course materials

1. Assignment: Climate today in healthcare
Assignment: Climate today in healthcare ON Assignment: Climate today in
healthcareMethodologySample/Setting: Number and criteria for inclusion and description
of place in which data will be collected.Sampling StrategyResearch Design: Type (e.g., Quasi-
Experimental), description, and rationale for selection.APA, sources no earlier than
2013Will find a packet with everything up to now. Thank you.Paperpacket has quanitative
and qualitative sources along with the first 3 sections of paper.Assignment: Climate today in
healthcareattachment_1Unformatted Attachment PreviewWith the climate today in
healthcare, hospitals must seek other ways to cut costs. Staffing tends to be the first area of
cuts to budgets. However; it has been found that patient safety errors tend to increase when
staff is decreased (Frederickson, 2013). Some states have taken it upon themselves to set up
maximum patient to staff ratios. These states have seen lower incidents and higher staff
satisfaction (Tellez & Ann Seago, 2013). PROBLEM: Increasing patient to staff ratios also
increases safety risks to patients. RESEARCH PURPOSE: To determine if there is correlation
between increased patient to staff ratios and increase in medication errors, treatment
errors, falls, cardiac arrests, and deaths. PIOCT Questions: (P) Do nurses who have higher
patient loads (I) make more errors and (O) potentially have worse patient outcomes (C)
than nurses who have smaller patient loads (T) over the course of 6 months to 1 year.
References Frederickson, W. (2013). Nurses Are Exposing the Reality: Patients Are At Risk.
Minnesota Nursing Accent, 5-7. Tellez, M., & Ann Seago, J. (2013). California Nurse Staffing
Law and RN Workforce Changes. Nursing Economic$, 18-26. Bibliography for Qualitative
Cox Patrick, W. W. (2014). The American Epidemic: The U.S. Nursing Shortage and Turnover
Problem. Marshall Digital Scholar. Kundson, L. (2013). Nurse staffing levels linked to patient
outcomes, nurse retention. AORN Connections. Mills Jane, C.-S. J. (2016). Assignment:
Climate today in healthcareRetaining early career registered nurses: a case study. Bio
Medical Central, 1-6. Susan Bradley, F. K. (2015). Too few staff, too many patients: a
qualitative study of the impact on obstetric care providers and on quality of care in Malawi.
BMC Pregnancy Childbirth. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377843/ References for Quanitative
Fitzsimons, S. M. (2013). Knowing Generation Y: a new generation of nurses in practice.
British Journal of Nursing, 1173-1179. Frederickson, W. (2013). Nurses Are Exposing the
Reality: Patients Are At Risk. Minnesota Nursing Accent, 5-7. Rep. Schakowsky, J. D.-I.-9.
(2017, May 5). H.R.2392 – Nurse Staffing Standards for Hospital Patient Safety and Quality
Care Act of 2017. Retrieved from Congress.gov: https://www.congress.gov/bill/115th-

2. congress/house-bill/2392 Tellez, M., & Ann Seago, J. (2013). California Nurse Staffing Law
and RN Workforce Changes. Nursing Economic$, 18-26. Theoretical Framework Tina M
Peek October 2, 2017 Theories explaining the impact of nursing work and staffing in care
organizations are limited. Additional theories are required to assist the management in
making effective decisions concerning nurse staffing in the organizations. Despite the
limited number of theories that explain the concept of nurse staffing, the few that are
available staffing leads to the establishment of the global duties placed on nurses within
care organizations (Duffy, 2013). Nurses are essential within the care organizations as they
help increase the quality of care offered to the patients. The nursing services delivery
theory, for instance, acts as a guide in research to help the management identify the nursing
services within care facilities. The theory allows organizations to determine aspects in care
organizations such as nurse staffing and nursing work and their work environment.
Further, the theory tries to identify the connection between the work of nurses, their
environment, and staffing with the global responsibilities placed on nurses in care
organizations (Meyer and O’Brien?Pallas, 2010). Thus, the theory claims that staffing
contributes to the work and responsibility given to nurses and their coordination at work.
