...Examining experiences of WA nurses workload under the NHPPD staffing model. One of onus for practising nurses as highlighted by the ANMC code of ethics (2008) is that “Nurses value quality nursing care for all people”. This becomes significantly harder as several complexity or factors within the health system impedes on nurses ability to efficiently fulfil this role. One of such issues is safe and effective workload or the optimal nurse to patient ratio for providing quality nursing care. As Twigg et al. (2011) noted the implementation of nursing hours per patient day (NHPPD) staffing model in 2002, a landmark event for western Australian public hospitals was a result of nurses taking a stand to combat the unreasonable workload that was being undertaken. With evidence showing, mandated nursing staff levels having a significant impact on health outcomes, implementation of various staffing models to foster quality nursing care and improved patient outcomes in the health care setting has been widely utilised globally (Twigg et al. 2011). With prominent research done by Aiken and colleagues in the US, and with several other studies carried out internationally the gains achieved for patient outcomes through appropriate nursing staffing levels has been thoroughly highlighted. Aiken et al (2002) demonstrates the significant impact low staffing levels has on patient’s mortality rate. The study noted that wards that had the worst staffing ratios saw a 31% increase in death rates. Increases...
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...PROVIDING QUALITY CARE Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units Sung-Hyun Cho, Kyung Ja June, Yun Mi Kim, Yong Ae Cho, Cheong Suk Yoo, Sung-Cheol Yun and Young Hee Sung Aim. To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes. Background. Nurse staffing has been reported to influence patient and nurse outcomes. Design. A cross-sectional study with a survey conducted August–October 2007. Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes. Results. The average patient-to-nurse ratio was 2Æ8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3Æ26; 95% confidence interval, 1Æ14–9Æ31) or 2Æ0–2Æ5 patients (odds ratio, 2Æ44; 95% confidence interval, 1Æ32–4Æ52), compared...
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...Jean Watson's Caring Theory to the Nurse Staffing Ratio in Practice Chamberlain College of Nursing NUR501: Theoretical Basis Advance Nursing December 05, 2015 Introduction Nursing theory impacts the practice of nursing in many different ways that can have a great influence. Theory provides a structure to support and shape nursing practice, encourage quality of patient care, and can be utilized in practice situations to give solutions to problems in nursing practice. Utilizing theories to solve nursing obstacles can be used in educational settings, research environment, direct patient care, informatics, as well as in administration and management of nursing care services. The advantages of applying theory to resolve a challenge in nursing practice can be demonstrated by applying Jean Watson’s theory of human caring. Jean Watson’s theory of human caring is a grand theory that provides to the empirical stand point of nursing. It emphasizes on genuine caring about the human being as whole; meaning caring about the human’s mind, body and spirit in order for the healing process to sustain at highest level. Her theory is portrayed as a model of caring which art and science are both included; presenting a framework that involves and divides art, science, humanities, spirituality, mind-body-spirit in medicine, and nursing (Watson, 2000). Nursing practice today is impacted by Watson’s caring theory. It does not only enable nurses to improve care for patients as...
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...Nurse to Patient Ratio 1 Safe Nurse to Patient Staffing Ratios A Qualitative Summary Introduction to Nursing Research Grand Canyon University Nurse to Patient Ratio 2 Abstract The healthcare industry stands in the face of many changes, one of which is the forecasted shortages of registered nurses in acute care settings. Unless action is taken and resolutions are not put in place evidence shows that this problem will only worsen in the coming years. Left unaddressed this shortage deprives the acute care patient of quality care, overburdens current staffing and detracts from the facilities overall performance. A further complication to the already strained workforce is the predicted retirement of the “ baby boomer” generation, which is forecast to increase the patient care needs at a rate that cannot be met by the current staffing levels. According to the “United States Registered Nurse report Card” issued by the American Association of Colleges of Nursing (2012) this shortage is predicted to spread across the United States through 2030. Nurse to Patient Ratio 3 Summary A quantitative approach to understanding this problem is the most appropriate choice to gather information such as low morale, increasing workload, high attrition levels and difficulty hiring replacement staff. The previously mentioned problems need to be understood...
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...organizing factors of inpatient psychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and verbal abuse directed toward nurses. Methods: This cross-sectional study used data from a 1999 nurse survey linked with hospital data. Nurse surveys from 353 psychiatric registered nurses working in 67 Pennsylvania general hospitals provided information on nurse characteristics, organizational factors, and the occurrence of adverse events. Linear regression models and robust clustering methods at the hospital level were used to study the relationship of organizational factors of psychiatric care environments and adverse event outcomes. Results: Verbal abuse toward registered nurses (79%), complaints (61%), patient falls with injuries (44%), and work-related injuries (39%) were frequent occurrences. Better management skill was associated with fewer patient falls and fewer work-related injuries to staff. In addition, fewer occurrences of staff injuries were associated with better nurse-physician relationship and lower patient-to-nurse staffing ratios. Conclusions: Adverse events are frequent for inpatient psychiatric care in general hospitals, and organizational factors of care environments are associated with adverse event...
