Abstract nurse staffing has always been an issue in the hospital setting. Different units with different patient acuities are staffed accordingly usually based on the patient census. While nurses who are in direct contact care with patients feel that a decreased patient load will lead to greater benefit for the patient, others who are usually in managerial positions are not persuaded that such a correlation exists. As of this time, no such research has been done with an intentional change in staffing ratios that has shown actual proof of such connection with nurse staffing and patient outcome.
In the hospital setting, no matter what unit a Registered Nurse (RN) works on, there always exists a nurse to patient ratio. The actual number of patients per nurse depends on the type of unit. Usually, the Intensive Care Unit (ICU) always has the least number of patients per nurse, while the general medical floor is one of the units which has the most number of patients assigned per nurse. The staffing ratio of RNs to patients has always been a great debate between nursing staff with direct patient care and management.
While nurses who have direct patient contact argue that a lower patient load will help lead to increased patient satisfaction and increased positive outcome, some members of management do not see this to be true. In order to tackle this debate properly, there must be a study of whether an actual change in staffing ratios will lead to greater good for the patient. Currently, there has been no research of an intentional change in RN staffing to see the effects on patient outcomes (Shekelle, 2013).
The purpose of this assignment is to compare and contrast the current literature related to advanced nursing practice. And to relate this literature to my practice and the role of the palliative care nurse across clinical settings. In my current role as a pain nurse specialist, I am involved in the care and management of patients with intrathecal (IT) catheters mainly for patients with intractable ...
The reasoning behind this is mainly due to financial restraints.
Nursing staff costs money, and hospitals are not willing to spend resources to for a study that does not guarantee a positive outcome. However, there is still some research on whether nursing staffing ratios actually have an impact on patient outcome. According to Shekelle (2013), it was found that there existed a consistent relationship between higher RN staffing and lower hospital related morbidity. It was found that an increase of RN per shift was related to a 9% reduction in the odds of death in the ICU, a 16% reduction in the surgical setting, and a 6% reduction in the medical setting.
Other findings including lower rates of hospital acquired pneumonia, pulmonary failure, unplanned extubation, failure to rescue, and nosocomial bloodstream infections were related to higher RN staffing which were found by other studies. However, there was no clear relationship to staffing with incidents of falls, pressure ulcers, and urinary tract infections, when these were thought to also be highly sensitive to nursing staffing. This finding was the meta-analysis of 28 other research studies aimed to find a correlation between nurse staffing and patient outcome.
Legislation recently passed in California called for an increase in nurse staffing. However, this law does not require the strict use of RNs. As a result, Licensed Practical Nurses (LPNs) as well as Licensed Vocational Nurses (LVNs) were used to fill the staffing requirements, more than the increase of the RN staff (Harless et al. , 2013).
This increase in staff allowed the RNs additional time in enhanced surveillance to assess and help prevent the deteriorating conditions of the patients. This ultimately led to reduced missed care and decreasing failure to response rates.
This assignment will focus on the holistic assessment and care plan of a patient who was cared for during practice placement. It aims to discuss how the care planning decisions were made and relate these decisions with the relevant literature. The setting was an emergency trauma and orthopaedic ward and the care plan was developed in order to meets the patient’s needs after 1 week admission. The ...
This early detection resulted in increased prompt treatment and decreased patient length of stay. However, not all of the findings were positive. There was no obvious decrease in the number of falls, pressure ulcers, or restraint use following the increased staffing. There was also a finding that there was an increase in postoperative infections and sepsis significantly more in California that other states due to medical care with the increased use of LPN and LVN staff, as compared to RN staff used by other hospitals (Harless et al. , 2013).
A study performed in Thailand tried to show a connection between nurse staffing and burnout. It was found that nurse burnout was directly related to the nurse staffing ratios. For each patient added to the nurse’s load, there was an increase of 1. 02 times in the odds of the nurses to report higher emotional exhaustion (Aiken et al. , 2011).
This was directly related to the nurses reporting a lower perception of patient quality of care. Nurses with favorable work environments were 30% less likely to report a lower patient quality of care score than those with less than ideal environments.
More favorable nurse staffing and work environments led to more favorable nursing outcomes such as reduced burnout and lower turnover rates, which then lead to a better quality of care (Aiken et al. , 2011).
On the other end of the spectrum, a study performed by surveying management members found that there was no direct correlation between an increased staffing ratios and increased quality of care (Chapman et al. , 2009).
Nurse satisfaction did increase after implementation of the ratios, but was not found to be clearly linked to job retention or quality of patient care.
Budget cuts were made to ancillary staff, which ultimately lead to decreased patient satisfaction. Based on these findings, there are some elements of nurse staffing that could be changed. The use of LPNs or LVNs to increase staffing might look great on paper, but they cannot replace the role of the RN. Limiting the use of LPNs and LVNs can help decrease incidences in patient care. Increasing the number of RNs on staff to decrease patient load can lead to decreased burnout, which can prevent the decline of the nurse’s perception of patient care.
There are many issues associated with the transition from graduate registered nurse into practicing registered nurse. Recent studies have found the phase to be a stressful period for many graduates the main challenges were fitting into social groups, delegation, hostility and patient-centred care (Rush et al, 2013); (Feng & Tsai 2012). However, research has shown that with appropriate ...
For those who believe that the number of RNs used on a shift might not make a great difference in patient care, then the use of higher quality RNs can. Registered Nurses who are certified in their special units are usually more competent than their non-certified counterparts. This can lead to earlier detection of declining patient status and decreased failure to save rates. Hiring of more nurses might not be practical due to financial reasons, but the hiring of certified nurses without increasing the staff count is another alternative that is not necessarily more expensive in the long term.
Based on these mixed results, it is not very clear whether nursing staffing has a direct connection with improved patient outcome. A study of intentionally increasing the staff would be necessary to properly test this research study, but that is the major problem. While staff nurses might feel that it is necessary to deliver higher quality of care, management might not be willing to accept it without researched proof of its benefits.?