Effects of Short-Staffed Nursing in Emergency Rooms

Introduction

The emergency departments efficiency is a critical component of delivering quality and safe care within the health sector. The utilization of the emergency department significantly increased minus the corresponding increase in the available emergency services (Ramsey et al. 2018). As a result, to attend to the increased demand, it is proper to evaluate the various factors contributing to care delays (Schull et al. 2003). Scholars have established multiple hospital features associated with worse emergency rooms or emergency room time on ambulance plus emergency room crowding, hospital occupancy, the proportion of emergency department patients admitted, treating Physicians level of training, elective surgical admission number, socioeconomic status of the neighborhood, decreased nurse staffing, access to expedited diagnostic testing, and hospital occupancy.

However, there is a lack of relevant data to connect hospital occupancy to overcrowding. According to Schull et al., hospital bed closures in Canada correlated with the rise in emergency room overcrowding within Toronto (Polevoi et al. 2005). Nevertheless, that finding was made in the context of concurrent changes within Torontos health services, like the closure of multiple emergency rooms (Ramsey et al., 2018). Also, some research studies seem to agree with the theory that hospital overcrowding determines the decision to admit.

Besides, it is critical to understand if bed availability impacts the disposition and length of stay within emergency rooms. Data regarding such relationships could assist in developing mechanisms for reducing overcrowding (Lucas et al., 2009). Moreover, if hospital occupancy varied with disposition, there would be a vivid indicator that hospital overcrowding results in low-quality emergency room care.

Statement of the problem

When healthcare facilities and the emergency rooms have inadequate staff, patients welfare is compromised. Also, overwhelmed staff could overlook some details or may not be fully attentive and engaged with patients. As a result, patients may be dissatisfied with the providers performance (Ramsey et al., 2018). Moreover, emergency rooms face multiple critical problems within the modern healthcare environment (Lucas et al., 2009). Simultaneously faced with growing public demand and decreasing hospital resources, emergency rooms usually undergo long overcrowding periods and extended waiting times. Reducing the delay between the initiation of therapy and the onset of symptoms is vital for enhancing outcomes for critically ill patients (Ramsey et al., 2018). Also, overcrowding pushes emergency rooms to work beyond their staff capacity, thus, leading to delays in diagnosis and treatment, affecting the quality of patient care (Lambe et al. 2003). The effect of overcrowding on the emergency rooms quality care and public health has recently received global attention, pushing for urgent calls for reform (Schull et al. 2003). Consequently, there is a critical and urgent need for mechanisms to improve patient flow to minimize the overcrowding burden with emergency rooms and enhance the general quality of emergency care.

Conversely, those supporting enaction of minimum nurse-patient ratio in emergency rooms believe that it would be able to lower nurse workloads to a manageable level, so that patient care, disposition, and evaluation activities can be accomplished within an appropriate time, hence, improving the patient flow and throughput within emergency rooms (Wiler et al. 2012). This paper discusses the effects of short-staffed nursing in Emergency Departments (Schull et al., 2003). Details include how patient wait times are affected, how patient treatment times are affected, and how patient satisfaction is affected if wait times are increased due to nurse staffing shortages.

Research Hypothesis

1. Short-staffed nursing in emergency rooms increases patients wait times.

2. The short-staffed nursing prolongs the patient treatment times in emergency rooms.

3. The increased wait times due to nurse shortage do not lower patient satisfaction.

Research Question

Central research question.

What are the effects of Short-Staffed Nursing in Emergency Rooms?

Specific questions.

How does Short-staffed nursing in emergency rooms affects patients wait time?

Does Short-staffed nursing in emergency rooms impact patients treatment time?

How is patient satisfaction affected if wait times are increased due to nurse staffing shortages?

Literature Review

Health researchers have reported connections between nurse staffing and patient care outcome and satisfaction (Polevoi et al. 2005). Nevertheless, nursing staffing and care were background variables in multiple such studies and not the main studys focus (Ramsey et al., 2018). Also, nurses are the largest group of hospital workers in charge of most patient care. Therefore, it is essential to investigate the effect of their work both on patient safety and healthcare quality (Schull et al. 2003). A developing evidence body suggests that a lack of enough nurse staffing within emergency rooms and hospitals could result in adverse events like health-care-related infections, patient falls, in-hospital mortality, and medication errors (Ramsey et al. 2018). According to Aiken et al. increased proportion of nurses with bachelors degrees and enhanced nurse staffing reduced the possibility of death among hospitalized patients within thirty days from the admission date (Lucas et al. 2009). Scholars have claimed that enough nurse staffing determines the patient surveillance quality since it enables more time for nurses to spend on indirect care.

