Nurses on Staff at Any

¶ … nurses on staff at any particular time has an impact on patients expected length of stay (LOS). The study was conducted to resolve the question of how much, if any, impact was affected by more or less number of nurses on staff. The reason this question is important to the field of nursing is that there are a number of hospitals currently looking to cut the costs of doing business and one of the areas that administrators are looking to cut is the number of nurses on staff at any one time. Other studies have shown that this approach to cutting expenses can actually backfire, with the end result being a longer LOS on average, therefore costing the hospital additional dollars, not less.

Study Purpose

The purpose of the study is to determine whether the level of nurses on staff affects the deviation of patient's length of stay from the expected length of stay, and to what degree. The study's purpose was also to verify previous studies that found that the level of nursing care was a factor in the average length of stay for various patients.

Research Question

The research question is whether a higher level of staffing would positively affect the deviation of the patient's expected length of stay, and if so, would the deviation mean that lowering the number of nurses on staff would have a negative effect on the same deviation.

Hypothesis

Some experts would say that the global economy is currently in crisis, and it would seem likely that many individuals, institutions, business and government entities are all looking to cut costs as much as possible. This is certainly true in a medical industry that has through the last couple of decades been one of the leading industries in terms of rising costs. Many hospital administrators are faced with the task of determining how to cut costs, and one of the areas most likely to face cutbacks is the number of nurses on staff. The common thought is that a fewer number of nurses can still handle the same workload and a higher number of patients under care. What might not be considered is that with a higher number of nurses on staff, patients receive more and better care, therefore their stay in the hospital is shorter than expected (which would cut costs). The study's hypothesis is that "greater nurse staffing, as measured by HPPD, skill mix, and expertise will be associated with a higher deviation from expected LOS (ie; the patient will be discharged sooner than expected)" (pg. 157).

Study Variables

The study's variables include the relationship between the various nursing staff levels and the length of stay and deviations in the length of stay of the patient(s). The independent variable is the staffing level at various times. The independent variable can then be measured to determine the dependent variable that is the deviation of the expected length of stay.

Other independent variables were measured in regards to the care provided by the nurses on staff, those variables included; the skill mix of the nurses as defined by The National Database of Nursing Quality Indicators (NDNQI), the skill mix of the nurses and the nurse's expertise.

Theoretical Framework

The theoretical framework that was used was that in theory the lower number of nurses on staff would automatically result in a lower cost to the hospital. Since one of the most controllable expenses is salary and wages, the theory is that if you lower the number of hours worked by the average nurse (assuming that the nurse is paid hourly) then the result would be less cost to the hospital. The conceptual framework used in the study is that there is a "direct relationship between structure and outcome (and even more specifically) structure components are linked directly with process and outcome" (pg. 155). Other studies have shown that there is a link between the structural characteristics of the care setting in regards to influences on the process of care, which in turn produces outcomes. This study seeks to show the direct relationship between the two, rather than the indirect relationship.

Literature Review

This study took a somewhat unique approach to determining what affects a lower number of nurses on staff has on a deviation for expected length of stay (LOS) in a hospital.

Other research has focused primarily on the length of stay, not on the expected length of stay. The difference between the two approaches includes the fact that previous studies have shown that there is a difference in the quality of care and the length of stay in the hospital, but this is one of the first studies to take into account the expected length of stay and the deviation based upon the quality of care and the number of nurses on duty. Other studies and the literature that is derived from those studies presents findings that include; "increased nurse staffing levels have been linked to a reduction in several patient complications, including mortality rates" (Aiken, Clarke, Cheung, Sloane & Silber, 2003; Needleman, Buerhaus, Mattke, Stewart & Slevensky, 2002; Sasichay-Akkadechanunt, Scalzi & Jawad, 2003; Tourengau, Giovannetti, Tu & Wood, 2002). The literature shows the positive aspects of higher nursing numbers on staff as shown by the lower mortality rates, as well as other positive affects including length of stay. However, this study was conducted in order to determine the deviation from the expected length of stay, not on the length of stay itself. This particular aspect had not been considered in other previous literature.

Study Design

The study's design was quantitative in nature and appropriate because the measurements were statistical and verifiable by categorization. A specific number of nurses would always be on staff, there would certainly be enough patients admitted and discharged throughout the course of the study and the expected length of stay would be based on specific circumstances. As with any study, there were a number of threats to the validity of the findings. Those threats were both internal and external in nature. The internal threats were that the nurses who participated in the survey were biased. This is almost certainly true, due to the fact that nurses know that their jobs are in peril, and would answer the questionnaire accordingly. Additionally, the study would have to take into account that the expected length of stay is not a concrete measure, but it is one that is subjective based on the doctor's opinion, the nature of the illness, how severe the illness is perceived, and the exact diagnosis.