Walden Nurs6052)
a concise synthesis and summary of the research process for your chosen topic. Write a 6 page paper that effectively presents these elements.
Course project incorporating 3 assignments including 1)Identifying a researchable problem (PICO question & its significance to nursing practice, summary of topic, 10 keywords,); 2) Literature Review-synthesis of what is revealed on question developed; 3)Translating evidence into practice-Summarized findings from 2 articles, describe one nursing practice supported by evidence in articles, justify with references. Explain how evidence based practice (EBP) contributes to better outcomes, identify potential negative outcomes from failing to use EBP. Strategy for disseminating to implementing the EBP, communicating the importance of practice. How to address concerns & opposition to the change in practice. *In addition, need 1-page summary of project.
Nurse to Patient Ratios and Its Effects on Patient Outcome
With regards to this topic, the PICO question would be, “What are the significance of nurse to patient ratio and which impact does it have on the patient outcome?”. Nurse to patient ratio is an aspect of nursing staffing which is very important in quality provision of health care services to patients. This factor would greatly impact the nurses as well as the patients in a great way. There are a number of theories on ideal staff to patient ratios that tries to give the best ratios which will result to quality health care provision. Staff shortage does not only comprise the provision of health care services to the patient, but also compromises the very work of the nurse. There is always a relationship between nurse workload and patients’ outcome and a number of researches have been conducted with regards to the same. An optimal nurse to patient ratios would improve the quality of nursing service thus enhancing patient outcome. As established by Aiken et al (2002), there is a close relationship between patients’ mortality and low staffing levels and this had great effect on the nurses in terms of job satisfaction and burnout cases.
In summary, an evaluation of nurse to patient rations and the effect it has on the out of the patients is always twofold; the impact on the patient outcome and the impact of nurse. The concern in relationship to the patient is the mortality rate and in relationship to the nurse are nurse hours and associated impacts such as job satisfaction and burnout related cases.
The objective in this paper is to discuss the effect of nurse to patient ratios on the patient out. It would deal with the impact that nurse to patient ratios would have on the nurses as the two are related factors (nurse and patient).
Literature Review
According to the study conducted by Aiken et al (2002) involving nurse to patient rations of 1:4 and 1:8, the patients who were on words with low staffing ratios had a mortality risk of 31 % and nurses under this situations scored high on job satisfaction. It was also established that those nurses who had highest patients’ workload were highly susceptible to work related burnouts. This was more than twice and it was also the same with job satisfaction. This is an aspect that greatly disillusions a number of nurses who get into the nursing profession with a lot of hope strong standards. They find that their ideals are compromised by the existing state of staffing in the hospitals where they practice. Thus, as established by Maben et al (2007), a number of newly qualified nurses have resorted to changing jobs or the profession because of burnout due poor nurse to patient ratios. The compromise standard ideals also results to a compromised standard of patient care. This has led to poor patient outcome (high mortality). To solve this case, then nurse to patient ratios must be improved. This will lower burnout and job dissatisfaction thus making the nurses to stick the standard ideals of patient care.
The factor that needs to be evaluated is whether nurse working hours is the same as the number of hours a nurse takes with the patients. According to Kane et al (2007), working hours are not proportionate to the number of hours that nurses spent with the patients and other duties such as clinical task, and administration activities. According to the studies conducted by Rafferty et al (2006) focusing on the UK hospitals, low nurse to patient ratios of 1:15 were recorded and mortality of 26% and 29% was also noticed in worse staffing cases. The study also suggested that lower nurse to patient rations would lead to a decrease in mortality rates. Despite the fact that other factors such as communication between the staff and physical environment can also lead poor patient outcome as stated by Carayon and Gurses (2007), nurse to patient ratios is the chief factor as it determines the physical environment. Complications such as urinary tract infection; hospital acquired pneumonia and extended stay in ward (Needleman & Buerhaus, (2003) and Kovner & Gergen (1998) can also be a measure of patient outcome that can evaluated with regards to nurse patient ratios. The system nurses work in such as staffing level would influence the quality of care that a nurse provides. This is attributable to the fact that nurses who work in hospitals with understaffing cases would experience fatigue and this would affect the quality of care that a nurse provides in a great way. Poor quality of care provided by the nurse results to poor patients’ outcome which is characterized by high mortality and other complications as stated above.
The aspects of patients’ outcome that would be influenced by nurse to patient ratios are safety outcome and clinical outcome. Safety outcomes are made up of preventable complications in those patients who are at risk and errors in care while clinical outcomes include mortality, maintenance /improvement in the status of function of the patient, duration of stay etc. A fixed nurse to patient rations have resulted to more nurses being committed to their job because of the boost of their self esteem and this can only be translated to better patients outcome when other factors are kept constant. This is because there are other factors that influences patients outcome besides nurse to patient ratios. High nurse to patient ratios have been linked to occupational hazards amongst nurses such as needlestick and back injuries which have been noted to be a precursor for nurse turnover.