This theory can be applied to the current study on staffing of nurses within care
organizations. For instance, the management within care facilities can rely on this theory
during research to establish how the aspects such as nursing work, staffing, and work
environment influence the duties of the nurses. Also, the theory can allow leaders within
care facilities to establish how staffing can be utilized to increase the quality of care
provided to the patients. Also, the theory can be integrated into the current study to
establish how nursing work influences the outcome of care services provided to clients in
the medical organizations. References Duffy, J. R., & Duffy, J. R. (2013). Quality caring in
nursing and health systems: Implications for clinicians, educators, and leaders. New York,
NY: Springer Pub. Meyer, R. M., & O’Brien?Pallas, L. L. (2010). Nursing services delivery
theory: an open system approach. Journal of Advanced Nursing, 66(12), 2828-2838.
Literature Review Introduction This section will provide a review of the literature on the
different studies done on staffing and the effect on retention and patient care. Patients were
more concerned about the cost of healthcare services as opposed to quality. However, most
of the studies done after the enactment of the Affordable Care Act emphasizes on quality at
a minimal cost. These trends indicate a shift to patient-centered care that incorporates the
needs of the patient. Assignment: Climate today in healthcareLiterature Review According
to a study done by Aiken et al. (2012), the inadequate nursing levels in American hospitals
have made it difficult for nurses to provide safe and effective care. The shortage in nursing
leads to workload which increases nursing burnout. There is an increased level of job
dissatisfaction among the nursing profession as compared to other professionals. The
nurse-patient ratio in most of the hospitals causes burnouts which influences the retention
rate. These trends have led to healthcare institutions losing their skilled and experienced
workforce hence affecting the quality of healthcare services. Mortality rate and ability to
save patients depends on the nurse-patient ratio. In a healthcare institution where there is a
nursing shortage, the rescue of patients admitted for inpatient acute care within the first
days of admission is limited. Nurses have a responsibility of monitoring patient condition,

3. early detection, and prompt intervention to save the lives of their patients. However, to
achieve all these functions nurses need to have the required skills and a reduced nurse-
patient ratio to meet the needs of the patients and facilitate the recovery process. The
discussed four variables; nurse staffing, patient mortality, nurse burnout, and patient
mortality. The study used a cross-sectional survey to analyze data of 10184 registered
nurses and 232342 patients discharged from the hospital between the year 1998 and 1999
in Pennsylvania. It was evident from the study that hospitals with high-patient ratio have an
increased mortality rate and inability rescue patients. Also, nurses work for longer hours,
hence increasing burnout which causes an increase in job dissatisfaction. Aiken et al. (2012)
sought to investigate the effects that nursing staffing has on three variables; job
dissatisfaction, nurse burnout, and quality of patient care services. The study used a cross-
sectional survey to analyze 10319 nurses working under the surgical unit in 303 hospitals.
The study analyzed nursing staffing in terms of the shifts of the nurses and number of
patients under their care. According to the study, nursing practice is dependent on the
working environment which is influenced by the organizational of the nursing practice.
Organization management influences the decision-making process and attributes that
impact on the practice of nursing. For example, an organization that s the nursing practice
will implement strategies aimed at improving the nursing working environment. The study
used a four-point scale to determine the satisfaction of the nurses. Assignment: Climate
today in healthcareThe scale ranged from highly dissatisfied to highly satisfied nurses.
Furthermore, the Maslach Burnout Inventory (MBI) was used in the study to measure the
burnout level. It was evident that majority of the nurses indicated scores between 0 and 54.
For nursing practitioner score above 27 are considered as high from the scale. In analyzing
the quality of patient care was analyzed using a four-point scale from poor to excellent.
