PICOT Statement: Impact of Nursing Shortage

PICOT Statement: Impact of Nursing Shortage Amarachi Kelly Grand Canyon University: Professional Capstone and Practicum. 02-10-19 PICOT Statement: Impact of Nursing Shortage Introduction Shortage of nurses expressed as a nurse-patient ratio is one of the major issues facing many hospitals (Johnson et al., 2016). The workload of nurses has a significant impact on patient care and safety. Research shows that high nurse-patient ratio is associated with adverse outcomes such as increased patient mortality, a decline in the odds of survival of patients in intensive care and increased stress and burnout among nurses (Lee et al. 2017). Nurse-patient ratio is crucial in delivering quality care and patient safety. There is adequate research which links low nurse-patient ratio to the provision of better care and improved patient care. Background information Medical caregivers are a fundamental aspect of health coverage and make up the biggest sector of health occupation. As per the World Health Statistics Report (WHO, 2013), there are roughly 29 million medical attendants and obstetricians on the planet, with 3.9 million of those people in the United States. Evaluations of more than one million extra medical caregivers will be required by 2020 (WHO, 2013). As indicated by The American Nurses Association (ANA) (2018), there will be more enlisted attendant occupations accessible through 2022 than some other occupations in the United States. The US Bureau of Labor Statistics (2018) estimates that 1.1 million extra medical attendants are expected to prevent further deficiency. Occupation openings for medical attendants are anticipated to increase at a quicker rate of 15 percent as compared to all other professions from 2016 up to 2026. The nursing occupation keeps on experiencing deficiencies because of the absence of potential instructors, high turnover, and biased conveyance of the workforce (Haddad and Toney-Butler, 2019). The factors linked to nursing deficiency are several. Among the most notable factors are maturing populace, Maturing workforce, Nurse burnout, profession and family, development, areas, and violence in the social insurance setting. The populace, in general, is maturing with the time of increased birth rates age entering the period of the extended requirement for health coverage skill. At present, the United States has the most astounding number of Americans beyond 65 years old in history (Grant, 2016). In 2029, the remainder of the person born after world-war two will achieve retirement age, bringing about 73 percent expansion in Americans' 65 years old and above, 41 million in 2011 contrasted with 71 million in 2019. PICOT section The purpose of this PICOT statement is to determine the benefits of reducing the nurse-to-patient ratio and seeks to answer the following: What is the impact of the nursing shortage on patient care and safety? Evidence-Based Solution Maintaining appropriate nurse-patient ratios aims to promote better patient care and safety. The Affordable Care Act and federal regulation mandates hospital management to emphasize on ensuring adequate staffing and the American Nurses Association supports staffing plans that put important factors into consideration (Kuwata, 2016). The American Nurses Association (ANA) is in support of a legislative model that empowers nurses to create staffing plans particular to specific units. Such a method gives hospitals the chance to establish flexible staffing levels that allow for changes such as the layout of the unit, the number of admissions, the intensity of patient’s needs, discharges and transfers, availability of resources such as technology and ancillary staff and the level of experience of the nursing staff (ANA, 2019). Establishing such plans will assist in achieving safe and appropriate staffing plans. Nursing Intervention The right nurse-patient ratio has its benefits and studies show that it is essential in clinical and economic improvement in patient care. Such improvements include improved patient satisfaction; a reduction in patient mortality, medical errors, length of stay and hospital readmissions; improved safety outcomes such as a reduction in incidents of falls; reduced cost of care due to the avoidance of unplanned readmissions; and prevention of nurse fatigue. The benefits of low nurse-patient extend beyond the hospital setting to even after the patient goes home. Apart from providing better care in the hospital, nurses who are not overwhelmed get the chance to teach patients how to take care of themselves at home, reducing the chances of readmission. Adequate staffing addresses problems such as the risk of infections and bed sores, and nurses have more time to teach patients on proper care of incisions and the warning signs to watch for. Patient Care High nurse-patient ratios can significantly impact patient care in healthcare facilities. Research has associated understaffing in hospitals to a higher rate of patient mortality. When a hospital is understaffed, it is the nurses working at that particular time who will handle the extra work, and with the additional workload, mistakes are much easier to occur. The nurses run the risk of becoming stressed out and are at higher risk of making medical errors. The positive effects of safe nurse-patient level include better patient care, improved satisfaction, and retention of highly qualified nurses among others. Health Care Agency Hospital management, as mandated by the Affordable Care Act (ACA), need to emphasize on the appropriate nurse-patient ratios by establishing effective staffing models that are more flexible which can be adjusted to meet both the needs the entire hospital and individual units. The following are some of the recommended approaches hospitals can take to ensure safe nurse-patient ratios (Kutney-Lee et al., 2016). Create a formal staffing plan as an alternative to rigid