Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

In both the United Stated and globally, patient safety and quality of care have been among the biggest concerns in healthcare. Several factors are associated with negative patient outcomes: heavy workloads and high job dissatisfaction. Unsatisfactory work environments result in nurse exhaustion and poor work quality, thus, putting patient care and safety at risk. To reduce these adverse effects on patient outcomes, reductions in nurse workload became obligatory in California when legislators approved Bill No. 394 (Tevington, 2011). The objective of this law is to increase nurse retention and reduce overworking by increasing nursing personnel. Unfortunately, this increase in nurse staffing will undoubtedly increase labor cost for hospitals and may in turn lead to a greater shortage of nurses due to a lack of resources. Research has yet to determine whether this type of regulation has any positive impact on patient safety and outcomes.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

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Background and Significance

In an attempt to address patient safety and quality care, California passed a law regulating nurse to patient ratios but studies have yet to find evidence that the mandate improves patient safety and care. Studies did not find a significant positive relationship between lower nurse staffing levels and better patient outcomes, such as a lower Failure to Rescue (FTR) rate. In a study conducted by Cook, et al. (2012) patient care did not improve after implementation of the law. Studies analyzed nurse to patient ratios by comparing statistics before and after the implementation of the California law. Hospitals with reduced nurse to patient ratios as per the mandate did not exhibit any substantial change in patient outcomes. Likewise a study by Bolton et al, (2007) found an increase in direct patient care by RN, but no improvement in patient safety indicators such as fall rate, FTR, or reduced hospital acquired ulcers, was reported.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

In response to California law, Pennsylvania also tried to reduce nurse to patient ratios. A study by Aiken et al. (2002) identified a significant relationship between mortality, failure-to-rescue and nurse staffing. The increase of one extra patient per nurse assignment was linked to a 7% increase in mortality rates, and an increase in FTR. The increases of patients from 4 to 6 and 4 to 8 per nurse would increase mortality rates of 14% and 31%. A study by Weichenthal and Hendey (2011) found that the percentage of patients left without being seen by a provider improved 0.7% after nurse to patient ratios were reduced. However, others indicators such as medication errors and administering aspirin in acute MI patient remained unchanged. Data from a study by Duffield et al. (2011) also noted that a higher number of nurses are linked with lower patient adverse outcomes such as decreased rate of pressure ulcer, pneumonia, and sepsis.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

In relation to nurse workload with patient outcomes, the studies conducted by Aiken et al. (2002), and Rafferty et al. (2007) found a strong relationship between decreasing nurse workload, balancing work environment and improvement in patient mortality rate. In a study of a Belgian acute care hospital by Myny et al. (2011) identified 26 factors that impact nurse workload. Among those factors work interruptions and high patient turnover rate were the highest factors associated with nurse workload. Another study designed to address the nurse workload and improve patient outcomes by Twigg et al. (2011) discovered patient outcomes improved after implementation of the NHPPD staffing method which served to reduce nurse workloads. In study overall, mortality rates decreased by 25—26% and post-surgical complications were reduced. A study by Cho and Yun (2009) concerning acute stroke patients admitted to ICUs throughout the Korean healthcare system found that the hospitals with high nurse to patient ratio had high mortality rate among stroke patients than units with better staffing. In unit with better staffing, nurses were able to provide basic care to their patient and did not use help from family member. On the other hand a study by Van den Heede et al. (2009) did not find any major correlation between the acuity-adjusted NHPPD, patient outcomes, and RNs with bachelor degrees. Although on patient adverse event the FTR was 6.16% the highest rate noted. Thus evidence of the effect of nurse staffing levels on patient outcomes are inconsistent. An article by Lyneham, Cloughessy, & Martin (2008) found the increased workload related to inadequate staffing in an emergency department of Australia impacted patient safety.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Overall, the literature indicated a strong relationship between nurses staffing levels patient sensitive outcomes. Most studies found high nurse workload impaired patient safety, and increased burnout, and decreased job performance. But whether or not a legal mandate can improve patient outcomes, improve staffing, reduce workload remains unknown.

