Nurse Staffing Ratio and Quality Outcome in Long Term Care - Essay Example

Nurse Staffing Ratio and Quality Outcome in Long Term Care affiliation Nurse Staffing Ratio and Quality Outcome in Long Term Care Introduction Research shows that there is a relationship between nurse stuffing and the health care services rendered in the hospitals. Empirical evidence from the nurse staffing field suggest that the quality of services and outcomes of health care provided by professionals in the hospitals improves with high nurse staffing ratios; hence, translating to better patient outcome. The National Center for Nursing Research in conjunction with the National Institute of Nursing Research in 1990s, for instance, convened a workshop to determine patient outcomes and the the efficiency of the nursing staffing practice. The study revealed that the patients’ wellbeing improved with better nurse staffing ratios such as skills and the hours of work spent on the patients (Castle & Anderson, 2011). Nurse staffing is an imperative aspect in determining the quality of services offered in hospitals and patient outcomes. The Topic Selected and Why Nurse Staffing Ratio and Quality Outcome in long-term care. I selected this topic because of the existence of research gaps on the topics investigating the existence of inefficient services in many health facilities and homecare due to understaffing. Research question How do nursing ratios in hospitals compare with patient outcomes? However, before examining the connection between clinical outcomes and nurse staffing, it is imperative to note that this research faces common challenges that are likely to crop up during the process of designing the staffing outcomes. For instance, the issue of getting suitable data sources that are reliable; correct measures for patient outcome and staffing and the problem of establishing authentic linkages between the two variables to come out with valid conclusions. According to Spilsbury et al. (2011), nurse staffing is a primary responsibility of the hospital administrators. The researchers go ahead to pinpoint budgetary constraint considerations and the nurse labor markets as some of the factors that influences nurse staffing ratios in hospitals. Moreover, according to the agency nursing staff model the hours assigned to each staff in a subunit within the facility and nature of supervision form another set of elements that significantly influences the nurse staffing (Spilsbury et al., 2011). The quality of care provided by the nurses is greatly influenced by the characteristics of the individual nurse such as fatigue, knowledge, and experience. The quality of care is also, affected by the system in which nurses work because it involves staffing levels and the needs of patient under care; organization of colleague officers, their availability, support services as well as the climate and culture created by the senior administrators in the hospital environment. For example, it is interesting to note that the same nurse working under the different condition can provide care and services of a different quality to patients with similar needs. The adverse outcomes that are linked to acute care include burnouts, inadequate staffing condition or thinner staffing coverage and lower skills (Flynn et al., 2010). Annotated Bibliography Castle, N. G., & Anderson, R. A. (2011). Caregiver staffing in nursing homes and their influence on quality of care: Using dynamic panel estimation methods. Medical care, 49(6), 545- 552. In the journal the authors looks at the nursing home caregivers and how staffing characteristics play part in influencing the quality of care. The researchers use longitudinal analysis to examine the relationship of staffing ratios and quality in caregiver nurses. They further instigate how staffing levels influence the mix of staff and turnover agency among the caregiver nurses. Thus, to carry out their study, the researchers use data collected surveys of nursing home administrators, online survey certification & reporting data, and Nursing Home Compare data from about 2839 hospital facilities collected between the period 2003-2007. The conclusions and recommendations are that nursing homes that focus in improving staffing characteristics also in the same way changes or improves the quality of care, which translates to better health outcomes for the patients. Therefore, this journal is recommended because it elaborates well the linkage between the quality of care and nurse staffing. Spilsbury, K., Hewitt, C., Stirk, L., & Bowman, C. (2011). The relationship between nurse staffing and quality of care in nursing homes: a systematic review. International journal of nursing studies, 48(6), 732-750. The authors focus on the influences that impact the staffing practice, experiences, care, management and training of staff. They explore clinical outcomes, important methodological lessons to be considered in the future; nursing workforce as well as the quality of care in the nursing home environment. The researchers through their research demonstrate that inadequate staffing ratios and skills mix have a positive correlation to poor care and health outcomes. The author use secondary data sources from published reports examining the levels of nurse staffing and the quality of care in homes. For this reason, the research sampled 13411 references from 83 papers out of which were chosen 50 after subjection to full analysis. Therefore, this journal is recommended because it elaborates well the linkage between the quality of care and nurse staffing. Flynn, L., Liang, Y., Dickson, G. L., & Aiken, L. H. (2010). Effects of nursing practice environments on quality outcomes in nursing homes. Journal of the American Geriatrics Society, 58(12), 2401-2406. The authors examine the impact of nursing staff ratios and modifiable attributes of the nursing practice on the quality of care outcomes by examining patients with pressure ulcers and deficiency citation numbers in nursing homes. The research employed a cross-sectional design to survey a sample size of 340 RN that provided resident care directly from 63 Medicaid and Medicare