Effects of Nurse Staffing on Patients Outcomes Essay

This study focuses on the issue of nursing staffing and its effects on the outcomes of the patients. To begin with, the tem nursing staffing will be defined and followed by a discussion of nursing staffing in relation to the nurses themselves. Nursing staffing levels and their effects on the patient outcomes will also be discussed with regards to morbidity and mortality besides other indicators of patient outcomes, the impact of nursing staffing levels to quality of care as well as an overview of past studies as far as the relationship between nursing staffing levels and the outcome of the patient is concerned. Nursing staffing The term nursing staffing refers to the levels of nurses that are employed at a particular institution. Normally, the nursing staffing levels are measured as ratios of nurses to their patients within their institutions and the higher the ratio, the more preferred as it is thought to mean a better outcome for patients in their care whereas lower ratios are associated with poorer patient outcomes. Nursing staffing and the nurses Nursing staffing has been investigated with the nurses themselves in mind and such studies have included the Schmalenberg and Kramer study of 2009 which sought to establish and assess the factors that influence the perceptions or the opinions of nurses as far as nursing staffing levels are concerned. Nursing staffing has also been studied with regards to the negative effects on the nurses such as nurse burnout and job dissatisfaction such as the study carried out by Aiken et al in 2002. As far as international literature is concerned, most of the studies that look at the impact of nursing staffing on the nurses themselves concentrates on adverse outcomes such as physical injuries, encounters with aggression and violence, sickness and absenteeism, self reports of job satisfaction levels as well as burnout. According to the study by Schmalenberg and Kramer (2009), the nurses’ opinion of their working environment is a strong predictor of their opinions as far as the staffing of their units and of their institutions is concerned. Additionally, the factors that were found to profoundly affect this opinion are the competence of the staff, teamwork, flexible delivery system, and a balance of positions in relation to the needs of the patients that are under their care. The study by Aiken et al in 2002 revealed that there was a higher chance of nurses experiencing job related burnout in hospitals with high Patient nurse ratios. Further, nurses in institutions which had the highest rates of patient to nurse ratios were twice likely to suffer from dissatisfaction from their jobs. These influenced the decisions of nurses to leave their current jobs and thus creating more staffing problems that would lead to more negative patient outcomes. Nursing Staffing and the Patient There are various outcomes that are thought to be directly related to the staffing of nurses in any institution are associated with the patients, such as morbidity mortality, nosocomial infections, falls, pressure ulcers, suicide, and length of hospital stay, medication errors, post operative complications, infection rates and adverse events such as cardiac or respiratory arrests, most of which are negative patient outcomes (Flynn and Mckeown, 2009). There are various studies that have focused on this relationship such as the study by Aiken et al in 2002 however, according to Liang et al (2012); most of these studies have been carried out in western countries. Flynn and Mckeown also studied the relationship between the patient outcome and the nurse staff levels in a bid to identify information that would enable nursing managers to determine the optimum nursing staff levels. The quality of care that is given in nursing homes, which is also an antecedent of the patient outcome has been investigated in studies such as the study done by Castle and Engberg min 2003. Some of the studies that have been used to investigate the relationship between patient mortality as an outcome of nursing staffing levels have been cross sectional and critics have argued that these have failed to include a direct link between staffing and individual patient experiences besides lacking sufficient statistical controls (Needleman et al 2011). One of the patients’ outcomes that have been associated with low levels of nursing staffing is the mortality of patients (Aiken et al 2002). This study was carried out in Pennsylvania hospitals whereby the patients to nurses’ ratio were in the range of 4:1 to 8:1. In the course of the study, 4535 out of 232 342 surgical patients died within thirty days (Aiken et al 2002). This study concluded that four patients less for every nurse would reduce in fewer deaths in the same time and not just in the surgical wards but among all the patients hospitalized in California (Aiken et al 2002). A study by Liang et al in 2012 confirmed the relationship between nursing staffing levels and patient mortality. Cho et al also investigated the relationship between nurse staffing and negative effects such as morbidity, mortality and medical costs. Nurse staffing levels were considered as nursing hours and as nurse proportions and the higher the number of patients that a nurse was supposed to take care of, the higher the rate of mortalities and complications such as atelectasis and pressure ulcers among others in post operative pneumonia patients (2003). This was attributed to the higher than usual demands of taking care of these patients which demanded lower patient to nurse ratios. In yet another study by Kiekkas et al in 2008, the relationship between nursing overload and mortality among intensive care unit patients was investigated whereby the nursing workload was considered the result of total patient care demands and nurse staffing levels. Of the three hundred and ninety six patients who were admitted in the intensive care unit of a Greek Hospital, one hundred and two of them died. The workload of the nurses was found to be significant especially as far as mortality as an outcome was concerned in surgical patients, medical patients, and both groups together which indicated that patient care demands were an important moderator in the course of investigating the relationship between nursing staff levels and mortality (Kiekkas et al, 2008). Staffing of nurses and work environment variables have been assessed with regards to their effects on patient outcomes in a conceptual model by Meyer et al in 2009. The study was carried out in Canadian hospitals in their cardiac and cardiovascular patient units whereby the PCDM together with regression models was tested. PCDM in this case is an acronym for the Patient Care Delivery Model and in addition to confirming the relationship between nurse staffing levels and patients outcomes , the study indicated that patient outcome are also the result of factors associated with patients themselves as well as factors associated with the nurses (Meyer et al, 2009. Additionally, Liang et al established some of the reasons behind the high patient to nurse ratio in Taiwan most prominent of which was the desire of hospitals to control their expenditure but which had negative outcomes for its patients. Flynn and Mckeown in 2009 found out that it was important for nurse managers and others that are involved in the recruitment of nurses to critically examine the common methods that are used for the purposes of determining nursing skill mix as well as staffing levels in their effectiveness in the course of health service organization and delivery. This is in spite of the fact that most studies have been unable to accurately determine or support a minimum level of nurse-patient ratios in various hospitals (Flynn and Mckeown, 2009). Castle and Engberg in 2009 proposed that poor staffing in nursing homes was the result of high rates of turnover among the patients, low staffing levels, low stability levels and low use of agency staff and that poor staffing in nursing homes is accompanied by poor patient outcomes. However, in order to enhance staffing in nursing homes, administrators should focus on all and not just a few select characteristics (Castle and Engberg, 2009). In response to the failure of cross sectional studies to establish or demonstrate a direct link between levels of nursing staffing and patient experiences besides lack of statistical controls, Needleman et al carried out their own study of the nursing staffing levels and the outcomes of the patients in 2011. This study utilized the Cox proportional hazards model and established that the staffing of nurses below the recommended levels was related to patient mortality. Conclusion This study has been a literature review with regards to nursing staffing levels and patient outcomes. The definition of nursing staffing has been defined as well as the effects of nursing staffing on the nurses themselves besides the effects of nursing staffing levels on the patient outcomes. This has been done with various studies that have been done in the past concerning the subject.