Nantsupawat, A., Nantsupawat, R., Kulnaviktikul, W., & McHugh, M. D. (2015). Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand. Nursing & health sciences, 17(1), 112-118.
The study examines the relationship that exists between the staffing levels of nurses and the subsequent nurse outcomes whereby the study was conducted in various community hospitals in Thailand. According to the author understanding the various factors that influence nurse outcome especially job dissatisfaction as well as emotional exhaustion could enable policy makers as well as hospital administrators in developing strategies to enhance the satisfaction of nurses and minimize emotional exhaustion among the nursing staff and subsequently improve the retention of nurses and the quality of care provided to patients. In the light of this, the study established that nurses working in Thailand usually care for more patients than required or recommended whereby this results to job dissatisfaction as well as increased emotional exhaustion. As such, the article provides valuable findings and information that shows the need to improve the nurse-patient ratios whereby this would help in minimizing nurse burnout, improve the satisfaction of nurses and subsequently enhance retention of nurses as well as the overall patient safety. However, the study mainly relied of self-reports that might be prone to biasness thereby minimizing generalizability of the findings. Thus, the author emphasizes that similar studies should be carried out in different setting and using a different study design in order to come up with generalizable findings.
Schreuders, L. W., Bremner, A. P., Geelhoed, E., & Finn, J. (2015). The relationship between nurse staffing and inpatient complications. Journal of advanced nursing, 71(4), 800-812.
The study focused on investigating the effect of staffing of nurses on patient complications specifically inpatients. As such, the study was conducted in three healthcare organizations in Western Australia. The study utilized an appropriate study design that enabled the investigator to come up with relevant and valuable findings. With regard to this, the study findings indicated that improving the staffing levels of nurses did not have a significant impact with respect to minimizing the complication rates of patients. Thus, the article provides valuable information that helps hospital administrators as well as policy makes in developing innovative methods to minimize patient complications instead of improving the staffing levels of nurses only.
Cho, E., Chin, D. L., Kim, S., & Hong, O. (2015). The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events. Journal of Nursing Scholarship.
The study sought to investigate the effect of staffing levels of nurses on the occurrence of adverse events among hospitalized patients. As such, the study utilized a suitable study design where information was obtained from clinical records in healthcare organizations in South Korea. The study established that an increase in the nurse-patient ratio was associated with a significant increase with regard to the occurrence of adverse events such as increase in wrong medication administration, higher rates of pressure ulcers as well as patient falls resulting to injuries. Thus, the article provides valuable information on the improve staffing of nurses as well as their working environments in order to minimize the occurrence of adverse events as well as enhance the overall outcomes of patients.
Zhu, X. W., You, L. M., Zheng, J., Liu, K., Fang, J. B., Hou, S. X., & Wu, Z. J. (2012). Nurse staffing levels make a difference on patient outcomes: a multisite study in Chinese hospitals. Journal of Nursing Scholarship, 44(3), 266-273.
The article examines the association between staffing of nurses and the subsequent patients outcomes. With regard to this, the study was carried in various economic zones in China whereby this enabled the investigator to come up with valuable and generalizable findings that could be used in improving the outcomes of patients in other clinical settings. As such, the study established that an increase in the number of patients allocated to nurses had a significant impact in regard to the outcomes of patients whereby this usually resulted to poor patient outcomes mainly due to an increase in incidences of missed care. Hence, the article provides relevant and essential evidence that can be used to enhance the outcomes of patients through adequate staffing of nurses. More importantly, the results obtained from the study are similar to those of other studies carried out on the same topic. However, the study mainly relied on patient as well as nurse reports that are largely associated with potential biasness. Thus, future studies should mainly utilize clinical records in order to enhance credibility of the findings.
Chau, J. P., Lo, S. H., Choi, K. C., Chan, E. L., McHugh, M. D., Tong, D. W., & Lee, D. T. (2015). A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals. BMC health services research, 15(1), 1.