nurse-patient ratios. Such a plan ensures that the nurse with the most appropriate skills care for an individual patient and supports standardization of care as it is unit and shift dependent. Reduce turnover by addressing the underlying issues such as limits on mandatory overtime, using the latest technology, other qualified staff to take care of paperwork and offering competitive compensation corresponding to experience. Establish a staffing committee. Such committees allow the hospital to deploy a collaborative approach to staffing by providing input on scheduling procedures and staffing policies as well as ensuring that the hospital standards are uniform across the entire hospital or a particular unit. Consult the staff nurses. The direct care nurses are in contact with the patients and have the best insight into patient flow and care delivery. They can take note of issues arising and make suggestions for improvement. Nursing Practice According to nurses, high nurse-patient ratios limit them from providing adequate comfort and emotional support to patients and their family members, and they cannot spend the ideal much time needed on patient education. Safe staffing prevents nurses from burnout and exhaustion, which helps keep the nurses dedicated and lowers staff turnover by keeping highly qualified nurses in an environment where they can provide quality care for their patients. A majority of nurses sincerely care about helping their patients, and adequate staffing gives them a chance to do so. Literature Review Search methodologies A literature analysis of various electronic databases like the British Nursing Index, MEDLINE, CINAHL, PsycINFO, Sociological Abstracts, Cochrane, and Poubmed, was carried out. These were utilized to find articles that had analyzed the elements adding to caregivers' aim to leave their present professions. Hospital Was utilized as a catchphrase since it was viewed as the standard of the health coverage sections that give 24-hour victim solicitude. The period of the examination results was limited to the period from January 2010 to March 2019 to analyze only articles with pertinent and current data concerning the contemporary deficiency of nurses’ challenge. Analyzed outcomes were evaluated dependent on the incorporation and prohibition criteria. Definite criteria for incorporation and prohibition were utilized to guarantee the importance of the chosen study articles by a manual screening of the summaries of the study outcomes. For consideration, the respondents of the papers needed to incorporate enlisted medical caretakers (RN) working in non-specialty sections. They needed to concentrate on the elements of medical caretakers' aim to leave, be unique research, and be written in English. The prohibition criteria included articles on respondents working in strengths or non-RNs, papers concentrating on regions other than medical attendants' intent to leave, literature surveys, theses, as well as articles not written in English. Keywords: Aim to leave, nurses, nursing shortage, review, turnover, Hospital Literature Evaluation Table Criteria Article 1 Article 2 Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Di Twigg & Kylie McCollough International Journal of Nursing Studies Volume 51, Issue 1 /science/article/pii/S0020748913001582 James Buchan, Christine Duffield & Amy Jordan Journal of Nursing Management Volume 23, Issue 5 https://onlinelibrary.wiley.com/doi/full/10.1111/jonm.12315 Article Title and Year Published Nurse retention: A review of strategies to create and enhance positive practice environments in the clinical setting 2014 ‘Solving’ nursing shortages: do we need a New Agenda? 2015 Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The paper summarizes and critically reviews strategies identified in the literature which support retention of nurses by the creation and enhancement of positive practice environments in the clinical setting. Often cited as a looming problem, the nursing shortage is a current issue that requires effective and contemporary policy action Design (Type of Quantitative, or Type of Qualitative) Literature review Descriptive study Setting/Sample A literature search was undertaken in February 2012 of major healthcare-related databases, Cinahlplus, Medline, and Proquest. Data on nurse projections in a range of high-income countries Methods: Intervention/Instruments Abstracts were reviewed, and articles which potentially outlined strategies were identified, and reference lists scanned for other potential articles Assessment of available data Analysis Lake's Practice Environment Scale of the Nursing Work Index provided a framework from which to assess the strategies. The main causes of nursing shortages in most high‐income countries are related to demographic change: to an aging population making increased, and changed, demand on health services; and to an aging nursing workforce Key Findings Creating positive practice environments enhances nurse retention and facilitates quality patient care. Managers and administrators should assess and manage their practice environments using a validated tool to guide and evaluate interventions. To support the effective use of the skills of nurses and other health workers, many countries need to enhance and integrate their workforce policy-making and planning capacity required to meet identified service needs. Recommendations The administrator needs to urgently enhance retention benefits and provide tools to work with as technology continues to evolve. The ‘new’ dimensions of the current shortage dynamic demand responsive and integrated policy solutions, with enablement for advanced practice at their core Explanation of How the Article Supports EBP/Capstone Project This study addresses one of the ways to tackle nursing shortage: by creating positive practice environments which also lead to better patient outcomes. This study gives recommendations on ...