Majority of the nurses indicated the fair or poor quality of patient care services. However,
nursing burnouts scores differed according to the jurisdiction. Pennsylvania indicated the
highest scores of 54% compared to Scotland with 34%. In all the jurisdictions, it is evident
that nursing shortage and quality of services affects the nursing practice hence increasing
the dissatisfaction of nurses. It is the responsibility of the nurses to identify critical issues
and the use of the evidencebased practices in the treatment of patients (Barton, 2013). The
quality of services according to the article is dependent on the best research and the ability
of the nurses to deliver these services in an effective manner. All the stakeholders such as
policy makers, patients and family members, and nurses have a role to play in promoting
quality of patient care. Developing a positive relationship and collaboration of all the
stakeholders is an essential factor in improving the quality of patient care services. This
process may lead to decreased fatigue and stress among the nursing profession hence
improving the job satisfaction which increases the retention rate of nurses. The quality of
patient care services and improvement of the working environment is dependent on the
culture of the health institutions. If the management s the nursing practice, they will put in
place strategies to improve the working conditions of nurses. A better working environment
will motivate nurses hence increasing the skills and experience. Quality of patient care is
achieved when nurses are fully motivated. There are technological changes in the field of
medicine. Therefore, continuous training is essential in improving quality of services in

4. nursing practice. It enables the registered nurses to keep abreast with the changing needs
and the application of current technology to enhance the quality of services. McHugh & Ma
(2014) conducted a study to determine how compensation, working environment, and
staffing levels on the outcome of nurses. The study analyzed nurses from different
healthcare institutions to determine how the different variables impact on the outcome in
nursing practice. The study found out that health institutions with adequate staff and
improved working environment had best nursing outcomes. Nursing in such environment
indicated reduced burnout, increased job satisfaction, and increased ability to continue
working for the institution over a long period of time. The study employed a cross-sectional
survey to investigate how the variables impact on the nursing outcome. According to the
findings of the study, it was evident that compensation plan adopted by the hospital has an
influence job satisfaction and retention rate. For example, nurses working in health
institutions with competitive wages and benefits indicated a high level of satisfaction and
ability to continue working for the hospital in future as compared to the hospital with fewer
benefits and wages. However, wages did not have an effect on the burnout rate. Therefore,
wages have an influence on nurses’ outcome but do not impact on the working environment
and staffing outcomes. The working environment and reduced nurse-patient ratio have an
effect on the nurse outcomes. Koy et al. (2017) provided empirical evidence on the
relationship between nursing care quality, nurse satisfaction, and burnout in the turbulent
environment. The current industry of health demands that hospitals should be a learning
institution in order to keep up with the trends and technological changes. Assignment:
Climate today in healthcareThe nursing practice in the current environment is seen as
multidimensional and multi-facet. Therefore, the complexity in the nursing practice has led
to the evolvement in the nursing practice to improve the quality of patient care. Quality of
care has also become complex due to globalization. Quality patient care demands provision
of patient-centered care to patients and family members. It also requires meeting the needs
of the patient in an effective manner. Therefore, nursing professionals have to deal with the
complex cultural practices in the field of nursing. To achieve this goal, staffing is an essential
tool. It was evident from the study that there is a relationship between nursing staffing,
satisfaction, working environment, burnout, and retention rate. Working environment
enhances job satisfaction and reduces nursing burnout while increasing the ability of nurses
to work for the health institution over a long period of time. The management has a role to
play in influencing working conditions through policies that are essential to improve the
motivation of the workforce and increase retention rate. Conclusion Kane et al. (2012) in
their study found that even though there are different tools used in the measurement of the
quality of patient care, nurse satisfaction, burnout, and retention rate; the complexity in
measuring the quality of patient care is still a challenge to the researchers. It is hard to
quantify the quality of healthcare services to determine the impact that the three variables;
nursing satisfaction, burnout, and retention rate. There are also other factors that affect the
nursing satisfaction which is not covered in the literature review. It is evident from the
literature review that working environment and burnout impacts on nursing practices and
quality of services. However, compensation and benefits increase the motivational level and
retention rate but have no impact on burnout and working condition. References Aiken, L.

5. H., Clarke, S. P., Sloane, D. M., & International Hospital Outcomes Research Consortium.
(2012). Hospital staffing, organization, and quality of care: cross-national findings.
International Journal for quality in Health care, 14(1), 5-14. Aiken, L. H., Clarke, S. P., Sloane,
D. M., Sochalski, J., & Silber, J. H. (2012). Hospital nurse staffing and patient mortality, nurse
burnout, and job dissatisfaction. Jamal, 288(16), 1987-1993. Barton, A. (2013). Patient
safety and quality: an evidence-based handbook for nurses. Aorn Journal, 90(4), 601-602.
Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2012). Nurse staffing and quality
of patient care. Evidence Rep Technology Assess (Full Rep), 151, 1-115. Koy, V., Yunibhand,
J., Angsuroch, Y., & Fisher, M. L. (2017). Relationship between nursing care quality, nurse
staffing, nurse job satisfaction, nurse practice environment, and burnout: literature review.