The article discusses the relationship between staffing levels of nurses and the subsequent nurse-sensitive outcomes of the patients. In regard to this, the study shall focus on investigating the relationship between the staffing levels of the nurses, education preparation of the nurses, practice environment and the subsequent nurse-sensitive outcomes of the patients. Thus, the study hypothesized that adequate staffing of nurses, favorable working environment and better preparation of nurses preferably at the baccalaureate level is associated with a subsequent improvement of the nurse-sensitive outcomes of patients in the surgical as well as medical unit. Although, the study shall focus on the surgical as well as medical unit, the findings obtained from the study shall help in improving the preparation and staffing of nurses as well as the practice environment in various other specialties.
Harding, T., & Wright, M. (2014). Unequal staffing: a snapshot of nurse staffing in critical care units in New South Wales, Australia. Contemporary nurse, 47(1-2), 7-15.
The article discusses the level of staffing as well as skills mix in various critical care units including the NICU (Neonatal Intensive Care Unit) and the CCU (Coronary Care Units) in Australia. According to the article, there is a huge variation in regard to nurse-patient ratios as well as skills mix in most of the critical care units in the country. Moreover, the study established that level of RN (Registered nurses) vacancies was significantly lower whereby this implied that the country has made significant strides with regard to retention as well as recruitment of nurses. However, the study was carried for a short duration, thus the findings obtained may not be a correct representation of the actual situation. Therefore, further studies should be carried out specifically for a longer duration and in other geographical regions specifically in rural hospitals and metropolitan areas in order to clearly understand the situation and come up with relevant and applicable findings.
Rochefort, C. M., Ward, L., Ritchie, J. A., Girard, N., & Tamblyn, R. M. (2012). Patient and nurse staffing characteristics associated with high sitter use costs. Journal of advanced nursing, 68(8), 1758-1767.
The study focused on investigating the relation that exists between the characteristics of nursing staff, health conditions of the patients and the costs associated with the use of sitters. According to the article, the use of sitters among patients with dangerous behaviors is usually associated in an increase in the medical costs. As such, understanding the factors that increase the utilization of sitters in an appropriate way that could help in minimizing their usage and the overall health costs. With regard to this, the study established that poor staffing of nurses is associated with an increase in the usage of sitters due to poor monitoring of patients whereby the nurses fail to realize when patients do not require sitters. In addition, having patients with psycho-geriatric conditions is another factor that leads to higher usage of sitters. Thus, the study provides valuable information that could be used in minimizing the usage of sitters mainly through improving the staffing levels of nurses as well as lobbying for additional resources that could be used in supporting and caring for patients with psycho-geriatric conditions.
Cho, S. H., Kim, Y. S., Yeon, K. N., You, S. J., & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing care. International nursing review, 62(2), 267-274.
The study sought to investigate the effects of nurse staffing in regard to missed care. In relation to this, the study compared incidences of missed care in units with adequate staffing as compared to those with low staffing. As such, the findings obtained from the study indicated that units that had adequate staffing of nurses had lower incidences of missed or omitted nursing care as compared to those with inadequate staffing. Thus, the article provides valuable and crucial information on the need to improve staffing of nurses in order to minimize incidences of missed nursing care as well as enhance the overall outcomes of patients.
Hughes, R. G., Bobay, K. L., Jolly, N. A., & Suby, C. (2015). Comparison of the nurse staffing based on changes in unit‐level workload associated with patient churn. Journal of nursing management, 23(3), 390-400. 5
The article aims at identifying on whether patient churn has any impact to determine nurse workload in staffing. Midnight census is the commonly used method of staffing, however the article indicates that the number of movements of patients in and out of a healthcare institution in admission and discharge highly impacts nurse workload. The research was based on secondary data from 32 hospitals which was divided in three categories. The three categories that were identified in the study were the intensive care unit, surgery unit and the intermediate unit. This was important in ensuring that all major departments of a healthcare facility were catered for to determine efficient staffing. The research was efficient in ensuring that by incorporating patient churn in the midnight census would improve in staffing and minimizing workload on registered nurses.
West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in intensive care: an observational study. International journal of nursing studies, 51(5), 781-794.
