Nurse Staffing and Patient Outcome - Literature review Example

NURSE STAFFING AND PATIENT OUTCOME Critical appraisal of reviews Heinz, D., 2004 Heinz (2004) focused on the implications that could be drawn from The first review reported here by Dian Heinz (2004) reviews previous research studies that examined Hospital Nurse Staffing and Patient Outcomes. This paper aimed to review earlier research literature on the effects of nurse staffing on patient outcomes and recommendations for further research and suggestions to enhance nurse recruitment and retention were discussed. This study result of 16 studies who investigated the association between nurse staffing and patient outcomes included mortality, length of hospital stay, and patient complications. The researcher used The above study concluded nurse staffing affects patient outcomes. Lankshear et al, 2005 Lankshear et al (2005) basically undertook a 2-tier methodology approach which is basically made up of primary data collection and secondary data collection. The secondary data collection was made up of two major components, first of which involved critical review of existing literature and the other being, policy analysis on nursing staff and patients outcome. The primary data collection involved interviews with key stakeholders in the health care provision in the United States and United Kingdom. Without any doubt, the methodology of the researchers is commendable since it paves way for both a qualitative research and quantitative research to be under taken (Landon et al, 2006). The idea of starting an entirely new research was a great ideal because it was important to come out with new results and conclusions on the impact of nurse staffing on patients outcome. Kane et al, 2007 Kane et al (2007) devised the use of several methodologies to ascertain the relationship between the number of registered nurses dealing with problems like patient falls hospital-related mortality, surgical bleeding, shock, and cardiac arrest and their effectiveness resulting in number of patients each nurse handled. The methodology involved the review of 28 separate secondary studies which had been conducted from 1990 to 2006. At the end of their research, Kane et al (2007) concluded that there was a link between higher nurse staff and fewer patients’ outcomes. The major critique of the study was however the fact that the researchers could not confirm the causality of the link that was established. This totally defeated the aim of their research because the objective of their research had an element of finding the association between the two phenomena. By this objective, it was important that the resultant factors bringing about the association be outlined (Blegen, Goode and Reed, 1998). Unruh, L., 2008 A very critical area of the research by Unruh (2008) had to do with the impact of hospital nurse staffing on patient outcomes. This means that the researcher set out an aim of going beyond the mere need to draw conclusions as to whether or not there was relationship between nurse staffing and patient outcome. The aim of the researcher actually entailed an attempt to assess how the relationship affected delivery of work and this is a step in the right direction. A total of 21 studies that had been conducted since 2002 were analyzed. Judging from the period of study, it would be said that there could be more studies included to make the conclusions drawn from the results more empirical and valid. The researcher however had a good cause to limit the number because he wanted to stay within the stipulated delimitation of the research objective. Once the 21 studies were identified, outcome measures, analytical model, and statistical analysis were used to analyze their results as has been presented in the next section. Flynn &McKeown, 2009 There are two very important appraisal points that can be raised on the research conducted by Flynn and McKeown (2009). The first has to do with the fact that in their method, the researchers did not limit nurse staffing and its effects on patient outcomes to only the number of nurses attending to patients but also include new variables for analysis such as the skills and experience of nurses. This was an important trend because if all nurses are seen as having the same level of competence in handing cases of patients, results of patient outcomes would always be wrong because there will be a refusal to appreciate the fact that when given the same number of patients, some nurses can handle the patients better than others depending on the expertise of the nurses (Lang et al, 2004). The second area has to do with the need to introduce new areas for assessing patient outcome. The researchers actually lamented that “mortality, hospital acquired infections, falls, pressure ulcers, suicide, length of hospital stay, medication errors, post-operative complications or infection rates and serious adverse incidents”, which has always been used in determining patient outcome was inadequate (p. 762). Penoyer, D.A., 2010 A highly commendable aspect of the research conducted by Penoyer (2010) was the number of articles used, which were 56. This was a very good number in generalizing the results that were obtained. Even more, the researcher did not stick to the articles alone but undertook some key primary data collection, which consolidates the authenticity and validity of the results. Furthermore, the usual diagnostic test used by most researchers in determining patient outcome was expanded. The researcher actually used several new dimensions of determining patient outcome including “intensive care units (intensive care, critical care), outcome and process assessment (health care), infection, infection control, outcome assessment, and personnel management” (p. 1522). An adverse critic of the research of Penoyer has to do with the fact that there was the use of to much of non-experimental methods and research design. This clearly defeats the basis of undertaking scientific research (Lang et al, 2004). Results of Reviews The results of Heinz in his research focused mainly on the implication and for that matter, negative effects of imbalanced nurse-to-patient ratio with excessively higher patient to nurse ratio as a focus. After series of data collection, the researcher came to the conclusion with results that imbalances in nursing ratios whereby one registered nurse is assigned to so many