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The Theorist-Avedis Donabedian

The Original Framework-A framework using the triad of Structure, Process and Outcomes to evaluate quality of care.

The Relationship to the Study-The research is applicable to this research problem as it relates to guided research to examine the association of nurse-to-patient ratios and patient outcomes in an acute care setting.

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The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. According to the model, information about quality of care can be drawn from three categories: "structure," "process," and "outcomes." Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment.

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1)    Nurse-patient ratios are expressed in two ways: the number of nurses working per shift or over a 24 -hour period divided by the number of beds occupied by a patient over the same time period; or the number of nursing hours per patient bed days (NHPPD). There are more ways to measure nurse staffing requirements, however, there is no single recommended approach (Driscoll et al, 2018). Studies included in this review has determined NPRs. For this purpose of this literature review, the topic of nurse-patient ratio indicates more nurses for assigned patients.

2)    Nurse-sensitive patient outcomes measures included in this study are based on adverse events that have been sensitive to changes in nursing staffing. The nurse-sensitive patient outcome measures were medical and mediation errors, length of stay, patient mortality, readmissions, preventable adverse events, including falls, pressure ulcers, health care-associated infections, and other complications (Driscoll et al, 2018).

3)    Registered Nurses a nurse who a graduated from a nursing program and met the requirements to obtain a nursing license outlined by a country, state, or province (Wikipedia, n.d.).

4)    Adverse Events is any untoward medical occurrence in a patient that can result in death or immediately life-threatening illness (Centers for Disease Control and Prevention, n.d.).

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The conceptual definition of the independent variable, nurse staffing is defined as factors directly related to nurse to patient ratio.

The operational definition is nurse staffing levels are related to patient outcomes and patient satisfaction within the health care organizations.

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PROQUEST

CINAHL

Journals OVID

Nursing & Allied Health Sources

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Acute care setting

Nurse Staffing

Nurse-to-patient ratio

Nurse-sensitive outcomes

Patient Safety

Patient Outcomes

Safe staffing

Qualitative Research

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The Importance of the Optimal Nurse-to-Patient Ratio

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What is the national benchmark when it comes to nurse-patient staff ratios? Maintaining appropriate nurse staffing levels does not just promote better care, in most cases, it's the law. But pinning down a specific number is hard to do, given the legal...

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Nurses play an integral role in the healthcare industry, providing care to patients and filling leadership roles at hospitals, health systems and other organizations.

But being a nurse is not without its challenges. It's a demanding profession that requires a lot of dedication and commitment.

Here are five big issues facing nurses today.

1. Compensation. When it comes to nurse compensation, regional differences are to be expected based on cost of living.

Nurses living in certain regions of the U.S. make much more than nurses in other regions, according to the Association of periOperative Registered Nurses organization.

Nurses in the Pacific region make about $18,000 more than the average staff nurse, for instance. Next is the Mid-Atlantic region, where nurses make $14,800 more than average. Nurses in the East South Central region, however, make $4,300 less than average.

Beyond regional differences in pay, nurse pay gaps also persist between genders.

Male registered nurses earn, on average, upwards of $5,000 more than their female counterparts. The gender pay gap is present in all specialties except orthopedics, according to a study published in JAMA. Among nurse specialties, chronic care had the smallest gender pay gap, at $3,792, and cardiology had the highest gap, at $6,034.

2. Workplace violence. Another major challenge nurses face is violent behavior while on the job, be it from patients or coworkers.

Between 2012 and 2014, workplace violence injury rates increased for all healthcare job classifications and nearly doubled for nurse assistants and nurses, according to data from the Occupational Health Safety Network. A total of 112 U.S. facilities in 19 states reported 10,680 Occupational Safety and Health Administration-recordable injuries occurring from January 1, 2012, to September 30, 2014. There were 4,674 patient handling and movement injuries; 3,972 slips, trips and falls; and 2,034 workplace violence injuries.

This year, North Carolina took a stance against workplace violence. Starting Dec. 1, people who attack hospital workers in North Carolina could be charged with a felony, thanks to a new state law. The News & Observer reported that the new law passed by "large margins" and was signed into law last month.

Other states are also cracking down on workplace violence: In Massachusetts, the Massachusetts Nurses Association union is pushing a workplace violence bill that would add enhanced plans around workplace safety.

3. Short staffing. Staffing is an issue of both professional and personal concern for nurses today. In fact, issues related to staffing levels, unit organization or inequitable assignments are one of the top reasons nurses leave a hospital job, according to Karlene Kerfoot, PhD, RN, vice president of nursing for API Healthcare.

Back in June, the Health Policy Commission unanimously approved a mandate on nurse staffing in intensive care units throughout Massachusetts. The regulations require that nurses in intensive care units in hospitals, including hospitals operated by the Massachusetts Department of Public Health, be assigned only up to two patients at a given time. The regulations apply to all ICUs, including special units for burn patients, children and premature babies.

