Quality care in the context of nursing shortage

Inadequate Staffing in Nursing

Explain the nursing/patient care concern, problems, issues observed at the senior level clinical practice

During the past decade, there certainly has been a rapid decline in quality patient care in the healthcare industry. This has been proven by cutting down the staff in hospitals, nurses working overtime along with quite a steeped nurse to patient ratio. The hospital staffing issue has driven great controversies. On the up side, hiring down nurses from the hospitals results in expanding costs and training them in return, while on the down side, cutting down staff results in unattended patients, which tarnishes the reputation of a hospital. The economy has been on a roller coaster ride since the last five years or so. The hospitals, private insurance companies and healthcare industry are head over heels with monetary crisis at helm. Thus, hospital works with least staff. The power struggle between hospital management and nursing staff continues as always. These conflicts have been seen in many researches and journals and one particular problem lies at the core. Nurses have significant influence on patient care. These researches have different centers as some are based on job discontentment, patient mortality rate and unemployed nurses. The researches have however found a significant connection between nurses vs. quality of care provided.

Public Health School in Harvard University conducted a research worked out a relationship between nurses registered vs. six end results. The end results consisted of measuring:

Duration of hospitalization

Number of urinary tract infections

Gastrointestinal bleeding

Pneumonia

Heart attack / cardiac arrest

Rescue failure

The researches made use of 799 hospitals from 11 states from different parts of USA. They were alert enough to keep their studies to hospitals with average staff level and neglected hospitals with exceedingly high number of employees and lowly staffed hospitals.

The end result of the research showed that there was a positive link between care a patient received from a nurse registered vs. rate wherein they experienced any of the above six factors. The more hours dedicated to the patient resulted in least amount of these factors occurred (Needleman et al., Nurse-staffing Levels)

Yet another research was conducted completed by the very same Harvard University researchers mentioned above, noticed another angle to this case. In a research, the researchers observed a huge academic medical center with 197,961 intake and 176,696 shifts taken by nurses in 43 hospitals. The aim of the research was to work out a relationship between lowly staffed nursing shifts and patient mortality rate. The researchers researched on the mortality rates of patients and the turnover rate, which includes admission, discharges and transfer to other hospitals.

The researchers came to the conclusion that with the depleted staff in a particular hospital resulted high patient mortality rate. In line with the research, the link between patient turnover rates vs. elevating patient death rate was hard to let go of. This in turn means that if rate of patient intake is high then rate of patient neglect will be subsequently higher too. Lessening the ratio of patient-nurse will also result in growing number of patient death cases due to negligence. Apart from that, it means that hospital needs to be properly staffed to curb down patient deaths (Needleman et al., Nurse Staffing and Inpatient).

Another research was done published in American Medical Association Journal which was done on 168 hospitals situated in the city of Pennsylvania. Their conclusions confirmed the ratio of patient mortality rates and patient-nurse ratios, job discontentment and nurse's fatigue.

In the 168 healthcare settings were taken in this research, the patient mortality rate was directly proportional to patient-nurse ratio. The study had sparkling results at its disposal for instance:

For every nurse for a patient, the rate of a patient from neglect and lack of care was nearly 7% in a month's time

Similarly, there was 7% chance of failing to rescue a patient

But, apart from that, the researchers were surprised to note that nurses were vulnerable to exhaustion due to intense patient care routine driving high levels of job discontent. The percentages are given below:

For every nurse per patient, the rate of nurse exhaustion was reaching 23%

For every nurse per patient, the probability of job discontent hovered at 23%

Apart from that, more than 40% of the hospitals have nurses exhausted by their job description

The job discontent in nurse industry is four times higher than for other U.S. employees

43% of the nurses working the healthcare industry had the intention of resigning from their duties in the same year

2: Recognize one or more than one QSEN competencies which pertain to particular skills, attitudes, behavior and knowledge for a specific competency.

Connecting the dots on quality care, work environs and nursing practice is nothing out of the ordinary. All of this research work began in 1980's starting with magnet hospitals. These hospitals were termed as Magnet hospitals because their rate of employment and retention was visibly higher in a period of nurse shortage. The research showed that 'Magnet hospitals' had some bright organizational attributes which included:

Practice control

Autonomy

Open access to resources

Nurse-doctor bonding

The nurses were attracted to these Magnet hospitals in comparison to rivaling hospitals. As a result, these hospitals had elevated and quality patient care and satisfaction ratio. Rate of patient contentment was high, while the patient mortality and morbidity rate was driven below the ground (Aiken et al., 1994; Aiken et al., 2008; Estabrooks et al., 2005; Friese, 2008).

With the passage of time, the Magnet hospitals became a force to be reckoned with as 14 forces of magnetism were categorized. These characteristics are driven by organization important for driving nursing excellence (ANCC, 2013a). The present Magnet Model (ANCC, 2013b) shows cordially interacting system, process forces and structural forces which can be translated into organizational strong points such as:

Structural empowerment

New knowledge

Revolutionary leadership

Professional practice

Innovations and improvements

Empirical results

Improved end results

A better global healthcare atmosphere

Some of these forces, if not all of them are clearly given in Quality and Safety Education for Nurses. Mutually interacting systems are covered by partnerships and teams working together. Structural empowerment as well as new improvement is entailed in informatics. Finally, the inventions and enhancements are examined in evidence-based practice.

This model can work in all environments where nurses are employed in. The focal point of this model is that it generates support for professional duty. The company and office place becomes a place of innovation and splendid practice. In such a place, the nurses can possibly deliver stellar practice as they are involved in evidence-based care coordination, which includes family involvement and quality care for the patient. They can make use of newer approaches and knowledge for instance team approach for patient-based medical care homes. This shows par excellence and cuts down corporate barriers such readmitting and rushing an appointment.