Identification of Knowledge Gap

After reviewing studies conducted in the U.S. and internationally, it is clear that studies have not produced an answer to staffing problems, nor identified a strong direct relationship between reduced nurse-to-patient ratios and patient outcomes. “Not only do the data fail to conclude that minimum standards would be beneficial, they fail to conclude that such standards would not be detrimental.” (Spetz et al., 2000, p. 57). Still, there are 17 other states considering similar legislation, despite a lack of evidence of successful nurse-to-patient regulation (Tevington, 2011). Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper  Closing the gap between nursing shortages, rising costs, and improving quality care have yet to be addressed in context with nursing environments and time management skills. Thus, it is necessary to continue to investigate the effectiveness (or lack thereof) of California’s nurse-to-patient law before other states enact this type of policy. In conclusion, it is imperative that research based evidence be produced to see if mandated nurse staffing ratios do actually improve patient safety and whether or not money may actually be saved.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Proposed Solution

It is important to further investigate the mandated nurse to patient laws before being adopted by other states. These future studies should allow California and other states considering nurse-to-patient ratios to quantify the impact that mandated laws actually have on patient safety. All twelve articles investigate pros and cons of mandatory nurse-to-patient ratios and discussed several factors associated with patient outcomes. The California law was enacted on January 1, 2004, almost eight years ago. Since then, healthcare has experienced several changes such as like increased cost, increased nursing shortage, and increased labor cost. These adverse effects, combined with the California mandate may potentially cause hospital closures. Therefore a study of California should be conducted determine whether the mandate has had a positive or negative impact on healthcare within the last eight years. This information may be used by the State of California to determine if the current law should be sustained or divested. This would allow California and other states considering nurse patient ratio mandates to recognize the impact the ratio has on patient safety, hospital closures, and increased cost. It will also provide other states with the knowledge to make the most effective and beneficial decision regarding nurse-to-patient mandated laws.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Purpose statement

The purpose of the study is to examine the association between nurse to patient ratios in the state of California, on three nursing-sensitive outcomes: failure to rescue (surgical inpatients who experience a hospital-acquired complication such as pneumonia, pulmonary embolism, deep vein thrombus, acute renal failure, or gastrointestinal bleeding, and death), pressure ulcers (developed during hospital stay from stage I- stage IV), patient length of stay and any hospital closures due to increased labor cost.

Nurse shortage is defined in relation to existing levels of demands that are not met either in the present or in the past and also in the comparison of existing nurses and those still in the institutions of learning. This deficit of nurse services has been observed among many healthcare facilities in the United States where there are instances of ageing nurse who do not get replaced being replaced. Notably, most retirements of the aged nurses are not being replaced by an equivalent number of new nurses. Buchan and Aiken (2008) lament that the shortage is not quantifiable, but it is much characterized by few nurses who are to fill up an enormous gap of vacant position in the healthcare center. Major consideration of this shortage is not in the terms of the unemployed nurses working in private clinic center but majorly on the Registered Nurses (RNs) who are less in number in government healthcare facilities (Bureau of Health Professions, 2004).Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Discussion

There is no positive benefit of nurse shortage to any country or the medical field worldwide. Shortages of nurses adversely affect the patients’ health where they lack adequate care for quick recovery. On the financial outlook this shortage affects the hospital by the high mortality rate translated by loss of the funds invested to the sick person in the hope of recovery. Death is also loss to the country labor and skill resources. Death is a loss by itself where with adequate staff; a hospital could be able to give quality and timely healthcare to each patient.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