International Journal of Research in Medical Sciences, 3(8), 1825-1831. McHugh, M. D., &
Ma, C. (2014). Wage, work environment, and staffing: effects on nurse outcomes. Policy,
Politics, & Nursing Practice, 15(3-4), 72-80. W3-2 Staffing and the Effect on Retention and
Patient Care Background of the Study Staffing is a critical area not only in retention of
nursing practitioners but also the provision of quality patient care services in the health
sector. The enactment of the Affordable Care Act led to changes in health care practices that
require nurses to provide quality care services that incorporate the needs of the patients.
Different factors impact on the outcome of nurses in their efforts to provide quality care
services. Staffing is an essential factor in facilitating provision of patient-centered care in
the field of nursing. Inadequate staffing and nursing burnout are the two moral ethical
dilemma issues that are facing nursing in the healthcare sectors. Assignment: Climate today
in healthcareTherefore, this factors impact on the job satisfaction of nurses hence affecting
the motivational level and retention of nurses. In many cases, health institutions adopt
voluntary or mandatory overtime practices a factor that leads to nursing burnout and
reduced quality of healthcare services. Maintaining optimal staff levels of a registered nurse
can lead to improved patient care and retention of the nursing staff hence improving the
quality of services (Knudson, 2013). Statement of the Problem Nursing staffing is a sought-
out topic both in the academic field and by industry practitioners. The introduction of ACA
led to the demand of quality patient care services in the healthcare industry. To meet the
industry demands, healthcare institutions have to put in place strategies for retaining their
nurses and reducing the nurse-patient ratio. The nurses have to use the available resources
including personnel to provide the required patient care services. The standards of practice
for nursing practitioners requires that nurses provide all the relevant material data during
the diagnosis process that will aid the patient in making informed consent on the treatment
plan to adopt (Kane et al., 2007). Also, the patients have a civil right to receive quality
services. The changes in technology also have impacted on the patient care. Therefore, there
is a gap for studying the staffing and the effect on retention and patient care services.
Significance of the Study The study will not only contribute to the theory building on the
concept of nursing staffing but also used as a theoretical reference by both the state and
federal governments when making laws in the healthcare sector. The study is also
significant in that it will contribute to the existing literature and establish gaps for further
studies for academicians. The findings in the study help in decision-making in both the
private and public sector on the standards of practice essential in promoting the quality of

6. healthcare services and promotion of patient-centered care. Also, healthcare institutions
may use the findings from the study to put in place strategies on how to retain their
workforce in order to reduce nursing burnout. Purpose of the Study The overall purpose of
the study is to determine the staffing and the effect on retention and patient care. The study
aims at determining the relationship between patient safety initiative and the nursing
staffing. Also, the study aims at analyzing the nursing workload and its impact on the job
satisfaction of nurses. Lastly, the study will discuss the strategies for improvement to
ensure retention of nurses and improvement of quality services. Research Questions,
Hypothesis, and Variables with Operational Definitions The general research question is;
what is the effect of staffing on the retention and patient care? The specific questions of the
study include: 1. What are the challenges of nurse staffing? 2. What is the effect of nursing
burnout on the satisfaction level of nurses? 3. What are the challenges facing healthcare
institutions in achieving the desired staff levels? The null and alternative hypothesis of the
study: H1: Staffing has an effect on the retention and patient care. H0: Staffing has no effect
on the retention and patient care. Study Variables The independent variable of the study is
staffing whereas the dependent variables are retention and patient care. The staffing level
in nursing practice has been a point of concern for many decades in the healthcare sector.
Staffing is operationally defined as the number of skilled registered nurses in a healthcare
institution that have the ability to provide quality patient care services to the patient. It
refers to the employees in the healthcare that facilitate the provision of quality services.
Quality services require an optimal nursing level and mix. Staffing is not only about the
numbers of nurses but the mix of the required skills. Adequate nursing is appropriate in the
reduction of the nursing burnout to improve motivation level and quality of services
(Stanton & Stanton, 2004). Retention refers to the ability of healthcare organizations to be
able to motivate the nurses in order to make them continue working for the organization
over a long period …Assignment: Climate today in healthcare