The quality of care delivered is determined by many factors which can either be nurse or patient related. Analysis of studies that have been done to provide backup information on the factors that influence the prognosis of patients and their ability to stay out of a hospital for more days in chronic and terminally ill patients. The quality of care provided is depended on personal characteristics of the nurses, but it is also true that factors around them such as being overwhelmed by work may influence how they deliver. The theme aims to identify if the number of nurses available in a unit is proportionate to the care that is provided to the patients. Literature Review
Selection of the proper resources ensures that the literature review is based on the context that has been asked. Therefore, different databases, journals, and websites were used to collect information where staffing issues were used as the key word for the information search. Emphasis was exerted on recent papers that had relevant information to ensure that what was used is the current trend in the nursing practice. Using well-researched sources is beneficial because the critical analysis that is done on the paper is relevant. A Research conducted on peer-reviewed papers will guide on what is available and what is not. Peer reviewed sources are also credible in that they have been presented and have been critically analyzed for validity. For this reasons the literature below was well cited and referenced with origin from such credible sources. The aim being to ascertain if, staffing of nurses has an effect on the quality of care and outcomes of patients, what can be done to rectify the situation and improve the quality of life.
A study was done by Koy et al., stated that is a direct relationship between the Nurse staffing, burnout, job satisfaction and quality of care provided (2015). The number of nurses that were available to serve in the hospital was proportionate to the quality they delivered. They also discovered that there is a shortage of personnel in the most hospital because hospital relies on agency staffs that are always on the move and many times are not available to give the services expect as the ratio is too large to cover. They continued to say that nurses who are residents in particular hospitals tend to provide better care due to job security that is provided by more permanent terms. One of the areas that can be used to measure if the issues of staffing are detrimental to health care is unit acquired pressure ulcers. Choi and Staggs did a study that gave evidence that a facility that does not have an adequate supply of nurses put its patients at risk of developing pressure sores which translates to increased infection rates since the same nurses have the responsibility of taking care of the wounds (2014).
Inadequate staffing predisposes the nurses to burnout. The burnout has been renamed psychological syndrome which makes the caregivers suffer from emotional exhaustion, reduced to non-feeling of having used the profession for personal growth and finally depersonalization of client care. The health workers do not feel that it is important for them to continue to provide a personal touch to the customer. This situation can be attributed to the patient nurse ratio that is at most hospitals (Poghosyan et al., 2002).
Patient outcomes are said to be potentially sensitive to nursing (Clark and Donaldson, 2008). This is a rather new concept which has not been researched on much. The measures are those services that have been provided or influenced by nurses but do not exclusively portray the nursing department. The new aspect is aimed at contradicting the opinion that patient outcomes rely on the nursing profession, but it is an interdisciplinary value with other medical personnel being just as responsible. Some of the factors that influence staffing include the budgetary allocations of any facility as well as the availability of the staff. They continue to say that other characteristics affect the practice of nursing which includes; management of the different units in the facility, where inter-unit collaboration is significant in ensuring that the handover of care is well done and followed.
Clarke and Donaldson (2014), continue to say that during staffing it is important to consider the qualifications of the members in the recent year's studies have been created in courses that are associated with nursing can offer benefits to the profession. Higher educated members can be put in charge of the units and have the rest supervised. Such include practical and vocational nurses as well as nurse aids. At the same time, budgetary allocations which they suggest are an influential factor that affects staffing needs to be based on shifts and units for specific durations and not done as a summation of the whole hospital for an entire year.
Department of Professional Employees states that understaffing is not a hazard for patients only but also affects the nurse (2016). The health situation of these workers is also put at risk by the long hours that they serve. Musculoskeletal disorders are prone to happen to them with an example of injury to the back, shoulders, and neck. These conditions render them incapable of taking care of their patients. A report done in 2012 showed that 11,610 nurses had these injuries which kept them away from work translating to an average of eight days off.
Aiken et al. studied a different angle to the topic of staffing where they considered the effects of well-staffed or understaffed hospitals to children. They concluded that the children with common medical and surgical diseases who are admitted to hospitals that do not have a big number of patients do not have cases of readmission, unlike their counterparts who frequent populated ones (2013). Pediatric readmission can be prevented well than adult cases. During the stay in a hospital, the nurses in charge have the role of educators where they teach the family on the home management of different disorders. They, therefore, attributed well-taught families to reduced cases of return to the hospital. The challenge of the situation is that if the nurses are few and exhausted, they do not spare the time to give the lessons needed..
