King Saud University
                College of Nursing




Nurse staffing and it is impact on quality of care


         ...
Nurse staffing and it is impact on quality of care


Introduction:

     Patient safety and quality improvement efforts ha...
Research questions:

Is there a relationship between nurses staffing and quality care
in KKHU?


Justification of the prob...
Slutsky J. et al (2007) assessed how nurse to patient ratios and
nurse work hours were associated with patient outcomes in...
Linda H. et al (2002) examined the effects of nurse staffing and
organizational support for nursing care on nurses dissati...
patient-to-nurse ratios, surgical patients experience higher risk-
adjusted30-day mortality and failure-to-rescue rates, a...
Mary A et al (1998) described at the level of the nursing care unit,
the relationships among total hours of nursing care, ...
Methodology:

Research design:

   The design of this study will be a descriptive/correlation
study.

Study site:

     Th...
Validity of the Instrument:


     To establish content validity the questionnaire will be review by
qualified nurse educa...
References

1- Needleman, J et al. (2006), Nurse staffing in hospitals: is there a
   business case for quality? Health Af...
7- Linda, H et al. (2002), Hospital nurse staffing and patient
   mortality, nurse burnout and, job dissatisfaction. JAMA;...
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Nurse Staffing And Quality Of Careللطالب عامر آل الري

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Nurse Staffing And Quality Of Careللطالب عامر آل الري