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...continually on the mend. Healthcare is ever changing and can always be improved. One way that healthcare can be improved is by ensuring that all health care facilities are properly staffed. Meaning that the patient to nurse ratio is adequate to meet patient needs while ensuring safety as well. The understaffing of hospitals and other healthcare facilities can greatly reduce the quality of care provided to patients in many ways. Understaffing leads to medical errors that can negatively affect patient outcomes and in more serious cases it could even lead to death. Understaffing affects healthcare providers and their ability to do their jobs properly, therefore risking patients overall safety. Understaffing is a serious issues that needs to be addressed to ensure that healthcare is being provided at the highest quality possible. In healthcare facilities such as hospitals, how does understaffing of nurses compared to properly staffing of nurses affect patient care during their stay? There is a growing body of research that validates the link between nurse staffing levels and patient outcomes. The study entitled Nurse Staffing and Inpatient Hospital Mortality by Needleman, Buerhaus, Pankratz, Leibson, Stevens, and Harris (2011), examines...
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...Can Adequate Nurse Staffing Improve Patient Outcomes? Nursing is more than caring for the sick and injured. It is a twenty-four hour inpatient monitoring system. It is well known that nurses spend significantly more time caring for and looking after patients than any other profession. They routinely monitor and report changing patient conditions around the clock that aid physicians in modifying and updating treatment plans to improve health and prevent complications. The level of safety of hospitalized patients and the degree of quality care that they receive has more to do than fixed nurse-to-patient ratios. It has been well established in the literature that when nursing workload increase to unmanageable levels; weather it be from the addition of patients, increases in acuity and/or care complexity, or from high levels of fluctuation in patient turnover, that nurses ability to perform patient surveillance is disordered, putting patients in undue risk (Needleman, et. al, 2011). Furthermore, excessive workloads contribute to burnout and dissatisfaction leading to nurse attrition that further compounds to the staffing problem. Hospitals need to be held accountable for providing safer nurse staffing levels. Payers and purchasers of care should demand compliance, but should also stimulate better quality and patient safety by providing financial incentives. In addition, a more comprehensive, proactive team approach to nurse staffing can help keep patients safer...
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...Safe Staffing Examine Nurse-to-Patient Ratios Primary health care organizations such as New York Presbyterian (NYP) are impacted by low nurse-to-patient ratios. The recent implementation of the Patient Protection and Affordable Care Act (ACA) has required organizations such as NYP to explore many approaches to improve quality and patient outcomes that contain costs. “Numerous studies reveal an association between higher levels of experienced RN staffing and lower rates of adverse patient outcomes” (www.nursingworld.org, 2015, para. 1). For this reason, nurse-to-patient ratios is an issue that needs to be addressed at NYP in order to improve quality healthcare within their organization. The acuity of the unit in which patient care is being provided, should determine the acceptable nurse-to-patient ratio. According to the American Nurses Association (ANA), factors that influence the nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; availability of or proximity to technological support or other resources ("Optimal Nurse Staffing," 2015). Currently, New York is one of only fourteen states that addresses the nurse staffing issue in hospitals. New York State requires organizations such as NYP to disclose their nurse-to-patient staffing ratios to the public; however the state does not require a minimum...
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...Nurse Staffing Plans & Ratios Background Identifying and maintaining the appropriate number and mix of nursing staff is critical to the delivery of quality patient care. Numerous studies reveal an association between higher levels of experienced RN staffing land lower rates of adverse patient outcomes. 42 Code of Federal Regulations (42CFR 482.23(b) requires hospitals certified to participate in Medicare to "have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed". With such nebulous language and the continued failure of Congress to enact a quality nursing care staffing act to date, it is left to the states to ensure that staffing is appropriate to meet patients' needs safely. Massive reductions in nursing budgets have resulted in fewer nurses working longer hours, while caring for sicker patients. In a survey of almost 220,000 RNs from 13,000 nursing units in over 550 hospitals and a response rate of 70%, nurses reported to ANA that: 54% of nurses in adult medical units and emergency rooms do not have sufficient time with patients; overtime has increased during the past year with 43% of all RNs working extra hours because the unit is short staffed or busy; and that inadequate staffing affected unit admissions, transfers and discharges more than 20% of the time. • The benefits of increased RN staffing have been demonstrated. Each additional patient care RN employed...