One of the ways to ensure that nurses function and avoid burnout is by motivating them and providing an environment for them to work at the top of their licensure. Whether a hospital suffers from inadequate staff or not the nursing scope of practice is significant for care to be delivered. Systems in the facility should be well connected to avoid a situation where similar information has to be sent to different areas over and over again. This position would contribute to waste of the few resources that are available.
However, according to Allen, on a visit to a hospital, it can be clear that some of the members of staff seem to be more dedicated to their job. The situation is prompted by the need for them to fulfill the requirements of their licensure. Many hospitals do not have in place a complete cycle of service provision whereby all the stages are well-taken care. This situation translates to nurses wasting time moving up and down to achieve care. Some of the non-value adding activities that are brought about by shortage are fixing broken items such as computers. Walking to the pharmacy or laboratory to collect results and drugs or waiting for them to be delivered. The Bureau of Labor Statistics predicts that on average $750,000-$1,000,000 are wasted on non-valued adding activities (2015).
The quality of care in any facility can be related to the amount of burnout that the caregivers suffer. Giving nurses reduced hours on shifts is a sure way of making them more confident and comfortable providing services. The situation translates to reduce hospital stay and decline in hospital-related injuries as well as the contraction of nosocomial infections. The inter-linkage between the staffing issue and the prognosis of the patient dictates that evidence-based and precise practices need to be put in place. Deploying nurses in different units in numbers that equate to the people being served so as to improve the quality of care they receive.
Studies need to continue being done on the assessment criterion that allows the nurses to analyze patients critically. Aiken et al., give the suggestion that for pediatric cases to reduce the nurse to patient ratio to be put to four or fewer children per nurse per shift. The baby boomers generation took advantage of the institutions and trained as nurses and years down the line most of them are at retiring age. They are leaving significant gaps in the health sector. Another challenge that arises is that they have put a strain on Medicare. With a rise in the number of inactive members of the Native American group, it is paramount that they take up the challenge and train so that they can qualify. The shortage in a few years will become significant when the current lot is also in need (Al-Asfour, 2016).
In the year 2004, California became the first state to mandate that there be a minimum nurse to patient ration, especially in acute hospitals. Their nurses cared for two fewer patients in medical, surgical units than other states which translated to lower mortality rates. The hospitals report consistent quality of care to their patients throughout the year. If similar laws can be passed to all states, then more nurses would be employed and quality of care would improve in the country (Aiken et al., 2010).
Aiken, L. H et al. (2010). Implications of the California Nurse Staffing Mandate for Other States. Health Services Research. 45(4), 904-921. Retrieved from http://doi.org/10.1111/j.1475-6773.2010.01114.x
Aiken, L. H. et al., (2013). An Observational Study of Nurse Staffing Ratios and Hospital Readmission among Children Admitted for Common Conditions. BMJ Quality & Safety. Retrieved from http://dx.doi.org/10.1136/bmjqs-2012-001610
Al-Asfour, A. (2016). Promoting Nursing as a Career Choice for Native Americans. Journal of American Indian Higher Education. 4 (27). Retrieved from http://tribalcollegejournal.org/promoting-nursing-career-choice-native-americans/
Allen, S. (2015). The Connection between Nurses Working at Top of Licensure and Patient Care. Infor Healthcare. Retrieved from http://www.infor.com/content/executive-briefs/connection-between-nurses-working-at-top-of-licensure-and-patient-care.pdf/
Choi, J. and Staggs, V. S. (2014). Comparability of Nurse Staffing Measures in Examining the Relationship between RN Staffing and Unit- Acquired Pressure Ulcers: A Unit-Level Descriptive , Correlational Study. International Journal of Nursing Studies. 51(10):1344-52. DOI:10.1016/j.ijnurstu.2014.02.011. Epub2014 Feb 22
Clarke, S.P. and Donaldson, N.E. (2008). Nurse Staffing and Patient Care Quality and Safety. Patient Safety and Quality: An Evidence Based Handbook for Nurses. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2676/
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