On the other hand, the lack of an adequate number of nurses impacts patients satisfaction. For instance, according to scholars, whenever a patient has a negative perception of nursing care, it equals missed care due to a shortage of nursing staff (Polevoi et al. 2005). As a result, patients lose confidence whenever they leave before being seen (Rathlev et al. 2007). Notably, patient satisfaction data are utilized by administrators in charge of emergency rooms to track aggregate information over the period, assess the performance of individual practitioners, establish financial incentive plans, and study the interventions (Ramsey et al. 2018). According to the literature, there are six aspects of emergency care resulting in a lack of satisfaction by the patients (Schull et al. 2003). One, failure to receive help whenever needed, not being informed when one can resume normal activities, lack of information about waiting times, failure to understand when one is supposed to return to the emergency room, failure to receive an explanation of the test results, and a poorly explained problem.

According to earlier studies, an increased nurse-to-patient ratio directly enhances patient outcomes. At the same time, understaffing is associated with a rise in patient left without being seen rates and emergency room care times (Schull et al. 2003). Several teaching hospitals, safety nets, and tertiary care have suffered nursing shortages due to administrative initiatives to reduce costs by decreasing nurse overtime hours (Ramsey et al., 2018). Minus a concomitant increase in hiring, this shift has resulted in substantial emergency department nurse staffing gaps (Polevoi et al. 2005). The gaps resulted in unpredictable closure of parts of the emergency departments in several hospitals and a rise in average nurse-to-patient ratios (Rathlev et al. 2007). Scholars have established multiple hospital features associated with worse emergency rooms or emergency room time on ambulance plus emergency room crowding, hospital occupancy, the proportion of emergency department patients admitted, treating Physicians level of training, elective surgical admission number, socioeconomic status of the neighborhood, decreased nurse staffing, access...…tasks like medication administration, discharge education, vital signs, triage, and phlebotomy (Ramsey et al. 2018). Due to increased nursing delays, there is a proportionate increase in wait times; thus, more patients are left without being seen (Schull et al., 2003). The increased wait time due to staffing shortage agrees with this studys first hypothesis that Short-staffed nursing in emergency rooms increases patients wait times. Also, increased patient indoor to discharge length signifies that treatment time has also significantly increased, thus, agreeing with the second hypothesis that short-staffed nursing prolongs the patient treatment times in emergency rooms.

Consequently, the increased number of patients who left without being seen due to increased waiting time translates to dissatisfaction. Hence, it disagrees with the third hypothesis that suggests that increased wait times due to nurse shortage do not lower patient satisfaction (Ramsey et al. 2018). Patients who stay in emergency rooms for long hours without being seen are highly dissatisfied because they need prompt services.

Besides, it is possible that the level of nurse staffing impacts all the essential processes in a patients path through the room and has initially been indicated to affect patient safety. Moreover, the global shortage of nursing practitioners continues to be a challenge (Lambe et al., 2003). Lengthy and tedious hiring processes, high nursing turnover, and changes in overtime rules, among other parameters, contributed to the global nursing shortage and decreased nursing hours within emergency rooms (Ramsey et al. 2018). This study also contributes to the evidence body that nurse staffing deficiency directly and significantly contributes to the sum of patients who left without being seen and increased emergency room length of stay, which is also indicated to reduce patient satisfaction.

Conclusion

Decreased nursing hours are directly associated with an increased emergency room length of stay for the discharged patients and a rise in the left without being seen rate. This analysis is vital in establishing and guaranteeing adequate nurse staffing that optimizes emergency room quality metrics. The lack of sufficient nurses impacts patients satisfaction. For instance, according to scholars, whenever a patient has a negative perception of nursing care, it equals missed care due to a shortage of nursing staff (Ramsey et al. 2018). As a result, patients lose confidence whenever they leave before being seen.

Additionally, these findings illustrate the appropriate daily number of nursing hours for maximum benefit. Moreover, healthcare facilities that fail to keep enough nurses on duty can ruin the patients safety. Nurses that have been overworked can suffer from burnout or fatigue, which can interfere with their ability to concentrate on duty (Schull et al., 2003). Lack of focus can cause missed nursing care, medical errors, and lack of engagement. Equally, patients in an understaffed emergency room encounter a higher risk of infection, increased in-hospital mortality rate, and increased postoperative complications.

On the other hand, the same proportion of work falls to fewer nurses forcing them to work long hours within the understaffed emergency room or healthcare facility. This can result in mental breakdown and physical and emotional health challenges (Ramsey et al., 2018). As a result, sick nurses may not attend to work, worsening the staffing deficiency. Additionally, nurses constantly exposed to work-related stress can develop health complications like hypertension, musculoskeletal disorders, heart disease, depression, anxiety, and exhaustion. Further research should be conducted on the cost-effectiveness of a rise in nursing hours related to lost revenues from patients who left without being seen. Lastly, understanding the nurse staffing effect on patient satisfaction is critical for…