  1. 1. King Saud University College of Nursing Nurse staffing and it is impact on quality of care Student Name: Amer Mane AL-Rishan 426104574 Prepared to: Dr. Mohammad AL Momani 1
  2. 2. Nurse staffing and it is impact on quality of care Introduction: Patient safety and quality improvement efforts have grown impressively in recent years. Despite these gains, though, questions remain about the value of improving quality from both societal and hospital perspectives. (1) The relationship between hospital nurse staffing and quality of care continues to be a significant concern for health services researchers, health care executives, policymakers, and consumers. Several early studies that included nurse staffing as a hospital characteristic found that higher levels of nurse staffing were associated with reduced mortality. (2) Research on the relation between the level of staffing by nurses in hospitals and patients’ outcomes has been inconclusive. Whereas some studies have reported an association between higher levels of staffing by nurses and lower mortality, as well as lower rates of other adverse outcomes. (3) A shortage of registered nurses, in combination with increased workload, has the potential to threaten quality of care. Increasing the nurse to patient ratios has been recommended as a means to improve patient safety. (4) 2
  3. 3. Research questions: Is there a relationship between nurses staffing and quality care in KKHU? Justification of the problem: The results of this study can benefit healthcare policymakers and especially, nurse administrators who need evidence-based information for making decisions about staffing nursing personnel in each nursing unit and developing policy regarding nursing personnel in the future. (5) Literature review: Needleman J. et al (2002) examined the relation between the amount of care provided by nurses at the hospital and patients' outcomes. They used administrative data from 1997 for 799 hospitals in 11 states (Arizona, California, Maryland, Massachusetts, Missouri, Nevada, New York, South Carolina, Virginia, West Virginia, and Wisconsin). The study covered 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients. The results show that higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalized patients. (3) 3
  4. 4. Slutsky J. et al (2007) assessed how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes. In European countries, the findings revealed that the higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay. (4) Kunaviktikul W. et al. (2008) identified the relationships between nurse staffing, including nursing working hours per patient day; and patient outcomes of patient falls, pressure ulcers, and UTIs. Descriptive correlational design was used and stratified random sampling. There were 98 nursing units of 15 public hospitals located in the northern region of Thailand that participated in this study. The finding show statistically positive relations between nursing working hours per patient day and three adverse patient outcomes – patient falls, pressure ulcers and UTIs. (5) 4
  5. 5. Linda H. et al (2002) examined the effects of nurse staffing and organizational support for nursing care on nurses dissatisfaction with there jobs, nurse burnout, and nurse report of quality of patient care in an international sample of hospitals. Multisite cross-sectional survey was used in this study. Adult acute- care hospital in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland. The response rates ranged from 42 to 52% out of 10319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. The findings revealed that dissatisfaction, burnout, and concern about quality of care were common among hospital nurses in all five sites. Organizational /managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse – assessed quality of care. Multivariate results imply that nurse reports of low quality were three times as likely in hospitals with low staffing and support for nurses as in hospital with high staffing and support.(6) Linda H. et al (2002) determined the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention. Cross-sectional analyses of linked data from 10,184 staff nurses surveyed, 232,342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999. The results show that in hospitals with high 5
  6. 6. patient-to-nurse ratios, surgical patients experience higher risk- adjusted30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction .(7) Linda H. et al (2007) examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events. Data from the 2000 National Sample Survey of Registered Nurses were used to determine whether the qualifications of supplemental nurses working in hospitals differed from permanent staff nurses. Data was taken from Pennsylvania state. The findings revealed that the temporary nurses have qualifications similar to permanent staff nurses. Deficits in patient care environments in hospitals employing more temporary nurses explain the association between poorer quality and temporary nurses. (8) Numata Y. et al. (2006) reported a review of the literature on the association between critical care nurse staffing levels and patient mortality. The findings revealed that the impact of nurse staffing levels on patients’ hospital mortality in critical care settings was not evident in the reviewed studies. Methodological challenges that might have impeded correct assessment of the association include measurement problems in exposure status and confounding factors, often uncontrolled. The lack of association also indicates that hospital mortality may not be sensitive enough to detect the consequences of low nurse staffing levels in critical care settings. (9) 6
  7. 7. Mary A et al (1998) described at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes. The finding revealed that the higher the RN skill mix is, the lower the incidence of adverse occurrences on inpatient care units is. (10) 7
  8. 8. Methodology: Research design: The design of this study will be a descriptive/correlation study. Study site: The study will be conducted at King Khaled Hospital University at Riyadh, Saudi Arabia. Teaching hospital has a total of 800 bed and approximately 1,300 registered nurses. Population of the study: This cross-sectional descriptive study was conducted all nurses employed in King Khaled Hospital University at Riyadh at the time of study. A total of 1,300 nurses working in different departments were surveyed. The instrument: Two recording forms were used to collect data. The details of each recording form and questionnaire were as follow: 1. Daily Working Record Form was developed for the purpose of collecting daily nurse staffing data and daily patient census in each unit. 2. Selected Patient Outcomes Record Form was created to record the quality of care incidences for each nursing unit. 8
  9. 9. Validity of the Instrument: To establish content validity the questionnaire will be review by qualified nurse educators.A pilot study among the nurse who work in king Abdul-Aziz hospital university at Riyadh. Ethical consideration: Ethical codes of conduct were strictly adhered to at all stages of the project. Data analysis: The data will be entered and analyzed on a personal computer using the Statistical Package for Social Science (SPSSPC). 9
  10. 10. References 1- Needleman, J et al. (2006), Nurse staffing in hospitals: is there a business case for quality? Health Affairs; 25 (1): 204-211. 2- Barbara, A et al. (2004), A longitudinal examination of hospital registered nurse staffing and quality of care. Health Services Research; 39(2): 279-300. 3- Needleman, J et al. (2002), Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine; 346 (22): 1715-1722. 4- Slutsky, J et al. (2007), Nurse Staffing and Quality of Patient Care. www.ahrq.gov/downloads/pub/evidence/pdf/ nursestaff / nursestaff .pdf 5- Kunaviktikul, W et al. (2008), Nurse staffing and adverse patient outcomes. Chiang Mai University Journal; 7 (1): 59-72. 6- Linda, H et al. (2002), Hospital staffing, organization, and quality of care: cross-national findings. International Journal for quality in health care; 14 (1): 5-13. 10
  11. 11. 7- Linda, H et al. (2002), Hospital nurse staffing and patient mortality, nurse burnout and, job dissatisfaction. JAMA; 288 (16): 1987-1993 8- Linda, H et al. (2007), Supplemental nurse staffing in hospitals and quality of care. Journal of Nursing Administration; 37 (7/8): 335-342. 9- Numata, Y et al. (2006), Nurse staffing levels and hospital mortality in critical care settings. Literature review and meta- analysis. Journal of Advanced Nursing; 55 (4): 435-448. 10- Mary, A et al. (1998), Nurse staffing and patient outcomes. The Official Journal of the Eastern Nursing Research Society & the Western Institute of Nursing; 47(1): 43-50. 11
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