Strategies For Addressing Nursing Shortage: Overview, Impact And Solutions

Appropriate nurse-patient ratio and its impact on quality of care

Discuss About The Strategies For Addressing Nursing Shortage.

Appropriate nurse-patient ratio is one of the major predictor of quality of care and nursing performance. However, the performance of nurse deteriorates due to staffing issues and lack of appropriate number of nursing available for care of patient. Staffing problems creates working overload and limits the amount of nursing care given to individual. All this contributes to many undesirable patient as well as job related outcomes for nurses (Aiken et al., 2014). The main purpose of this report is to give an overview about the issue, the people affected by the challenges and the significance of the issue. It also offers the scope to find solutions to the issue by framing a research question and proposing a research design.   

One significant challenge in my current work role is the issue of staffing level.  Staffing level issues is related to low number of staffs available for care delivery compared to the number of patient in clinical setting. This issue is a critical challenge for nurses because nurse staffing level has direct impact on the quality and outcome of care. This can be said because low staffing level contributes to higher workload for existing nursing staff and this reduces the level of attention that a nurse can pay to a patient on a single day. Heavy work load causes nurse to become distressed and commit mistakes while delivering (Cho et al., 2016). Evidence has also showed that a hospital which has low staffing level have higher rate of adverse event compared to hospitals which maintain good staff patient ratio (Aiken et al., 2014).

Nurse staffing highly contributes to burnout and such issues leads to many challenges for nurse in their job. Cimiotti et al., (2012) argued that nursing staffing issues and burnout is the reason for high incidence of health care associated infection. The study mentioned that 1.7 million hospitalized patient acquire infections in a year. Nurse staffing ratio and number of nursing hour per patient is regarded as a major cause for the spread of infection. From this perspective, it can be said that staffing issues is linked to suboptimal medical care and patient satisfaction. Since this is  having an impact on patient safety and healthcare outcome, the issue is significant. As nurse staffing and burnout is a cause of adverse events like falls and health care associated infection in hospital, there is a need to take steps to maintain a good staffing ratio. The health care leaders can reduce cost burden significantly by improving nurse staffing level, providing appropriate working environment to nurse and alleviating job related burnout in nurses.

Challenges faced by nurses due to staffing levels

Although there are many inter-professional staffs who work in health care setting, however nurses are the main health care staffs, who are affected by the issue. This is because nurse spends the maximum time with patient and they are directly involved in implementing the care proposed by clinician. Hence, when a nurses is overloaded with work due to poor staff level, the likelihood of negative patient outcome and negative job outcome increases. For instance, nurse reported adverse events such as medication error, fall injury, pressure ulcer increases (Cho et al., 2016).

Due to staffing level issues, nurses are overworked and stressed out. They do not get the ideal environment and time to safely provide care to patient. Therefore, high occurrence of adverse event and burnout also minimizes nurse satisfaction their job. Apart from burnout, other impact of nurse to patient ratio on nurse outcomes includes poor job satisfaction and intent to leave the job. Everhart et al. (2016) showed that a nurse with higher patient load reported more about intention to leave the job or being dissatisfied with their current job.

The significance of the staffing level challenges is understood from the fact that it not only influences quality of care and nursing performance, but also affects the overall profitability of health care organization. This implies that nursing staffing level has direct relationship with patient outcome as well as financial performance of hospital. Therefore, the issue of staffing level should be given top priority to achieve competitive advantage within health care industry.

Evidence has shown that nurse staffing issue is associated with nursing burnout, high turnover and dissatisfaction with the job (Khamisa et al. 2015). All this occurs because nurses do not get work flexibility to manage their workload and other priorities. Hence, health care providers have the highest responsibility for bringing changes in the system of recruitment as well as work environment at the hospital. The possible solution is to provide attractive work schedule and attractive work environment to existing nurses in health care setting (Wright & Bretthauer, 2010). Before proceeding with this initiative, there is a need to find out nurse’s view about work environment and flexibility in work. This would help to develop appropriate protocol to bring changes on work environment in the hospital. Hence, the research question that is of importance to engage in proper planning for addressing nurse staffing issue is ‘What are the expectations of nurse regarding an attractive work schedule and work environment at the hospital?’

Impact of nurse staffing on nurse burnout and job satisfaction

To get answers to the formulated research question, deciding the best research design is necessary to ensure that relevant data is obtained. As the research question is looking to analyse the view of nurses regarding work environment of the hospital, it means the aim of the research is to get descriptive data related to the research question. Hence, qualitative research approach is most suitable to address the research question as qualitative research process can help to get detail insight related to an event. There are many research designs that can be done by means of qualitative research approach. This includes cross-sectional study, randomized controlled trial, descriptive and cohort based study. Descriptive research design has been chosen for the research question.

Descriptive research design with the use of survey questionnaires will help to collected data related to nurse’s perspective on desired work environment in hospital. Adhering to the descriptive study design would bring in a number of benefits to the study. Firstly, the participants can provide information in an unchanged and natural environment. Further, such a research would be a pre-cursor for future research as useful variables can be identified. Since the data collection method is simple in nature, multifaceted approach for data analysis is applicable. With such a research, rich data can be extracted that is huge in volume. The attitudes, habits and beliefs of the participants can be studied adequately (Parahoo, 2014).

25 nurse participants are to be recruited with the help of purposeful sampling. The participants are to be employed as registered nurses at healthcare units. They are to have an experience of at least two years. Survey questionnaires with close open ended questions are to be distributed to the respondents and one week time is to be given for data collection. The transcribed data is to be coded and categorisation is to be done. Key themes are to be highlighted from the paper, and the analytical process comparison between the questionnaires would be pivotal. Ethical consideration is to be given by not involving invasion of integrity of individuals (Kieft et al., 2014).

Conclusion

Study of relevant literature points out that the performance of nurses is guided by staffing and skill mix of nurses. A major challenge in my current work role is the issue of staffing level.  There is evidence to support that staffing level issues relates to low number of staffs available for care delivery compared to the number of patient in clinical setting. The issue is prominent since it influences quality of care and nursing performance, apart from the overall profitability of health care organization. The research that is to be carried out would be based on the research question of “what are the expectations of nurse regarding an attractive work schedule and work environment at the hospital?’. A descriptive study with survey questionnaire is to be carried out in this regard.

References:

Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., … & McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824-1830.

Cho, E., Chin, D. L., Kim, S., & Hong, O. (2016). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82.

Cho, E., Lee, N.J., Kim, E.Y., Kim, S., Lee, K., Park, K.O. and Sung, Y.H., 2016. Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: a cross-sectional study. International journal of nursing studies, 60, pp.263-271.

Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care–associated infection. American journal of infection control, 40(6), 486-490.

Everhart, D., Neff, D., Al-Amin, M., Nogle, J., & Weech-Maldonado, R. (2013). The effects of nurse staffing on hospital financial performance: Competitive versus less competitive markets. Health care management review, 38(2), 146.

Khamisa, N., Oldenburg, B., Peltzer, K. and Ilic, D., 2015. Work related stress, burnout, job satisfaction and general health of nurses. International journal of environmental research and public health, 12(1), pp.652-666.

Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC health services research, 14(1), 249.

Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.

Taylor, S. J., Bogdan, R., & DeVault, M. (2015). Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons.

Wright, P. D., & Bretthauer, K. M. (2010). Strategies for addressing the nursing shortage: Coordinated decision marketing and workforce flexibility. Decision Sciences, 41(2), 373-401.