patients is the ultimate cause of medication errors among nurses. Inversely, the research also pointed to the fact that higher rates of success in medication delivery and other professional care from nurses are enhanced in situations whereby several nurses are assigned to a relatively equal number of patients. Lanshear et al (2005) were also particular about how imbalanced nurse to patient proportion affected the rate of work delivery of nurses. First the results looked at the proportion of registered nurses to the entire nursing staff and found that the number of registered nurses in the various studies they reviewed was generally low. This led to a situation whereby one registered nurse had to cater for several patients at a time. Resultantly, registered nurses had only few number of hours to spend on each patient because they had to finish up with one patient in order to attend to another patient. With rate of hospital based mortality as one of their major focus, the research conducted by Kane et al (2007) concluded that once there are enough registered nurses catering for a proportionate number of patients, the rate of hospital based mortality reduces. What is more, patients who had better care from nurses because there was no pressure on nurses to rush patients through hospital care also recorded lower adverse patient events. This is a general justification of the fact that the role of nurses are better enhanced if they would not be made to work under stressful conditions that encompasses the need to attend to several patients at a goal. Results from Unruh (2008) gave a much narrowed implication of increase in patient ratio to nurse ratio. In a clear quantitative description, it was identified that for each additional patient that a nurse was assigned to, there was a “7% increase in the likelihood of failure to rescue” (p. 65). This means that imbalanced nurse-to-patient ration is even worse in the case of handling emergencies that had to do with the outright rescuing of patients. The results actually showed that where there was the need for recovery from serious complications, patients were at a worse disadvantage of hoping for the recovery of their lives because nurses who are to handle them are likely to have only fewer number of hours to give then care. The results from Flynn & McKeown (2009) took a little bit of twist by looking at the wider perspective of patient outcomes in relation to staffing and patient proportions. According to the result, the unfair and imbalanced proportions of nurses to patients is a major cause of poor performance among nurses. They also paid tribute to how the issue becomes worsened when intensive care processes are involved. However, the results went further to explain that the nursing proportions alone are not to be blame as “contextual factors, such as the hospital management and their commitment to quality of medical care, are also likely to have an important impact on patient outcomes” (p. 762). Like Lanshear et al (2005), much of Penoyer (2010) had to do with the impact of nursing staffing on the time allocated to each nurse to cater for patients. The results revealed that nurses are often forced to deliver ill-completed services to patients because the fact that they have several patients waiting leaves them with that option only. Consequently, nursing staffing is often related to the number of hours that each nurse has to work with. In facilities where there were fewer nurses, it was identified that this resulted in a situation whereby only few hours were given to each nurse to be with patients. This is of course a major deficiency for the nursing profession. Discussion The assertion and results from Heinz (2004) and Flynn & McKeown (2009), which indicates that when one registered nurse is made to handle several patients, it leads to medication errors should be a source of worry. This is because medication errors come with their own attendant risks to patients. It is actually disheartening to note that in situations whereby patients have to suffer from wrong medications, there is the tendency that the problems they reported at the health facilities will be worsened (Blegen, Goode and Reed, 1998). The results from Lanshear et al (2005) and Penoyer (2010) is very worrisome considering the fact that the care that nurses are expected to give to patients is one that involves life and death. For this reason, any practices that cause nurses to have limited time with patients must be curtailed. If not, patients can never be guaranteed of receiving the best of carefully scrutinized service from nurses. From Kane et al (2005) and Unruh (2008), there is the urgent need for policy making in addressing the issue of assigning several patients to fewer nurses if indeed we want to achieve better results in the healthcare delivery. This assertion is made against the backdrop that whenever a relatively proportionate number of patients were assigned to nurses, the resultant effect was that mortality reduced as well as adverse patient events. REFERENCE LIST Flynn & McKeown, 2009. Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research. Journal of Nursing Management, 2009, 17, 759–766 Heinz, D., 2004. Hospital Nurse Staffing and Patient Outcomes. A Review of Literature. Dimensions of Critical Care Nursing. Vol. 23 No. 1 Kane et al, 2007. The Association of Registered Nurse Staffing Levels and Patient Outcomes. Systematic Review and Meta-Analysis. Medical Care • Volume 45, Number 12, December 2007 Landon BE, Normand SL, Lessler A, et al. Quality of care for the treatment of acute medical conditions in US hospitals. Arch Intern Med. 2006;166:2511–2517. 67. Blegen MA, Goode CJ, Reed L. Nurse staffing and patient outcomes. Nurs Res. 1998;47:43–50. Lang TA, Hodge M, Olson V, et al. Nurse-patient ratios: a systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. J Nurs Adm. 2004;34:326 –337. Lankshear et al, 2005. Nurse Staffing and Healthcare Outcomes. A Systematic Review of the International Research Evidence. Advances Nursing Science. Vol. 28, No. 2. pp. 163-174. Uppincotl Williams &. VPiikins. Inc Penoyer, D.A., 2010. Nurse staffing and patient outcomes in critical care: A concise review. Society of Critical Care Medicine and Lippincott Williams & Wilkins. Crit Care Med 2010 Vol. 38, No. 7 Unruh, L., 2008. Nurse Staffing and Patient, Nurse and Financial Outcome. AJN January 2008 Vol. 108, No. 1 Read More