In a study by University of Pennsylvania School of Nursing Aiken observes the high mortality rates that can result from the inadequacy of nurse services within the hospital operation. There is the idea that if the nurses in a healthcare facility are few, then the present ones are overworked. The effect is spread to other staff like the physicians where for example when in an operation with few nurses they may have a lot to do which can result to errors. The American Medical Association (2002) notes the resultant effect of shortage observing that few nurses in a big healthcare facility are overworked which results to burning out or losing their morale in carrying out their duties of care. High levels of this overworking result into frustration making many of the nurses quit working. This makes the situation more pathetic: a hopeless situation where the facility needs nurses but the available ones are quitting. From these facts it is clear that a hospital needs adequate nurses to have them for long and be able to give quality care has not been achieved satisfactorily yet.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Recent projections have shown that the shortage is on an upward trend. Nurses being given out to the market from the schools of nursing are not adequate to feed the market demands. The same has been observed on the enrollment trends. There are people willing to be nurses but the schools are few or have few positions judged by the size of the institutions. As said earlier, hospitals are affected by the retirements that are not being replaced by an equivalent number from the market. The new jobs created out of the retirement and from those who quit the service have not been replaced.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Quality of care is majorly affected by this shortage. Patent health is affected negatively by poor health care which is possible due to lack of nurses or in the situation of an overworked nurse. A tired person can never be efficient in giving care. Hospitals as recommended by the Institute of Medicine (2011) report should work as a team. Nursing will be effective when done within a tem. Where the team is lacking some members as in this shortage, it may not function effectively. Hospital managements have grown used to the shortage. A number of them do not associate patient safety with conditions surrounding their staff especially the nurses. They seem to have given up from the high turnovers they have not been able to control.

The Journal of Medical Association relates the shortage in a ratio to the mortality rates. The number of nurses is directly proportional to the patient deaths. With high number of nurses there is complete or good monitoring of patient progress and vice versa to few numbers. When there is a close watch the patient health’s is monitored having immediate actions taken in case of adverse changes which cannot be possible with few nurses. In addition, nurses who have worked adequate hours without being overworked have been observed to be hospitable to patients giving them quality care.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Delays in giving care are common in this situation. With the shortage, sick persons are not admitted into the hospital as quick as the urgency demands. There is much queuing and waiting for many patients before they are received and taken care of. It is a sad thing when a patient dies within the hospital environs where just a single injection could have saved their life. An example can be that of Asthmatic patients or pneumonia that needs quick care in case has a blockage of bronchioles. With enough nurses such patients can be received fast and taken care of.

Overworking can be defined as a poor working condition as the nurse has to cope with endless chores even without motivation. In this scenario, the nurses have to move from activity to another without any rest or plan as they want to accomplish much. This can result to severe errors. The Institute of Medicine report, To Err is Human (2009) notes that errors are attributed to a number of patient deaths in the medical field where it says that most of these errors can be avoided. The issue is worse as even the nurse’s safety is compromised when overworked as they may lose concentration. When handling patient with infectious diseases a nurse can be infected. When tired, a nurse may not be keen to observe all the rules of the safety where a single error can cost even their life.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Having come to this end, question can be, why this shortage? There are several reasons why the shortage is innevitable. Some reasons have been mentioned like the lack adequate facilities to train enough nursing staff to meet the current demands. On the same, due to the shortage the nursing field has been observed to be stressful by most people. This has also resulted to people shying away from this field. The conditions of a working nurse are poor well observable to be a culture. This can be reasoned out to be the cause of the poor enrollment levels to the people who believe they have a duty to care for sick as part of their lives. In addition, one may want to look at the rewards given to the nurses. It has been observed that payment for nurses is still low compared to the work they do. Performance payments are not well implemented in the nursing field. The Registered Nurses are still poorly paid compared to the other field. This results to low motivation, dissatisfaction, and even quitting.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

The Medial field is a human oriented field. While being overworked, a nurse may not have time for their family. Being in a position not to care for those whom you love is reflected in not being happy to take care of others and in this case the sick patient. This is another effect of the shortage. With enough nurses, shifts and leaves could be possible and adequate to refill the lost energy

Recommendations

In the very first step to improve patient healthcare, there is need to train more nurses to reduce the shortage. The American government ought to consider building more training facilities, funding the existing ones and subsidizing the cost of training so that students can afford to train in these institutions. There is also need to change the present culture where the society through families and schools should positively reinforce their children to embrace the nursing career.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Healthcare facilities ought to improve the conditions of a working nurse. Measures to motivate the nurses should be addressed. Payments should be sufficient where schemes of payment should also relate to the performance and sometimes workloads. The hospital should endeavor to have enough nurses so that leaves and shifts can be there and if possible leaves should be mandatory to ensure that the nurses do not suffer burnout in their work.

