Patient Outcomes Related to Nurse Staffing Nurse to Patient Ratio Capstone Project

Excerpt from Capstone Project :

Staffing in Nursing

Staffing and Other Nursing Issues

The main topic of this paper is staffing related to the field of nursing, here it is very important to realize a correct balance between the demand of nurses and available nurses at any medical facility. Since the duty of any medical professional like a doctor requires much assistance from a subordinate such as nurse therefore it is vital for any organization to fulfill this requirement in a way that best suits all parties involved especially the patients. This paper will focus on many different aspects related to the issues of staffing and will also shed some light on some of the difficulties of keeping a low or high number of required nurses.

The emphasis here would also be on many different aspects related to staffing such as the economical perspective, the quality perspective of any medical organization and so on. The paper is divided into three main sections, in the first section the focus would be given on introduction as well as some of the negative aspects of patient outcomes or care due to insufficient nurse staffing, this would also look at the losses that the medical organization may suffer from because of these mentioned aspects. The second section will identify much of the positive aspects related to the outcomes with sufficient nurse staffing, this may include some of the benefits as well which the medical organization could attain if it maintains the appropriate level of nursing standards in itself.

Finally, the third section will address the Californian law related to patient or nurse ratio alongside the conclusion page which will summarize all of the information that we have discussed in the paper and would also give the reader an idea regarding the overall importance safety of patients in the field of healthcare.

1.2 Negative aspects related to irregular staffing and other facts

Hospitals currently in the United States are under extreme pressure to control the overall cost of its medical care while improving patient health outcomes at the same time especially with respect to a proper reduction in medical errors that might be damaging for some cases or even fatal for others. These and many more concerns including irregular staffing are on the agenda of the top decision makers of hospitals. Intuitively, anyone would expect that a higher ratio of nurses associated with patients could lead towards better patient outcomes and if this is correct then various patient benefits must be deemed as an important consideration in the overall determination of levels of nurse staffing.

It is ideal for hospitals to make their decisions regarding nurse staffing guided by proper empirical evidence, here different studies have properly examined this issue and by analyzing some of the data from more than one hundred and fifty hospitals in the state of Pennsylvania, it was determined that a cross-sectional variation related to nurse staffing levels is correlated negatively with the patient morality, this is measured as risk adjusted thirty day failure and mortality to the rescue rates.

Another analysis of different sorts of administrative data from more than seven hundred and fifty hospitals in eleven states that took over an year span concluded in finding out higher levels of staffing of nurses being directly associated with lower than average failure to rescue rates, this analysis also reported better patient outcomes alongside a variety of different specific facts such as reduction in upper gastrointestinal bleeding, rates related to urinary tract infection, cardiac arrest, pneumonia and shock cases at hospitals.

The regression analysis in the above mentioned cases gave important evidence related to cross-sectional correlations, but there are still some concerns that remain about casual relationships in all of these mentioned cases. With regard to this, there are many potential problems, two of which are as follows. The first is related to a specific type of omitted variable bias. "There is a relative amount of variation across various hospitals at the level of resources which are devoted to patient care" (Cimiotti, 2012).

The mentioned variation exists at primarily the nurse staffing but it is also found at different other aspects such as the quality and quantity of medical equipment, the proper adoption of educational efforts in order to keep the current medical staff on best practices, the efficiency related to the management practices and so on. The cross-sectional regression analysis attempts to take control of the mentioned factors but the researches in this regard have a very limited set of covariates in the beginning to work with. Therefore it is easy to assume that those hospitals which possess a relatively higher level of nursing staff also have above average level of various different positive and negative factors that are associated with patient care. Cross-sectional regression analysis tends to state the effect of high patient or nurse ratio on the health outcomes of patients.

Second problem is related with endogenous sorting. Generally it is expected that medical providers would devote relatively high resources towards patients who are statistically much more likely to show the highest effect for that attention, this includes those patients as well who are at much greater risk with regards to the adverse outcomes. Example here includes the expectation of high mortality rates on those medical units which have high nurse or patient ratios.

A researcher could attempt to take control over the severity of the medical conditions of patients but this practice is extremely difficult to do considering what is available as data. Here, the researchers would usually underestimate the vital beneficial impact related to higher nurse-to-patient ratios at the patient outcomes. Concerns somewhat related to these belong to the evaluations which are based upon hospital-level paned data, therefore the hospitals which experience improved and better nurse staffing levels may well be increasing their resources alongside other factors which are unobserved. Converse to this, those hospitals which increase their levels of nurse staffing may well be doing that because of an increase in the levels of their patient's general acuity levels which might also show signs of improvement in the overall health of patients.

An appropriate response towards these mentioned concerns is for researchers to do a search for shifts to nurse staffing that are exogenous and then use that variation for the exploration of the affect on patient outcomes. Though true exogenous variation might not be available for this procedure but there are various other ways to figure out the so called natural experiments for the purpose of generating plausibly exogenous changes at the nurse-per-patient ratios.

A good example here is related to the identification strategy, which is used to utilize natural variation that occurs at hospital admissions, this in turn create variations at patient loads. Using this approach, it is found out that those patients who are admitted when their patient load is high have a greater mortality, but effects are calculated to be relatively small and therefore are not significant statistically in different specifications.

It is acknowledged that the mentioned interpretation is very difficult since it has no independent data which deals on how hospitals might deal with situations where a sudden influx of patients occurs, therefore if the hospitals respond by providing overtime shifts to its nursing staff then the ratio of nurse to patient might not change much in case where there is any sort of surge in the hospital for admissions.

This paper will also provide an analysis which exploits a sort of exogenous shock for the nurse staffing so that the relationship between patient outcomes and nurse staffing is studied in more detail, here the California Assembly bill 394 will also be analyzed which mandated the optimum amount of patients per nurse at any given hospital setting. When this law was passed, some of the hospitals had the appropriate staffing figures as related to nursing whereas others did not have their nurse staffing according to the mandated standards proposed by the bill. Therefore changes in staffing ratios at the hospitals from pre-mandate to post mandate time is partially because of this legislation.

Here are some of the other facts associated with nurse to patient ratios, according to federal law the nurse to patient ratio at any given health facility should be 1:1 at the main operating room, at intensive care, neonatal intensive care units, critical care, labor and delivery units and at post-anesthesia recovery departments it should be 1:2, at general medical-surgical units it should be 1:5. The main factor which makes the law hard and controversial to implement for hospitals is that it requires those facilities to be in a state of continuous compliance with the ratios.

This means that the amount of patients designated to each nurse must not exceed the ratio during any given time interval of the nurse' duty or any of its shift. This also means that if the nurse has to take a break for the restroom then even in that scenario it has to reassign its patient to any other nurse available on duty at that time. Since…

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