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... American Nursing Association Registered nurses join professional nursing organizations for many reasons. For example, some join to learn what's going on and stay current in their field or specialty. Others want to network or enjoy the peer recognition that comes from being an active member of a major organization. These are just a few of the benefits of being a part of a professional organization. Nurses may join a general organization, such as the American Nurses Association to stay current on the latest technology and advancement of nurses. “The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public” (ANA, America Nursing Association, 2011). In addition the ANA helps establish regulations for appropriate staffing and mandatory overtime are some of the aims and activities of the ANA. Mandatory Overtime An article within Health Affair magazine states, “Research indicates that risks of making an error are significantly increased when work shifts are longer than 12 hours, when nurses worked overtime, or when they worked more than 40 hours per week” (Rogers, 2004). Mandatory overtime is one of the many workplace issues that may be contributing to nurses leaving the workforce. The American Nurses Association has taken the position “that regardless...
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...staff turnover a problem in the nursing profession? First and foremost, this is not a unifactoral issue. In fact, staff turnover is the byproduct of multiple job related factors and stressors in the nursing profession. For instance, job-related stress plays a major factor in decreasing one’s job satisfaction. Stress in nursing usually occurs when one perceives that his or her resources are exceeded in a given situation (Esther, et al., 2005). Typical factors that can promote stress in a nurse are high job demands and excessive work hours. With these factors, the nurse may continually feel overworked, while also feeling like they are working “all the time.” Other factors that could cause stress are having little control over your work environment or having limited supportive relationships in the workplace. As we all realize, at least some sense of control and peer support are necessary to promote feelings of job satisfaction (2005). Finally, staff turnover itself can cause stress for the nurse, as he or she may feel overwhelmed by the increasing workload, which is promoted by the decreasing amount of available staff. Furthermore, “burnout” will usually occur after a prolonged period of stress causes increasing exhaustion, emotional instability, and career dissatisfaction (2005). It should also be mentioned...
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...Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction Grand Canyon University: NRS-433V 06-04-2016 PROBLEM STATEMENT: The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. Some of these outcomes include very high patient to nurse ratio, fatigue for nurses leading to costly medical mistakes, social environment, nursing staff attrition from the most affected facilities. The study specifically attempts to find a way to understand how nurse staffing levels has an impact on patient outcomes and nurse retention in hospital practice. Purpose d Research Questions: With one of the most critical steps being the determination of the problem that will be studied in the research process. (Nieswiadomy, 2008, p.45). Linda H. Aiken et al states the research question as 1. Determine the association between patient-to-nurse ratio and patient mortality 2. Determine the association between patient-to-nurse ratio and failure-to-rescue (deaths following complications) among surgical patients 3. Determine the association between patient-to-nurse ratio and nurse retention/attrition. 4. Determine the association between patient-to-nurse and the facts that contributed to the stress that lead to nurse burnout ...
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...non-licensed personnel is by professional nurses, staffing requirements are based on acuity levels and optimum staffing models, and nursing leadership and management as areas I would address as a nurse manager. As a registered nurse you are responsible for the supervision of unlicensed direct care staff in the performance of nursing tasks and activities. It is the responsibility of the nurse manager and the company to ensure that all staff is adequately trained regarding the elements of supervision and delegation of duties. As a nurse manager address the following will help improve quality of care for patients. The initial training of the task or activity, and periodic inspection of the actual act of accomplishing the task or activity are important for proper patient care. The amount and type of nursing supervision required will be determined by the registered nurse responsible for supervising the task or activity, and will depend upon the complexity of the task, the skill, experience and training of the staff, and the health conditions and health status of the patient (Potter & Kuhrik, 2010). The purpose of delegation is to gain work efficiency, which can only be achieved when registered nurses and patient care technicians work together in partnership to manage the changing priorities of care within a patient care assignment (Potter & Kuhrik, 2010). Delegation is not only key for the registered nurse it is key for the nurse manager. Delegation is the link that joins...
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...Research and Educational Trust DOI: 10.1111/j.1475-6773.2011.01274.x RESEARCH ARTICLE Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes John R. Bowblis Objective. To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design. Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care...
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...Material Appendix A: Matrix of Theoretical Models |Theoretical Model |Description of Theoretical Model |Type of health care change situation where | | | |model best applies | | Expectancy Theory |For any given situation, the force that |Clinical Ladder Program | | |drives a person to perform is dependent |Valence - wanting to participate in a | | |upon three factors: valence, |clinical ladder program | | |instrumentality, and expectancy |Instrumentality – participation in the | | | |program will lead to recognition of the | | | |bedside nurse | | | |Expectancy – a bonus upon success | | | |completion of the program | |Equity Theory |A model is based on a person evaluating |Preceptor...
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