If staffing is inadequate, nurses contend it threatens patient health and safety, results in greater complexity of care, and impacts their health and safety by increasing fatigue and rate of injury.

Indeed, a Minnesota Department of Health review of literature found strong evidence linking lower nurse staffing levels to higher patient mortality, failure to rescue and falls in the hospital. There was also strong evidence that other care process outcomes such as drug administration errors, missed nursing care and patient length of stay are linked to lower nurse staffing levels.

Furthermore, a study published in Health Affairs found that inadequate staffing can hinder nurses' efforts to carry out processes of care. Researchers found that hospitals with higher nurse staffing had 25 percent lower odds of being penalized under the Affordable Care Act's Hospital Readmissions Reduction Program compared to otherwise similar hospitals with lower staffing.

That's why unionized nurses often bring up staffing levels when they are in the middle of contract negotiations. For instance, dozens of nurses protested Aug. 3 outside of St. Petersburg (Fla.) General Hospital over staffing levels and wages. Additionally, nurses and other healthcare workers planned to hold a picket July 15 outside Renton, Wash.-based Valley Medical Center over staffing levels.

4. Long working hours. Nurses are often required to work long shifts. But in a number of cases, nurses must work back-to-back or extended shifts, risking fatigue that could result in medical mistakes.

A 2012 study published in Health Affairs found that the longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Survey data from the study showed that more than 80 percent of the nurses in four states were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than 13 hours increased, patients' dissatisfaction with care increased. Furthermore, nurses working shifts of 10 hours or longer were up to 2.5 times more likely than nurses working shorter shifts to experience burnout, job dissatisfaction and intent to leave the job.

And a 2014 study in the American Journal of Critical Care found that nurses impaired by fatigue, loss of sleep, daytime sleepiness and an inability to recover between shifts are more likely than well-rested nurses to report decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome.

5. Workplace hazards. Nurses face a number of workplace hazards each day while just doing their jobs. These hazards include exposure to bloodborne pathogens, injuries, hand washing-related dermatitis and cold and flu germs.

OSHA estimates 5.6 million out of roughly 12.2 million workers in the healthcare industry and related occupations are at risk of occupational exposure to bloodborne pathogens.

And rates of workplace injury are higher in healthcare than other industries. Nurses experience more than 35,000 injuries involving the back, hands, shoulders and feet each year, according to the Bureau of Labor Statistics. Many things influence the likelihood of injury, including age of the nurse and environment.

Aside from acute injury, nurses are also likely to suffer harm to their hands. A recent study from the University of Manchester revealed healthcare workers following hand hygiene protocols are 4.5 times more likely to suffer moderate to severe skin damage. In the same study, researchers found healthcare workers made up roughly 25 percent of reported cases of irritant contact dermatitis.

Protecting nurses goes beyond their hands. As cold and flu season nears, hospitals and health systems can prepare to protect their workforce, including extra measures for those who do not receive the vaccinations for personal or religious reasons. One option is having the nurses wear an antiviral face mask, which has been show to kill or inactivate 99.99 percent of laboratory-tested flu viruses.
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5 of the biggest issues nurses face today

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Nurses play an integral role in the healthcare industry, providing care to patients and filling leadership roles at hospitals, health systems and other organizations. But being a nurse is not without its challenges. It's a demanding profession that requires a lot of dedication and commitment. Here are five big issues facing nurses today.

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The hypothesis formulated for this study is as follow: There is no association between nurse to patient ratio and safety outcomes for patients. This hypothesis has required a policy response to not only increase the number of nurses in the workforce, but more importantly the number of nurses at patients’ bedsides (Twigg et al, 2010).

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What Are Independent, Dependent And Controlled Variables?

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The independent variable of in this literature review is nurse staffing, and the dependent variable is the patient outcomes.

Nurse staffing is dependent of staffing levels and the work environment to have the ability to meet patient needs.

Through data collection and analysis, the relationship between nurse staffing and patient outcomes will be measured.

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The objectives of this literature review are as follows

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A new safe staffing bill was introduced, 2018.

Required medicare hospital to develop policy concerning staffing.

Research-higher level of nurse staffing cared by 1 nurse per shift and nurses that are FTE.

Nurse-sensitive outcome measure was mortality in hospital setting.

Length of stay, medications, and medication errors were included in study in which staffing levels affected outcomes.

Occupational health issues, psychological state and experiences, factors that have significant association to patient outcomes.

Acuity-based staffing-utilizes a patient classification system (PCS) to predict requirements of care.

Validity and reliability not accurate in achieving adequate nurse staffing levels.

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What are your feelings about nurse to patient ratios and the affects of patient outcomes?