Dr. Majid Al Maqbali Staffing Levels Sept 30 DHA Dubai
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Dr. Majid Al Maqbali Staffing Levels Sept 30 DHA Dubai

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This presentation discusses the results of a qualitative study done in Oman to determine nurse staffing levels in the ICUs.

This presentation discusses the results of a qualitative study done in Oman to determine nurse staffing levels in the ICUs.

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  • 1. Perceptions of ICU Stakeholders toward Nursing Staff Levels in Omani Hospitals: A Qualitative Case Study Dr. Majid Al Maqbali, RN, DHA Director of Nursing & Midwifery Affairs MOH(HQ) – Sultanate of Oman
  • 2. Outline  Background  Problem statement  Purpose  Why qualitative case study?  Theoretical framework  Research questions  Data collection  Results  Findings  Implications  Limitations  Further studies
  • 3. Background • Studies examining the relationship between nurse staffing and health outcomes strongly support the importance of effective deployment of nursing resources. • High nurse staffing and an effective skill mix are associated with improved patient outcomes (RCN, 2010) • A strong link between quality of care, patient safety, and nurse staffing (Spetz, 2004). • Policies and regulations requiring an increase in the number of nurses would reduce the risk of medical errors (Spetz, 2004).
  • 4. Background • Skill mix of nurses, not merely the number of nurses, strongly influences patient outcomes. Despite poor nurse staffing levels, positive patient outcomes could still be attained (Blegen and Vaughn, 1998) . • If nurse managers are well-prepared in their human resource planning and conduct adequate staffing projections, cost savings occur. • A higher ratio of nurses is associated with reductions in cost and length of stay (Wiest et al. 2009). • The adequacy of registered nurses can also prevent unnecessary stays and reduce the possibility of cross infection of other patients that may lead to costly adverse effects (AHRQ, 2004).
  • 5. Background • There is significant disagreement about the best way to determine an appropriate number of nurses. • Nurse job satisfaction, organizational commitment, and intent to leave/stay were interconnected. • A significant relationship between ineffective deployment of nursing resources and negative patient and organizational outcomes. • When determining an appropriate level of staffing, the RCN (2010) recommended healthcare leaders incorporate staff involvement, triangulation, and regular performance reviews.
  • 6. Problem Statement  Excessive Nursing workload in ICUs  Leaders Fail to anticipate the significant impact of:  low staffing levels  deployment and utilization  excessive workloads
  • 7. Purpose Statement Explore the perceptions of ICU stakeholders regarding high nurse workloads in critical care units in Oman
  • 8. Why Qualitative Case Study?  Explore a problem and gain further understanding  Excessive ICU workloads are poorly understood by Omani healthcare leaders  Confusion about the severity of the ICU nurse shortage  Empower and sacrifices personal interests to others
  • 9. Why Qualitative Case Study?  Prior studies have not measured ICU stakeholder perceptions about the study problem  Allowed exploration and understanding of the reasons contributing to excessive nursing workload  Data were collected by means of in-depth individual semi-structured open-ended interviews
  • 10. Research Questions  RQ 1 – How do stakeholder perceptions differ regarding the severity of the intensive care unit nurse shortage in Oman?  RQ 2 – What factors contribute to excessive nursing workloads in Oman’s intensive care units?  RQ 3 - How can Omani healthcare leaders improve the management of nursing workloads in intensive care units?
  • 11. Theoretical Framework  Taylor's Scientific Management Theory o To replace the “rule-of-thumb” o To select, train, and develop each employee scientifically, rather than promoting a worker's self-development. o To provide continuous supervision and performance appraisal o To separate the work between supervisors and employees  Virtually synonymous with maximization of the use of available nurses in hospital wards or units
  • 12. Population and Geographical Location  ICU stakeholders representing Royal, Khoula, and Sohar hospitals  The population of ICU stakeholders included clinical and non-clinical workers (nurses, physicians, and hospital administrators)  21 ICU stakeholders were interviewed.  Stratified sampling  Inclusion and exclusion criteria
  • 13. Data Collection  Pilot study o Rustaq Hospital o A convenience sample of five volunteer healthcare stakeholders o Fit within the sampling frame and willing to provide timely feedback on the study’s interview questions. o Data were not included in the results of the main study
  • 14. Data Collection  Main study  Semi-structured open-ended questions  Face-to face interviews (scheduled for 60 minutes)  Multiple stakeholders from different hospitals strengthened the validity of the study’s results.  Digitally recorded and transcribed for accuracy  Participants re-read and checked what they said  Participants were able to provide feedback on a draft copy of the final case study
  • 15. Data Collection  Three coders  After identifying open-ended themes, coders categorized responses  Category frequencies were determined.  A Cronbach’s alpha was computed to determine an inter-rater reliability score.  The study’s coding produced a Cronbach alpha of .91 which was considered reliable
  • 16. Data Analysis  Pilot study  Interviews were digitally recorded and transcribed  Five of the seven pilot study questions were retained without any phrasing changes  Two questions were revised for phrasing  Two new questions were added
  • 17. Results – RQ1 (Severity of the ICU nurse shortage)  RQ1 was supported: 81% indicating ICUs are inadequately staffed  Institutional Perceptions: Sohar Hospital expressed highest level of concern (100%)  Role Perceptions: 83% of Hospital Administrators, 78% of nurses, and 50% of doctors did not believe there was an adequate number of ICU nurses
  • 18. Results – RQ2 (Factors contributing to nursing workloads in ICUs)  RQ2 was supported: 74 comments, three main themes emerged:  Shortage of ICU nurses  Shortage of support and resources  Distractions  Nurse Turnover:  Negative working environment  High workloads  Unpopular shifts  Communication, compensation, and hospital policies
  • 19. Results – RQ3 (Suggestions for improving ICU nurse workloads)  RQ3 was supported  More experienced ICU nurses  Increasing the availability of support staff, resources  Revising hospital policies  improve pay  More education and training  Increase recognition
  • 20. Implications (Health Vision 2050)  Nursing and midwifery human resources: the need for an adequate number of skilled nurses  Positive practice environments : the importance of career pathways (promotions, pay increases, and professional recognition) for nurses.  Access and quality of education: the importance of offering multiple and convenient modalities of professional development programs that includes face-to-face, e- learning, and distance education
  • 21. Implications (Health Vision 2050)  Scaling up capacity of nursing and midwifery: the need for ICU nurses to be specialized practitioners with a post-basic certificate  Strengthening regulatory capacity : the importance of nurses receiving a minimally acceptable level of education so they are licensed, certified, and/or baccalaureate trained nurses.  Research : the importance of using evidence-based practices when managing Omani ICUs
  • 22. Limitations  Self-reported perceptions of 21 stakeholders at three major hospitals in Oman  Study participants were limited to health administrators, doctors, and nurses  The study’s principal researcher was a senior leader in the Ministry of Health  Face-to-face interviews may have influenced the candor and openness of study participants
  • 23. Further Studies  Identify the types of ICU nurses required to work  Conduct an educational needs assessment  Develop the best career pathways, financial incentives, and educational programs for nurses in Oman  Align all workforce initiatives within the framework of the Health Vision 2050 recommendations
  • 24. Thank you!