A Model of Minimum Nurse-to-Patient Rations in Victoria, Australia - Literature review Example

CRITICAL ESSAY: RESAERCH ANALYSIS STUDENT NAME PROFFESSOR’S NAME COURSE TITLE DATE CRITIICAL ANALYSIS RESEARCH RESEARCH PAPER: 5-20: A Critical Review of Gerdtz, Gdaet and Nelson (2007) 5-20: A model of minimum nurse-to-patient rations in Victoria, Australia. Journal of Nursing Management 15, 64-71. The study by Gerdtz, Gdaet and Nelson (2007) was conducted after the introduction of the 2001 legislation that provided for the minimum nurse-to-patient rations in the large public hospitals that exists within the state of Victoria. The main component of the Model is that for every 20 patients at least five nurses will be available to handle their needs in the surgical and acute medical wards. The main aspect of the research was whether the skills of a nurse, dependency of patients and workload management affects the outcome of health care services that are provided by the hospital. In their analysis, a comparison was drawn from the California patient-nurse ratio model on whether it is successful in the provision of health care. The nurse –patient ratio has ensured that the health care given is of a high quality and efficient (Hurst 2002). This model of health care system adopted in Australia is universal in structure where the providers of health care services operate on fee for the service offered basis but they are indemnified by the Medicare system. The nurses that are employed are also highly regulated by legislation or Acts of Parliament and protect the registered nurses and the recruitment of nurses. The health care system according to Gibb (1998) is very complex due to government regulation in relation to derivation of income and funding of hospital activities. It is therefore upon the nurse in charge to balance work allocation to ensure that maximum work hours are effectively utilized to make it more economic friendly and avoid mishaps within the workplace. Further, the professional qualifications of nurses have an impact on the outcome since a ‘quack’ cannot purport to take care of a patient. The study type adopted involved the collection, analysis and the integration of qualitative and quantitative study coupled with literature review. In Gerdtz et al (2007) anecdotal evidence was used to support the 5-20 ratio model with a study of both the Victoria and California and the study of the Trend Care Patient and Acuity and Care Management System (Trend Care Pty Ltd 2004). The research also used data obtained from the USA by Aiken et al (2002) that determined between nurse-patient ration and failure to rescue, morality and factors that are linked to nurse relation. The data that was obtained from the study carried out in 168 different non-federal hospital indicated that at least 7% of the of every patient that was added to a hospital had averaged the hospital nurses workload. That is the more the patients are assigned to a given nurse the higher the nurse increased productivity. Literature review was also an important research element since it was important for Gerdtz et al. (2007) to show the gap that exists in research in relation to nurse-patient ratio. Gerdzt (2007) also highlighted the evaluation conducted by McGillis et al (2004) that studied the influence of skill mix that focused on whether a nurse is licensed or unlicensed workers and on patient safety outcome. The skill of the nurse directly affects how they take care of wounds, urinary tract infection and whether they make errors that relate to medication. Skill is a crucial element in the determination of whether the health care system works or it faces criticism for failing to adequately give medical care. The outcome stated that high incidence of medication errors and wound infection is experienced when there is a lower mix of professional nurses. The term skill mix in the study refers to the ‘mixing of posts within the hospital, mix of employees in a post, combination of skills at the specific time or the combinations of activities that compromise each role.’ (Buchan et al. 2001 p.33). Skill mix within the health care system is closely linked to the elements of skills that are obtained by nurses, unlicensed workers, the levels of appointment of a nurse, education and relevant training. This therefore means that nurses that are assigned to patients is not random but takes into account the relevant skills necessary to ensure that the patient gets maximum care and attentions. In the study, it was highlighted that the Australian health care system had experienced cost reduction in the early 1990s and due to economic fiscal measures and shortfall of nurses in the labour market resulted in a nationwide shortage in the labour force. This led to the resignation of nurses from the public health care system since they were incapable of meeting their professional and legal responsibilities to ensure better care and safety within the workplace (Barnet et al. 2004). In the wake of the 5-20 nurse patient ratio, the previous ration was fixed at 1-4 on both the morning and the afternoon shift in major hospitals in the medical and surgical wards. The benefits of the nurse-patient rations according to Gerdzt et al. (2007) is that it is quite responsive to any fluctuations in the status of a patient status, the handling of emergencies as well as the unit workflow within the