3: Examine the importance of concern of nursing practice with respect to QSEN competencies.

Majority of the researches have concluded same results as mentioned earlier above. The bottom line is that understaffed hospital is prone to have high number of patient cases. In Patient Safety and Quality, chapter twenty five: The overview of this research concludes that high patient-nurse ratio accumulates in higher work load causing greater exhaustion level, depression and job discontent. Apart from that, with low staff in hospitals, the rate of patient death can be high. (Clarke et al., 2008).

Nurses are an essential component of patient care, but can't provide adequate services due to low staff. According to countless researches, it clearly shows that patient death cases rise with poor enlistment. Due to high work load sustained by the nurses, the exhaustion rate is sky rocketing, not to mention high turnover rates (Clarke et al., 2008).

Safety of patients

Registered nurses are not content with their jobs

Patient's look after takes a back seat, lessening the quality care of patients

Job description of nurses

Deliver stellar patient care

Cause of nurse resignation

Vacant nursing position

Resignations

Expected retirements

Lack of students available for the role of nursing degree to join the nursing army in the following five-year

4: Provide a brief review of literature pertaining to nursing and patient care concern, not to forget QSEN competency.

Many of the past researches have shown clear connection between registered nurses and particularly excellent patient care. Apart from that, the American Journal of Infection Control magazine in August 2012 published a research from Dr. Jeannie Cimiotti and associates noticed a rising trend in nurses with burnout cases with respect to urinary tract and surgical infections. In case of Pennsylvania hospitals, the researchers found out excessive work load shouldered by nurses. This leads to higher infection rates and inadequate teamwork and participation. Apart from that, nurse exhaustion must be reduced one way or the other (as cited in Bozack et al., 2013).

Dr. Mary Blegen and her colleagues from University of California, San Francisco published a study in Medical Care magazine in April 2011, saying that with growing number of nurses in a hospital, the coordination and teamwork among nurses also increased. This being said, quality care was delivered to the patients. Thus, least deaths, less failure to rescue cases, brief hospital admittance and low infection rates were observed (as cited in Bozack et al., 2013).

Dr. Jack Needleman and associates in March 2011, released their report in New England Journal of Medicine which shows that inadequate staffing of hospitals resulted in accumulating deaths of patients. The researchers were able to see through 198,000 patients in hospitals and oversaw 177,000 nursing shifts in a broad spectrum of 43 hospitals with average staffed nurses. The death rate of patients was 6% higher for hospitals with least number of nurses employed. 'Nurse staffing and in-patient hospital mortality' is a research in which researchers noted that, 'With rate of patients increasing, the risk of mortality also rises'(as cited in McNellis et al., 2013).

Apart from that, Health Services Research magazine of April 2010, a research spearheaded by Dr. Linda Aiken and associates concluded that nurse-patient ratio did matter in medical and intensive care units which results in less patient death cases (as cited in McNellis et al., 2013).

The International Journal of Nursing Studies magazine in the summer of June 2009, released a research headed by Dr. Koen Van den Heedestumbled upon a high number of baccalaureate-based registered nurses in cardiac-heart hospitals and hospital mortality. The research team had collected their data from some countries such as Netherlands, Canada, Belgium and USA. According to the research, there were 4.9 deaths in 1000 patients attended in emergency units which had hired nurses with a bachelor degree (as cited in Bodenheimer, 2013).

As more research is pouring through, it is now a confirmed fact that nurses armed with baccalaureate degrees are shown to be efficient at curbing down rates of mortality and keep failure to rescue in check. According to the Journal Health Services Research edition of august 2008 and Journal of Nursing Administration of May 2008 found out the existing link between patient's health and educated nurses. In order to maintain the standard quality of patient care, more baccalaureate degree nurses should be hired, thus driving down the patient death cases and negligence issues (as cited in Bodenheimer, 2013).

In the summer of March 2007, a detailed report was prepared by the Agency for Healthcare Research and Quality focusing the nurse staffing and patient care quality issues. In this research, the researchers stumbled upon a fact that, due to staff shortage, the work load was exponential which drove down the patient care quality. This meant that nurses couldn't deliver their best. With increased number of employed nurses, the patient death cases generally decreased along with failing to rescue a potential death case ratio was driven down. In any case otherwise, the patient's life was at risk (as cited in Naylor et al., 2013).

This report was published in the summer of March 2006 in Nursing Economics magazine; it's a detailed analysis of national surveys based on nursing industry. It concluded that most nurses reported that: Deficiency of registered nurses is counterproductive to patient care and lowering the quality care standards set up by Institute of Medicine and National Quality Forum (as cited in Naylor et al., 2013).

One article appearing Nursing Economics back in September 2005 issue states that according to Dr. Peter Buerhaus and colleagues, most of the registered nurses (79%) and chief nursing officers (68%) deemed that inadequacy of nurses in hospitals drove quality care into the ground. Other problems faced are (as cited in Naylor et al., 2013):

Student health centers

Ambulance care system

Long-term care facilities

Most of the registered nurses have sufficient time on their hands to report particular problems, deliver patient care, maintain safety level and work with team members (as cited in Bozack et al., 2013).

In winter of November 2004, National Survey on Consumer's Experience with Patient Safety and Quality Information released its report. It showed that at least 40% Americans deemed that hospital care had been buried in the ground during past half a decade. The clients noted that issues afflicting this scenario were stricken by (as cited in Peikes et al., 2013):