certified homes. After analysis, the researchers found out that no association eisted between staffing ratios and the quality indicators. However, the researchers discovered that conducive environments that support the nursing practice created by the administrations of nursing homes were critical to the nursing practice. Therefore, this journal is recommended because it elaborates well the linkage between the nursing environment to improving the quality of care and the practice. List a minimum of four keywords that you used for your search and the databases you used to perform your search Nurse Staffing Ratio (UMUCs library) Quality Outcome (UMUCs library) Long term care (UMUCs library) Nurse Staffing (UMUCs library) Part 2 Literature Review The issues of linking nurse staffing and the quality of patient care are still tantamount since there are no individual parameters that can be deployed to ascertain the relationship between the two elements and how they influence each other. Spilsbury et al. (2011) illustrates that the level of services that nurse’s offer in their line of duty lies solely with the administrators who are the overall custodians of the nurses’ practice. It is prudent that nurse’s work under the instruction of their leaders and thus all major decisions as far as patient care is concerned come from the managers. The administrators influence the quality and level of patient care rendered since they are responsible for developing the nursing system at each unit or rather workstation to serve the patients (Spilsbury et al., 2011). The composition or rather nurse staffing structure that the administrators will adopt will be influenced by a number of factors, for instance, budgetary consideration is very crucial. The nursing operations in any health facility work under an individual budget thus the administrators ought to compose the nursing system bearing in mind the budget that has been allocated for that function. Likewise, other ramifications in the nurse labor market might affect the composition of the nursing system. Case in point the administrator might have been allocated funds sufficient to hire, for instance, twenty nurses per unit for a period of six months. But due to the dynamism of the labor market the rates per nurse changes and thus the funds becomes insufficient. The administrator will have to cut off some staff to work within the budgetary allocation. In such a situation, the nurse staffing will have been reduced due to unavoidable circumstances. However, Spilsbury et al. (2011) goes on to argue that nurse staffing is not only about the number of nurses that are working in a particular section or rather attending a certain number of patients. The number of hours assigned to each nurse plus the levels of support they receive is very crucial in determining the kind of services they offer. Case in point a nurse might be working for a shift totaling to eight hours may be attending six to ten patients. However, despite the considerably long working hours that he/she may be subjected to if he/she receives the necessary support whenever he/she requires it is evident that the level of service that he/she will be discharging will not be compromised but will improve due to the kind of support that he/she receives from others. Apart from fatigue there are other factors that will ultimately influence the kind of services that a nurse offers to a patient in an ideal setting. The level of skills and know-how in the nursing field is a crucial element. A nurse who is conversant with his/her duties will not compromise the kind of care he/she will be discharging to the patient despite the circumstance he/she is working under. The experience gained in the field enables informed decisions to be made that will always be aimed at improving the kind of care that the patients receive. Conventionally, the quality of care services that an experienced nurse offer will not be comparable to those of a newbie by virtue of the knowledge gained in practice. Relatively, the quality of decisions that a nurse will make while fatigued will not necessarily be compared to those while under normal working conditions. It brings to the argument of Spilsbury et al. (2011) that nursing support is crucial and influences the level of service more than staff composition and the number of hours worked. Flynn et al. (2010) illustrates how cynical it is for the same nurse to offer different levels of services in different settings. The degree to which nurse staffing and the quality of patient care relate with each other cannot be merely attributed to the simple elements of staff number of the number of working hours that the workers is subjected to in their shifts. Other issues such as the level of morale and motivation that the nurses also receive plays an important part in determine the kind of care they offer their patients. It is prudent that some nurses’ work for voluntary organizations under very severe conditions but the overall quality of service that they provide is exceptional reason being the motivation and self-drive that they developed for their job ensured they gave their best. However, the element of money also comes into play in a very compromising manner in that when the patient is well of the quality of nursing services tends to differ as compared to when the patient is reduced. Circumstances of this case are isolated cases that are as a result of a nursing staff that has lost touch with the principle of nursing or rather the job in general. It is safe to call such practitioners quacks since they do not represent the real face of the nursing fraternity since the primary purpose of nursing is to provide care irrespective of the affiliations of the patients. There is evidence of these practices, but there is no single empirical research that has linked the social well-being of a patient to the quality of care that he/she receives in the same setting (Flynn et al., 2010). Flynn et al. (2010) goes on to argue that the issue of comparing the levels of nursing staffing with nursing practice are premature and cannot be satisfactorily be elaborated since the composition of the