The research was aimed at identifying the relationship between the mortality rates for patients in the intensive care unit and staffing levels. Various investigations had indicated that there was a relationship between staffing levels and the mortality rates of patients in Intensive Care Unit. The study was undertaken by comparing the outcome of care of various patients in ICU in relation with the staffing levels from information retrieved from the Intensive Care National Audit & Research Centre. The outcome of the research indicates that a higher number of nurses and consultants results in higher chances of the patients surviving. However, in patients who were in critical conditions, a higher number of nurses rather than consultants was crucial in ensuring the survival of the patients. One of the most important aspects that was revealed by the study was that nurses had the more impact on critically ill patients.
Nantsupawat, A., Srisuphan, W., Kunaviktikul, W., Wichaikhum, O. A., Aungsuroch, Y., & Aiken, L. H. (2011). Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand. Journal of Nursing Scholarship, 43(4), 426-432.
The study aimed at identifying the relationship between nurse staffing and work environment in regard to the quality of care provided. The researchers analyzed secondary data collected from the 2007 Thai Nurse Survey. The study was important in order to find out whether it was important for nurses to work with policy makers in order to improve their working conditions which would be reflected in improved quality of care. The result of the study found out that 27% of the nurses were not happy with their job while at the same time, 27% stated that nursing care provided was poor. The study also found out that nurses who claimed that they had favorable working conditions were more likely to report improved quality of care. The findings of the study found out that there was a huge relationship between the work environment and quality of care in nursing. In order to improve the quality of care nurses should be able to work with policy makers to ensure quality working environment.
Yu, D., Ma, Y., Sun, Q., Lu, G., & Xu, P. (2015). A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre‐post intervention study.International journal of nursing practice, 21(4), 339-349.
The research carried out, aimed at finding out whether a classification system developed by assessing the workload of nurses was important to determine the optimal staffing levels in a teaching hospital was effective. In the method used to undertake the study, nursing grades were divided into four depending on workload. The new staffing system was then compared to the recommended china’s staffing system on patient satisfaction and quality of care. The results recorded showcased that patient satisfaction levels increased from 96.9% to 97.6%. The study brought into attention the importance of nurse staffing levels in relation to the workload per person rather than the number of patients. It is important to understand that some patients may require more attention as compared to others. By optimizing staffing levels in relations to patient needs improves the quality of care provided.
van Oostveen, C. J., Mathijssen, E., & Vermeulen, H. (2015). Nurse staffing issues are just the tip of the iceberg: A qualitative study about nurses’ perceptions of nurse staffing. International journal of nursing studies, 52(8), 1300-1309.
Nurse perceptions in regard to staffing levels and methods in Netherland was the issue of consideration in the above study. In response to nurse patient levels, nurses in Netherlands believe that the staffing levels have become too low thus affecting the quality of care. By grouping nurses in a university hospital into four specialties, they were later interviewed. The results of the interview showcased that there were a number of issues affecting nurses. Some of the underlying issues that were seen to be affecting nurses were the lack of autonomy and the lack of a professional model that can help nurses innovate.
Hinno, S., Partanen, P., & Vehviläinen‐Julkunen, K. (2012). Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. Journal of clinical nursing, 21(11‐12), 1584-1593.
The quality of nursing is highly associated with staffing numbers. The study conducted in both the Netherlands and Finland aimed to compare the staffing levels in both countries to come up with some findings. The nurse patient ratio in Netherlands was slightly lower than in Finland. However, in Finland nurses had more administrative duties to undertake thus affecting the quality of care. The findings of the study showcased that changes in a nurses roles adversely affected the quality of care provided.
Carthon, B., Margo, J., Kutney‐Lee, A., Jarrín, O., Sloane, D., & Aiken, L. H. (2012). Nurse staffing and postsurgical outcomes in black adults. Journal of the American Geriatrics Society, 60(6), 1078-1084.
The study aim to identify the mortality rates on surgical patients being attended by nurses working with a higher working load. The results of the study showcased the mortality rates and failure to rescue was high to patients with patients with higher mortality rates. Black older patients were the ones highly affected while being attended by nurses with higher workloads. The study was conducted on patients aged 65 years and over.