Though the Federal government has scholarships programs for the nurses they are not funded appropriately. Enough funds should be given to ensure that adequate number of nurses are trained having the schools not strain in giving the education. The government should also consider having further programs that allow advancement of the nurse education as a motivation even without having to repay the loan fully in order to be allowed to advance. This would ensure adequate numbers of nurses are trained resulting to good numbers for the hospitals.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

There is the need for hospital management to understand the correlation between the number of nurses, patient safety and mortality rates. Physicians should understand that poor healthcare can result from the overworked condition of a nurse. They should pressurize the hospital management to get more nurses where a shortage occurs knowing that they work as a team with the nurses.

Organizations and institutions in healthcare ought to train nurses on their safety and the prevailing working conditions. Several nurses may not be aware of the resultant effect of them being overworked. A few may accuse the hospital management of deliberately failing to employ other nurses in a plan to oppress them, which can result to anger and bitterness towards the management and in high levels for lack of co-operation. Seminars and workshops should address these issues. Motivation and team building should also be an important part of such events. This will prepare the nurses when in the field to enabling them to cope with any emerging issue related to the shortage.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

Registered Nurses have been featured in this report. There are other nurses outside the government employment. Maybe their situation is worse being that they are not in the limelight. The government should enact laws like minimum wage requirements to protect these unregistered nurses from exploitation. Their working conditions ought to be checked out where penalties should be imposed to private clinics that lack the standards of safety as regards the working environment. Reports ought to be mandatory for all nurses expressing their situations and the errors they make while in practice

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Teamwork would solve a multitude of problems as far as the shortage is concerned. It has seemed in the whole discussion that nurses suffer alone while doing their practice and the patient on the other side gets the outcome of the suffering: The poor quality of the service given. It is evident that management and physician do not appear to be part of the shortage. The hospital may find it costly to employ nurses with attractive payment schemes and remuneration, but it is even more costly when a life is lost to the nation due to poor quality care.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

The cost saved for not employing expensive nurses is also transferred to cost incurred in trying to save a patient who dies in the hands of the overworked nurse who cannot figure on time adverse changes on patient’s health to take a step. The country loses its funds invested in the hospital and also in the economic world by the loss of a worker or the important skills a patient dies with when not taken care of (U.S. Government Accounting Office, 2011).

As captured earlier, the shortage may be for long as long as the recommendations are not being implemented. The government will continue to lose economically and the society as a whole due to the high mortality rates. It is important that these measures be implemented to save people’s lives. Paying nurses well and training many seems to be a good solution but working should not be left out for the nurse.

In the article “Addressing staffing shortages in an era of reform,” Stanford point out that in a time when change is necessary because of mandated healthcare requirements, there is a shortage of nurses in the field of direct patient care, because they are offered jobs with better pay to oversee office positions. “Health system leaders recognize that these shortages threaten the quality of care they can provide to patients. As a result, competition for talent is becoming more heated in several parts of the country,” (Stanford, 2013). By nurses taking on jobs in other areas of the field, we are left to find people to replace them and when that happens, it creates a shortage on the front line of patient care.Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper
The literature, “The Unintended Consequences of Staffing Mandates in Florida
Nursing Homes: Impacts on Indirect-Care Staff,” talk about the effect that staff shortage has on the direct care staff like the certified nurse aids, activity staff and others who see and interact with the resident on a daily bases, (Thomas, et all, 2010). By increasing the number of direct or non-licensed staff members, the work of indirect care members like housekeeping and other minor jobs feel onto the burden of the direct care staff. This created a problem as they tried to complete all task as assigned to them. Once again staffing was blamed for any problems, although this time they included the staff that was not directly involved in the care of the residents. Have less indirect care staff meant that everyone had to pick up extra job duties and the indirect care staff was left to hold the bag with less than standard quality of care.
Interventions

Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project? Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

A short but great article to help explain clinical versus statistical significance. Share your thoughts

https://www.students4bestevidence.net/statistical-significance-vs-clinical-significance/ Topic- The Effects Of Inadequate Nurse Staffing On Patient Care Essay Paper

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