Critical Issue Paper: Proper Staffing related to Patient Safety Introduction The appropriate staffing of Registered Nurses is critical in the safety of hospital patients. Nursing shortages, along with major cuts in nursing budgets, have combined to result in fewer nurses at the bedside. This creates a safety hazard for patients, as well as a critical issue in the nursing profession. Nursing and patient outcomes are both highly affected by inadequate staffing.
This paper will focus on the necessity for appropriate RN-to-patient ration and the evidence based research that supports the effect this has on patient safety, patient outcomes and the nursing practice. Why is this issue a concern for nursing practice and healthcare delivery? Inadequate staffing and unmanageable workloads place an unnecessary burden on nursing staff members and reduce the quality of care that the nurses are able to provide. Nurses are left fatigued, striving to achieve unmanageable expectations, which in turn affect the delivery of care to the patients.
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Inadequate staffing is unsafe and is an impediment to giving high-quality care in the hospital. (Garrett, 2008) Nearly every person’s health care experience involves the contribution of a registered nurse. Birth and death and all the various forms of care in between, are attended by the knowledge, support and comfort of nurses. When there are too few nurses, patient safety is threatened and health care quality is diminished. (Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), 2002)
Nurse staffing and individual nurse workload has an absolute measurable impact on patient outcomes such as nosocomial infections, length of stay, medical errors. Garrett noted research finding that adding one additional patient to the nurse’s workload is linked to a seven percent increase in patient mortality within thirty days of admission. In addition, a seven percent increase in the odds of failure to rescue was found. Research also provides evidence that a high patient ratio is directly responsible for nurses’ job related burnout and dissatisfaction.
It was found that each additional patient per nurse resulted in a twenty three percent increase of the odds of burnout and dissatisfaction. (Garrett, 2008) Patient outcomes are also affected by hours of care per patient per day (HPPD). The Needleman group examined data from hospitals paying close attention to the hours of care given. Research verified that a higher RN HPPD is associated with lower adverse outcomes and shorter length of stay. (Unruh, 2008) Insufficient staffing results in a large array of issues, which create a vicious cycle.
Heavy workloads lead to nurse burn out. Nurse burnout leads to poor delivery of care, which then leads to a reduced patient satisfaction. Poor outcomes from the nurses and patients contribute higher cost to the hospital as a result of low efficiency, high turnover, longer hospitalization, and expensive treatments. When the hospital loses money, finances tighten and result in cuts in nursing budgets and bed closures. These factors all lead to poor staffing, and the cycle continues. (Unruh, 2008) This writer has experienced the vicious cycle first hand.
It has been nearly impossible to tend to every patient’s specific need with an overloaded assignment. It is a constant battle to complete paper work, admissions, discharges, transfers, deal with families, and intercept medication errors while juggling up to eight patients. Lack of ancillary help and few RNs assigned to the unit makes completing tasks very difficult. This writer has experienced much job related physical, mental and emotional strain. A lot of the strain stems from having to complete tasks left from prior shifts, while also doing the job of a unit secretary and nurses aid.
This is unsafe practice because when overwhelmed and in constant motion, something or someone is getting ignored. Charts not being read, patients not checked on often as they should be, or medications are administered late. In addition, a nurse must be prepared for unexpected changes in the patients’ status, think critically, attend to details, and problem solve. When exhausted and weighed down, following through with these responsibilities become impossible, and is very discouraging. What aspects of this issue are being analyzed?
Factors influencing patient safety have been researched for almost fifty years. Florence Nightingale even recognized the linkage between having nurses on the battlefield during the Crimean Wars, but more thorough regulation found in current research has advanced our understanding of why staffing makes a huge difference. (ANA, 2009) Unruh conducted literature reviews to assess the impact of nursing levels on patient, nurse and financial outcomes. The evidence showed that a balanced workload and safe staffing is the central in accomplishing good patient outcomes.
The findings highlight the importance of hospitals recognizing the effect nurse staffing has on patient safety, staff satisfaction and institutions’ financial performance. (Unruh, 2008) Difficult work enviroments is a result of inadequate staffing and excessive workload. Time limitations, inability to complete tasks, inadequate supervision and poor communication, are just a few examples of what forms a chaotic and stressful work enviroment. These factores result in poor job performance and employee distress. Employee distress affects patient outcomes.
When nurses are unable to give good care, they become emotionally exhausted and dissatisfaction, which in turn diminishes patient satisfaction, and continues the vicious cycle. These links are demonstrated through nurse surveys, hospital data and literature review. (Unruh, 2008) Not many can disagree that there is a close relationship between nurse staffing levels and patient outcomes in a healthcare setting. The Agency for Healthcare Research and Quality (AHRQ) reports presented evidence that showing hospital staffing is directly related to patient outcomes.
One report called Nurse Staff and Quality of Patient Care by the (AHRQ) noted critical findings related to RN staffing and patient safety, including failure to rescue. (Unruh, 2008) Another AHRQ-funded report titled, The effect of Health Care Working Conditions on Patient Safety, reviewed studies on nursing staffing levels and patient results. When comparing the hospitals with low rates and high rates of RN staffing, the hospitals with higher RN staffing had fewer adverse results.
Some principle adverse outcomes include pneumonia, pressure ulcers, shock, upper gastrointestinal bleeding, and hospital stay. (Garrett, 2008) Conclusion Appropriate RN staffing is vital in providing quality patient care and greatly affects the nursing practice. There is a substantial amount of good research on the relationship between nurse staffing and patient outcomes. Unfortunately, after many years, this critical issue is still at the top of the list in health care related problems. Ensuring an adequate number of urses to provide effective patient care is a challenge for many hospitals but the rewards could be more positave outcomes such as less nurse burnout, higher quality patient care, higher nurse retention, and lesser financial burden for hospitals. (Garrett, 2008) Impeding error, prevention of supplementary illness, and adequately caring for a patient, will ultimately save their life. There is no better reason to continue research and put forth effort in finding a better way to deliver healthcare