Incorporating theory
The NSM (Neumann Systems model) is one of the most appropriate theory that supports the proposed solution (Improving the staffing levels of nurses) in order to minimize adverse events among patients as well as enhance their overall outcomes. The theory emphasizes a holistic approach in patient care whereby this involves alleviating all the stressors that have an impact on patient care (Alligood, 2014). As such, the theory stresses on the need to effectively assess the healthcare environment in order to identify and respond to various stressors as well as other factors that may negatively impact the outcomes of patients. With regard to this, the theory provides an appropriate framework that shall guide healthcare administrators as well as nursing leaders in responding appropriately to improve staffing of nurses in order to enhance the delivery of nursing care and subsequently the outcomes of patients.
References
Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.
Carthon, B., Margo, J., Kutney‐Lee, A., Jarrín, O., Sloane, D., & Aiken, L. H. (2012). Nurse staffing and postsurgical outcomes in black adults. Journal of the American Geriatrics Society, 60(6), 1078-1084.
Chau, J. P., Lo, S. H., Choi, K. C., Chan, E. L., McHugh, M. D., Tong, D. W., & Lee, D. T. (2015). A longitudinal examination of the association between nurse staffing levels, the practice environment and nurse-sensitive patient outcomes in hospitals. BMC health services research, 15(1), 1.
Cho, E., Chin, D. L., Kim, S., & Hong, O. (2015). The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events. Journal of Nursing Scholarship.
Cho, S. H., Kim, Y. S., Yeon, K. N., You, S. J., & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing care. International nursing review, 62(2), 267-274.
Harding, T., & Wright, M. (2014). Unequal staffing: a snapshot of nurse staffing in critical care units in New South Wales, Australia. Contemporary nurse, 47(1-2), 7-15.
Hinno, S., Partanen, P., & Vehviläinen‐Julkunen, K. (2012). Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. Journal of clinical nursing, 21(11‐12), 1584-1593.
Hughes, R. G., Bobay, K. L., Jolly, N. A., & Suby, C. (2015). Comparison of the nurse staffing based on changes in unit‐level workload associated with patient churn. Journal of nursing management, 23(3), 390-400. 5
Nantsupawat, A., Nantsupawat, R., Kulnaviktikul, W., & McHugh, M. D. (2015). Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand. Nursing & health sciences, 17(1), 112-118.
Nantsupawat, A., Srisuphan, W., Kunaviktikul, W., Wichaikhum, O. A., Aungsuroch, Y., & Aiken, L. H. (2011). Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand. Journal of Nursing Scholarship, 43(4), 426-432.
Rochefort, C. M., Ward, L., Ritchie, J. A., Girard, N., & Tamblyn, R. M. (2012). Patient and nurse staffing characteristics associated with high sitter use costs. Journal of advanced nursing, 68(8), 1758-1767.
Schreuders, L. W., Bremner, A. P., Geelhoed, E., & Finn, J. (2015). The relationship between nurse staffing and inpatient complications. Journal of advanced nursing, 71(4), 800-812.
van Oostveen, C. J., Mathijssen, E., & Vermeulen, H. (2015). Nurse staffing issues are just the tip of the iceberg: A qualitative study about nurses’ perceptions of nurse staffing. International journal of nursing studies, 52(8), 1300-1309.
West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in intensive care: an observational study. International journal of nursing studies, 51(5), 781-794.
Yu, D., Ma, Y., Sun, Q., Lu, G., & Xu, P. (2015). A nursing care classification system for assessing workload and determining optimal nurse staffing in a teaching hospital in China: A pre‐post intervention study.International journal of nursing practice, 21(4), 339-349.
Zhu, X. W., You, L. M., Zheng, J., Liu, K., Fang, J. B., Hou, S. X., & Wu, Z. J. (2012). Nurse staffing levels make a difference on patient outcomes: a multisite study in Chinese hospitals. Journal of Nursing Scholarship, 44(3), 266-273.
