nurses, their work week consists of more than sixty hours. Working that many hours can double their chances of sicknesses. When they compare the working week hours of nurses who worked the normal 21 to 40 hours with those that work more than 40 or 60 hours a week, they found that in comparison the ones who worked 40 hours or more a week increased the risk by almost 50 percent for type 2 diabetes (Stress and overwork 2006). If nurses were to work their normal work hours without mandatory overtime, then their health would improve.
Simpson, R (2005).Patient and nurse safety: How information technology makes a difference. Nursing Administration Quarterly. 29, 97-101.