Colleagueship Analysis Nursing

Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

Determining nurse-to-patient ratios in nursing facilities remains a challenge for the nursing profession. Two main staffing methods that are currently used in most nursing facilities are staffing by patient acuity using patient classification systems and staffing by mandated nurse-to-patient rations. Each method has an impact on patient outcomes, safety and overall satisfaction determined from different articles and studies done on each staffing method. There are pros and cons to each staffing methods. Nursing facilities look at many of these pros and cons when determining staffing methods that are used, cost, patient outcomes, nursing satisfaction and

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

Nursing-sensitive indicators are defined by the American Nursing Association (ANA) as “indicators that reflect the structure, process and outcomes of nursing care” (ANA, 2014). These indicators help define how nursing care is given by measuring the amount of nursing staff, skill level of the nursing staff, and the education level of nursing staff. These indicators depict the quality of care provided to patients and the outcomes of the care provided. Careful tracking of these indicators provides evidence for keeping current practices or for implementing new policy and procedures. A formal set of indicators measuring the impact nursing interventions have on patient care was not implemented until 1998 (Montalvo, I. (2007). With the establishment of the National Database of Nursing Quality Indicators (NDNQI), hospitals and other care settings are able to assess how nursing interventions impact patient outcomes, quality of care, and the overall work environment in health care facilities. Nursing-sensitive indicators are a quality improvement measure used to determine how the quality of nursing care is evaluated in hospitals and other healthcare facilities. Nurse sensitive indicators allow healthcare facilities to evaluate how the care they are providing is following evidence-based practices and how they can improve their practices to achieve better patient outcomes. The American Nurses Association is promoting these indicators as the definitive standards for patient care

2. Some of the ways in which these processes can be implemented include the development of new indicators to ensure that the contribution of nursing to patient care is at an optimal level. One way to accomplish this is by a review of peer-reviewed literature to determine the indicators that prove nursing sensitive, as well as to determine the reliability of information currently available on such indicators. On a less theoretical level, topic experts can also be approached for discussion on measurement issues and additional information to support theoretical reports and analysis. Patient risk level could be the focus of such discussion. After a plan for data collection and reports have been drawn up, comments from participating facilities can be invited regarding the feasibility of data collection methods, as well as for suggestions on additional methods to collect data and information, as well as how to implement processes.

Nurse-Patient staffing ratios have created debate among health care professionals for years. Who determines where, when and how many patients a nurse can handle on any given shift? Who determines the acuity of the patients handled by the nurse? Does the floor nurse have a say in what she or he can feasibly handle during their shift? At what point does patient care begin to suffer? These questions and many others have led to federal and state legislation coming to light to better serve the care of a patient. “The varied agendas and the inability of nurses, hospital administrators, and financial experts to communicate toward a single purpose, as well as the complexity of meeting staffing needs, have moved the issue into the political arena (Hertel, 2012, p. 1)”. Several states have already instituted mandatory nurse-patient ratios. While you can debate for or against political involvement, I will look at many factors regarding care and safety of patients.

Healthcare is a busy, fast paced environment. Nursing Managers have a difficult job of juggling staffing and patient acuity to assure safe and appropriate patient care without over or under staffing. Nurses providing direct patient care voice they are too busy to complete all the required tasks during their shift, such as documentation. However, there are tools available to help increase nurse productivity while providing safe, efficient patient care.

Striving for excellent patient care is the cornerstone of nursing. However, delivery of innovative care requires nurses to take initiative in finding issues and concerns in current clinical practices to promote change that leads to optimal patient outcomes. One current issue in clinical practice is the varying patient-to-nurse ratios (PNRs) amongst different hospitals (Aiken et al., 2012). Having high PNRs may lead to nurse burnout, medical errors, and ineffective nursing care (Aiken et al., 2012; Karavasiliadou & Athanasakis, 2014). The solution would be to regulate PNRs, especially in areas such as the emergency room. To initiate this change, a task force would have to be established to use current data and research as evidence to propose the change, implement the change and evaluate its effectiveness.

Nurses are integral key players in multidisciplinary teams caring for patients in complex healthcare systems. Hospitals, a primary care delivery portal within the health system, are inundated with patients requiring higher acuity care. Nurses must be prepared to recognize patients’ health care needs and provide quality patient care outcomes. The knowledge of nursing sensitive indicators can be helpful in providing the care which meets quality standards. Nursing sensitive indicators rely on evidence-based practice. The American Nurses Association created a repository for implementing, developing, and

Nurses are crucial in providing quality care in the health care industry. It is imperative to maintain the proper staffing ratio to ensure that nurses can maintain high quality care for their patients. Studies have shown that the increasing workload of nurses can be linked to increased patient deaths, medical errors, hospital-acquired infections, longer hospital stays, and many other complications. (National Nurses United n.d. ) Leaders and managers play a vital role in developing

Nursing-sensitive indicators can be an important tool in identifying patient care issues that could potentially arise during a hospital stay. By analyzing the data on specific nursing-sensitive indicators, the quality of patient care can be optimized and patient satisfaction can be improved. The American Nurses Association (ANA) and the National Database of Nursing Quality Indicators (NDNQI) are two sources of information and guidelines for nurses and nurse managers to use in planning patient care and workloads for each nursing unit. The use of available resources, staffing by acuity and patient needs, appropriate referral indicators, and cooperation

In Thomasos et al. (2015), it indicates that educating nurses is vital in the care of a patient as it reassures accurate acuity assessment scores. Educated nurses will reinforce the safe practice of patient cares. Once a nurse is educated on the tool, they’ll be qualified to complete acuity assessments that will provide the autonomy to plan the intervention and care for the patient (Andrade et al., 2017). Having an educated nurse, knowledgeable about how to assess patient acuities, reinforces the dependability as the nurse has prioritized their cares to meet the needs of the

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

The greatest negative impact that affects me as a primary healthcare provider is the nurse to patient ratio. This is a historical and modern day issue that has been in contention well before the 17 years that I have practiced. Physicians and nurses are in agreement that the major impediment on quality care is inadequate staffing and unrealistic workloads (Carlson 2010). An issue with nurse patient ratios primarily exists because the formula used for staffing a facility overlooks a patients’ acuity level. The acuity level is based on the overall condition of the patient and the time needed to safely provide patient care. Patients with a higher acuity are generally more time consuming because they require more care due to the seriousness of their condition. This can leave lower acuity patients with minimal care, minimal education, and a feeling of rejection. If the right nurse to patient ratio is not achieved patient outcomes suffer and readmissions increase.