hospital. The other benefit is that the 5-20 model has played a role in the decision making process since the unit manager with authority to appoint nurses according to the skill mix and staffing needs to ensure better health care service. This ensures that the burden within the workplace is balanced and shared equally amongst the nurses. The success of the 5-20 models depends on the proper classification of the patients who seek medical care by their level of acuity by the staffing managers. The measure of patient acuity is determined by the risks involved, the skill mix and the complexity of the care that is necessary for the patient (Van Slyck 1991 a, b). The decision made in relation to staffing within the health care system is dependent on the length of stay, the unit geography , discharge, transfers, competency levels , the doctors practice patterns and clinical judgment (Slyck 2000). It is also important as stated in the study that the categorization of patients is important in determining the success of the5-20 model since it gives managers and opportunity to determining how managers make the informed decisions about staffing. The research classifies patients into the task type (criterion based or summative) or process oriented. A comparative study between Victoria and California was also undertaken. In the state of California a similar nurse-patient relationship was also introduced (Spetz 2004) in 1999 that limited the number of nurses to a minimum of one nurse for six patients. The difference identified is that; the USA model is iterative since it is flexible and that the nurse in charge can increase the number of nurses depending on the patient acuity and unit workload compared to the Victorian model that is static. Further, the USA model allows the use of unlicensed workers to increase the hours of care while the Victorian model depends mainly on recruiting nurses from the regulated work-force. In regards to examination of the impact of ration variability, the researchers state that there is no adequate report that supports the ratios that are currently adopted (Bolton et al.2001). Despite the fact that the legislation has been tremendously successful in catching the attention of nurses into getting back to work in the public sectors, there has been no reported or published work to show that the specific ratio exists through empirical evidence. Moreover, neither ratio nor Patient Dependency Systems advancement had accounted for the significant influence of skill mix on hospital, employee, or patient outcomes. The gap in research in the 5-20 relationship does not adequately state the relationship that exists between the rations, skill mix and clearly defined quality indicators. It is difficult to prove through anecdotal evidence in determining the accurate number of nurses that are needed at a given particular time and in any given hospital setting (Shuldham 2004). Gerdzt et al. (2007) have also highlighted that the 5:20 nurse-patient ratio no research has been conducted in relation to the costs and consequences of the ratio of staffing. This therefore means that there is no empirical evidence of whether the ratio optimizes resources and the quality outcomes of the model adopted within the state of Victoria. The authors conclude that there is need to urgently further research that specifically analyses the relationship between models of staffing, quality outcomes and skill mix. Further Gerdz et al (2007) state that health services that relate to patient outcomes and staffing has been poorly developed since the health service sector is regulated by professional nurses with an opportunity to effectively study the effects of staffing and skill mix in relation to the outcomes experienced within the workplace. There is also little research that centres on the empirical work of patient-nurse relationship within the micro-levels or macro –levels to ensure that there is an improvement in the health outcomes. The patient-nurse ratio is also a tool that measures implications on labour force learning. References Bolton L.B., Jones D., Aydin C.E. et al. (2001). A response to California’s mandated nursing ratios. Image Journal of Nursing Scholarship 33 (2), 179–184. Buchan J., Ball J. & O’May F. (2001) If changing skill mix is the answer, what is the question? Journal of Health Service Research Policy 6 (4), 233–238. Gibb H. (1998. Reform in public health: where does it take nursing? Nursing Inquiry 5 (4), 258– 267. Hurst K. (2002). Selecting and Applying Methods for Estimating the Size and Mix of Nursing Teams. Nuffield Institute for Health. Leeds University, Leeds, UK. McGillis Hall L., Dorna D. & Pink G.H. (2004). Nurse staffing models, nursing hours and patient safety outcomes. Journal of Nursing Administration 34 (1), 41–45. Spetz J. (2004). California’s minimum nurse-to-patient ratios. The first few months. Journal of Nursing Administration 34 (12), 571–578. Trend Care Pty Ltd (2004). Trend Care Patient Acuity and Care Management System. Available at: http://www.trendcare. com.au [accessed 19 April 2006]. Van Slyck A. (1991b). A systems approach to the management of nursing services: Part II. Patient classification system introduction. Journal of Nursing Management 22 (4), 23–25. Van Slyck A. (2000). Patient classification systems: not a proxy for nurse busyness. Nursing Administration Quarterly 24 (4), 60–65 Read More