Having established that nurse to patient ratios has effect on the patient outcome according to the review of the literature. It is necessary for hospital to consider adjusting their nurse to patient ratios for the purpose of quality care that will reduce some of the negative outcomes such high mortality as documented.
A number of measures can be taken to help in sorting out this situation which include:
- A computerized system that will help to determine the word that require additional staff and reveal the reason of the change in the dependency of the word and also help in mapping out busy periods. This is due to the dynamic of busy periods which are also dependent on the patients in various wards.
- An idea of having a floating staff may also help in a great to make the nurse to patient ratios better. This staff would move from one ward to another and help in the wards that are experiencing busy periods. The task covered by these kinds of staffs should be specific. This should not be used as a replacement of mandatory staffing as the nursing from one patient to another differs greatly (Kovner & Gergen, 1998).
- The recruitment of the staff should be with a view of long term priorities. The aim of recruitment should be to enhance quality of services provided since this is an aspect of the code of ethics of registered nurses (RN).
- Another way of improving nurse to patient ratios is by considering a formula that will help in offsetting the cost of additional staff. This can be done from the savings from the improved patient outcome e.g. reduced inpatient stays.
- Some of the non clinical duties that is possible to be performed by other staffs other than the nursing staff can be identified and this will help in lowering the nurse to patient ratios by a great percentage.
The nursing practice that most of the articles that addresses the issue of nurse to patient ratios address is standard care. This is because standard care, nurse to patient ratios and patient out are closely associated. Low nurse to patient ratios would make it easy for the nurses to adhere to quality standards while high nurse to patient ratios would make it very difficult for nurses to adhere to quality care practices because of the workload. Consequently, the patients’ outcome is compromised.
According to Evidence Based Practice (EBP) which can be defined as “the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients” (Kovner & Gergen, 1998). Nurses have to engage by asking questions with regards to interventions in place and to relate if at all they would give the best outcome for the patient. The evidence can always be used to enhance the quality of care thus a positive patient care. An example of how evidence based practice improves patient outcome is a case presented by Needleman and Buerhaus (2003), which gives the benefits of discontinuing the routine practice that entails listening to the patients’ bowel sounds in the case where the patient have undergone elective abdominal surgery. The new guidelines according to this evidence based practice project showed that clinical parameters like the return of flatus and first postoperative bowel movement were of more help compared to bowel sounds in determining the return of gastrointestinal mobility following abdominal surgery. This helped in sorting the negative outcome. Thus, EBP can be applied in the case of high nurse to patient ratios to come up with ratios which will ensure that is a positive patient outcome. This will help in solving the current situation with regards to nurse to patient ratios. Generally, EBP is important in the provision of high-quality patient care. This is because of its high emphasis on knowledge and research which are the key to better patient outcome.
Failure to embrace EBP would lead to poor patient outcome and also stagnation in the nursing field since most nurses will not be open to new scientific findings in field of nursing. This will narrow and close the many areas that need to be researched on in nursing thus making the field unprogressive. One of the ways by which EBP would be made popular is sensitize individuals in the nursing profession of the importance and the value of research as many people regard research as something which very tedious. Because of the emerging challenges, research would be the only answer to unlock these challenges. Research education will be a very important strategy in responding to the individuals who hold different opinion with regards to EBP. Making research reports and articles available will also come handy in adoption of EBP.
Summary
Other factors notwithstanding, nurse to patient ratios is a factor that has great impact on the patient outcome as illustrated in the literature. Consequently, it needs to be given focus if the quality care is to be achieved. The negative outcome related cases such high mortality rates can be reduced by lowering nurse to patient ratios. Adoption of evidence based practice would also be vital in realizing positive patient outcome besides other recommendations such having floating staffs which help in lowering nurse to patient ratios.
References
Aiken, L. et al. (2002). Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. Journal of American Medical Association 288(16), 1987-1993.
Carayon, P., & Gurses, A. (2007). Performance obstacles of intensive care nurses. Nursing Research 56(3), 185-194.
Kane, R. L. et al. (2007). Nursing Staffing and Quality of Patient Care. Evidence Report/Technology Assessment. No. 151. Rockville, MD: Agency for Healthcare Researchand Quality.
Kovner, C., & Gergen, P. (1998). Nurse staffing levels and adverse events following surgery in US hospitals. Image: Journal of Nursing Scholarship 30(4), 315-321.
Needleman, J., & Buerhaus, P. (2003). Nurse staffing and patient safety: current knowledge and implications for action. International Journal for Quality in Health Care 15: 275-277.
Maben, J. et al. (2007). The sustainability of ideals, values and the nursing mandate: evidence from a longitudinal qualitative study. Nursing Inquiry 14(2), 99-113.
Rafferty, A. M. (2006). Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. International Journal of Nursing Studies; doi:10.1016/jijnurstu.2006.08.003.