Hospital Nurse Staffing and Quality of Care

According to Stanton and Rutherford (2004), healthcare institutions with low nurse staffing levels are characteristic of poor patient outcomes. These poor outcomes include the incidences of shock, pneumonia, urinary tract infections and cardiac arrest. These were the findings from a study funded by the Agency for Healthcare Research and Quality (AHRQ). The factors that make the nurse-staffing levels low comprise the dynamic needs of today’s patients, who present the need for more care as well as the gap between the nursing staff required and the qualified Registered Nurses (RNs) available and willing to fill the vacancies. This deficiency is evident from the persistent typical vacancy rate of 13 percent (Stanton & Rutherford, 2004, p. 4).

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My work place, a hospital within my locality, has a patient-to-nurse ratio of 8:1. The death rate registered in 2010 was 4800 out of the 230,312 patients admitted between January 1st and December 31st. For the year 2011, 4530 patients out of the 220,015 patients admitted between January 1st and December 31st died. The causes of death were primarily, the negative outcomes of urinary tract infections, shock, pneumonia, metabolic derangements and cardiac arrest, especially among medical and surgical patients. Mortality levels among medical patients stood at an average of 3.15% and 1.6% among surgical patients. Failure to rescue stood at an average of 18.4 percent among medical patients and 19.78% among patients undergoing major surgeries. The average total hour count of inpatient-hospital nursing time stood at an average of 11.4 hours a day. Of this total count, RNs take an average of 7.8 hours of nursing for every inpatient day. The aide staff hour averages 2.3 while LPNs average is 1.3 hour for every in-patient day.

Following the nursing profile at my working place, it is clear that the situation is not any different from that in many hospitals, especially public hospitals. The problem of low nurse-staffing consists in the fact that it has potential implications to nursing practice in general. For instance, Stanton & Rutherford (2004, p. 5) point out that mortality was directly related to staffing levels. From the first study, the study uncovered that each additional patient for a practicing nurse was linked to a 7% increase in the likelihood of a patient dying after 30 days of admission. The same change led to a 7% increase in the likelihood of failure to rescue a patient. The second study showed that mortality levels over a 30-day period were lower among AIDS patients under the “conditions of higher nurse-patient ratio and the services of an AIDS specialty doctor” (Stanton & Rutherford, 2004, p. 5). Stratton (2008) points out that there is a correlation between nurse staffing and the quality of care delivered at healthcare intuitions. The findings from the study showed that there is a direct association between the proportions of nursing hours spent at pediatrics wards as delivered by registered nurses. Increasing the hours spent on care reduced the incidences of bloodstream and central line infections, and the parental complaints lodged (Stratton, 2008, p. 108). From the two studies, it is clear that low nursing levels or the fewer the hours spent by nurses on patient care are linked to adverse patient outcomes. The evidence-based facts show that the problem of low nurse staffing has the potential to affect the outcomes realized from the nursing care delivered at health institutions.

Butler et al. (2011, p. 9) reviewed a total of 6202 studies of relevance to the study on the relationship between nurse staffing levels and the outcomes from nursing care. From the review, the team chose 15 studies, whose results were incorporated into the current review. Through the review, it was established that the addition of specialist nurses to the hospital nursing staff-base reduced patient mortality resulting in shorter hospital stay, and led to a reduction in the incidence of pressure ulcers. The review showed that specialist support from caregivers like dietary assistants caused a positive effect on patient outcomes. The introduction of midwifery teams as opposed to administering standard care caused a reduction in the medical procedures required during labor. As a result, there was a resultant reduction in the length of hospital stay, without adversely affecting maternal or prenatal safety (Butler et al., 2011, p. 7-9). A study by Kane et al. (2007) identified that staffing healthcare centers were linked to a reduction in mortality, cardiac arrests, failure to rescue, hospital acquired pneumonia and other adverse outcomes. The effect of increasing nurse staffing was stronger and more consistent among ICU and surgical patients. Increased patient care by RNs led to a decrease in the rate of hospital mortality and resulted in shorter length of stay.

Across the two evidence-based studies, Kane et al. (2007) and Stanton & Rutherford (2004, p. 5) both retrieved from the Agency for Healthcare Research and Quality database that there is a direct association between nurse-staffing levels and the quality of care offered to patients. Both studies are quantitative as the independent variable for the study is nurse staffing numbers, while the dependent variable is the number of adverse patient outcomes registered. These include patient deaths, cardiac arrests, failure to rescue and hospital infections. The subtype of the Kane et al. (2007) study is experimental, as the researchers were trying to establish the cause-effect association through manipulating the cause. The sampling model for the study was non-probability as the sample was chosen on the basis of definite exclusion criteria. In the case of Stanton & Rutherford (2004), the subtype of the study was experimental. This is the case as the researchers sought to establish the cause-effect association, through manipulating the cause, which is the level of nurse staffing. The sampling model for the study was probability as the sample was not chosen on the basis of a definite exclusion criterion. The findings from the two studies are supported by the studies of Butler et al. (2011) and Stratton (2008), which point out an association between nurse staffing and patient outcomes.

Key findings from the study emphasize the fact that there is a direct association between nurse staffing levels and the incidence of adverse patient outcomes including patient mortality. An association between the length of stay and the quality of care offered is also directly linked to increased nurse staffing. These findings can be applied to my workplace where the patient-to-nurse ratio is as high as 8:1, and mortality rates are in the range of 3.15% for medical and 1.6% among surgical patients. Considering the patient-to-nurse ratio, it is evident that increasing nurse staffing will positively impact patient outcomes resulting in a decrease in adverse outcomes, including patient mortality. From the evidence given by Stanton and Rutherford (2004) and Kane et al. (2007), it is clear that there is a direct link between nurse staffing and patient outcomes. Following the high levels of mortality registered at the hospital, it is clear that there is need for change at the workplace. However, further research is necessary to expose the effect of the care over other support staff who can substitute the care of RNs and LPNs. This is the case since little has been studied and discussed regarding the contribution of other care personnel except for the issue discussed by Butler et al. (2011). They acknowledged the significance contribution of other personnel, for instance, dietary assistants.

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References

Butler, M., Collins, R., Drennan, J., Halligan, P., O’Mathúna, D., Schultz, T., Sheridan, A., & Vilis, E. (2011). Hospital nurse staffing models and patient and staff- related outcomes. Cochrane Database of Systematic Reviews, 7 (7), 9-11. Web.

Kane, R., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. (2007). Nursing Staffing and Quality of Patient Care. Evidence Report/Technology Assessment, 151 (4), 25- 26.

Stanton, M., & Rutherford, M. (2004). Hospital nurse staffing and quality of care. Research in Action, 14 (29), 1-7. Web.

Stratton, K. (2008). Pediatric nurse staffing and quality of care in the hospital setting. J Nurs Care Qual., 23 (2), 105-114.

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