nursing systems has many factors that can influence the overall practice. Thus, Flynn et al., (2010) counter argues that there is no direct link between staff levels and the quality of service since there are a number of ramifications that affect the composition of nursing staff alone. As much as different staffing levels will provide varied service quality to the patients the composition of the nursing staff is more crucial to influencing the level of care that patient receives than summing up the entire issues understaffing levels. A nursing unit might be assigned with twenty nurses to oversee only two patients, but still inadequate services might be experienced. Nursing is a holistic practice that involves an inner drive to perform not being coerced or rather forced to perform those duties. The level of motivation and self-drive plays a critical role in determining the quality of services that the patients receive. If the nursing staff is composed of a team of well-coordinated members irrespective of their number teamwork and consistent support of each other’s roles will result in exemplary results as opposed to a large nursing staff that has uncoordinated members some who lack the prerequisite skills to handle patients’ needs adequately. Thus, it is better to link nursing practice in general to the quality of service that patients receive since the deliverables within the nursing staff will have been factored out. Spilsbury et al. (2011) concurs with Flynn et al. (2010) as he argues that there are a number of factors that influence staffing practice that, on the other hand, go to the effect the overall level of nursing practice. Experience is very crucial in nursing since the care that patient X received due to an individual problem will inform the nurse the kind of care that patient Y will be accorded who depict similar symptoms. It also acts as a learning situation since a nurse will constantly be improving his/her skills since the past encounter will enable informed decisions to be made in future thus improving the overall quality of service. Different health facilities have varied philosophies, and this greatly influences how patients are handled. Sometimes it is difficult to link directly the quality of service that patients receive to the nurse sine the policies of the health center plays a crucial part if determine the same. Conversely, some health institutions and mere profit making organizations whose sole mandate is to generate revenue, thus they have not instituted any structures to monitor how the patients are handled and the level of services that they receive. In such situations, the nursing staff will be uncontrolled, and thus the decisions that are made will be arbitrary since they are not subject to any liability of responsibility. Failure of the health facility to institute care management structures will cause unruliness within the institution that, on the other hand, will result in the low quality of service being rendered to patients. It is worth noting that facility might be well equipped in terms of staff but still quality of service issues arise due to the management’s failure to come up with policies that protect the services offered to their clients (Spilsbury et al., 2011). Castle and Anderson (2011) reiterates that in the context of nursing home caregivers staffing is critical in determining the overall quality of care since issues such as turnover, professionalism, and staffing levels will affect service delivery in one way or the other. For instance, if in a given day three of six nurses mandated to provide care in a particular subunit do not show up it means the other three will have to perform duties meant for six nurses. Typically, it is evident that they will be trained to an extent whereby they will not be able to satisfy adequately the patients’ needs of all clients and thus the level of care will be jeopardized to some extent. Relatively, despite a nursing staff being equipped with an ideal number of practitioners the level of professionalism that is depicted by individual members will influence the quality of service. It is because efforts made by dedicated and disciplined nurses will be overridden by mistakes made by one of the two unprofessional nurses that may be among the group. In this case, it is prudent that despite the right nurse staffing ratio being in place professionalism of the members influenced the quality of service that was provided to the patients. Conclusion and Application Based on the discussion above it is prudent to note that still there is no clear link between nurse staffing ratio and the quality outcomes from nursing practice. Nurse staffing has a number of parameters that individually influence the overall quality outcomes and thus it cannot be generalized that the level of staffing has a direct link to quality issues. Thus, the study should serve as a benchmark for future research work that will be aimed at refining the subject further to elaborate the parameters that influence quality outcomes as a result of nursing practice as far as nurse staffing is concerned. Similarly, results from such a study will be handy for decision makers in the nursing sector as it will assist them to come up with the right mechanisms for staffing to ensure the quality of service is not compromised. Some of the sources tried to make a link between two aspects but it was evident that Nurse staffing is composed of numerous elements whereby a change in one will affect the overall outcome of the work of the entire team and thus it cannot be generally be blamed on staffing, but the element should be isolated from the primary influence of the same. The study has attempted to bring out meaningful insights that will be vital to encourage more research work on the same subject to extensively explore the topic conclusively to come to a collective agreement to the extent to which nurse staffing influences the quality of output. The study is ideal as it provisions can be implemented in the field of nursing to assist in the development and selection of nursing staff in accordance to meeting quality objectives in an organization. Read More