Evidence-Based Practice Proposal to Address Nursing Shortage

Healthcare Streamlining Name Course Professor Date
Introduction
Access to affordable healthcare is what is usually considered when assessing the reliability and value of a healthcare system. Not surprisingly, most social, economic, and political policies tend to focus on making healthcare accessible to as many people as possible, especially among the middle and lower class families. In the U.S., for instance, the Obama administration, through the National Health Care Act, intends to expand healthcare access to majority of Americans through affordable insurance policies. In the quest to achieve affordable health care, however, it is easy to forget, as is often the case, a very important aspect of healthcare delivery; quality of care. Most people are not concerned about the quality of healthcare services they receive (Camphor, 2010), as long as they are able to access it when they need. This is understandable given the harsh economic times that many families today are contending with, more so after the recent economic meltdown whose effects are still visible across many industry sectors. Regardless, receiving quality healthcare is as important as being able to access it. This is because healthcare delivery is a result-oriented service, in which patient outcome is the point of focus. Access to healthcare is meaningful only when the patient receives adequate and effective treatment to improve their health. In this regard, promoting quality care is a factor that policy makers and health institutions should consider when implementing policies related to patient care.
Nevertheless, the role of nurse staffing in promoting quality care is commonly overlooked due to its implications on cost (Lorh, Yordy, & Thier, 2008). While it's undeniable that increasing the ratio of physicians to patients will improve service delivery, this approach is usually put aside because it means spending more. Healthcare providers, managers and policy makers attempt to compensate for this problem through cheaper alternatives, such as managing the available nursing staff effectively. Through a review of the literature, this paper examines the importance of sufficient nursing staff in improving the quality of care and patient outcome. It argues that increasing the level of staffing of nurses informed at policy level for patients that have inadequate and unsafe nurse staffing levels decreases negative health outcomes, compared to better management of existing staff.
Research Problem
Quality of care is primarily defined in terms of its clinicians' technical care delivery in a way that accommodates other relevant opinions by patients, their representatives and the wider society. For instance, the Healthcare Financing Administration (HFCA)' releases are increasingly compelled by the need to heed to consumers' interests (Lohr, Yordy, & Their, 2008). In delivering quality care, clinicians ensure that the patients receive it safely, effectively, promptly, equitably and in a patient centered fashion (Mitchell, 2008). Adequate and safe staffing of nurses is a protracted quality of care issue. Inadequate staffing has a direct correlation with high levels of mortality, and a general dissatisfaction with the healthcare system among consumers(Camphor, 2010). Mortality rate increases with a single digit with the increase of 40 patients without increase in number of nurses.
Shortage of nursing workforce is a pervasive quality of care issue that is facing healthcare across nations in the globe. In Camphor, 2010 researchers have engaged in studies to determine how low levels of nursing workforce negatively impacts on patients' health outcomes. Their studies have consistently established a positive correlation between the shortage and several negative outcomes. The results of their studies indicate higher prevalence of infections that affects urine tracts, pneumonia, many patients going into shock and higher levels of prolonged but unavoidable stay in hospital care. They also cite that patients that receive prompt and ample care have a tendency to recover more expeditiously. It also reflects that the rate of error is higher, there is higher levels job dissatisfaction, turnover and compelled overtime with limited nurse staffing.
Purpose
There is significant research on the implications of limited staffing levels on negative health outcomes for patients. One report commissioned by AHRQ with funding from evidence-based practice center which reviewed twenty six studies on the phenomenon indicated that it results in non-fatal outcomes at both the hospital and nursing unit level (Stanton, 2004). Some of those reports indicated that urinary tract infections occur at a rate of between 1.9 to 6.3 percent and pneumonia in 1.2 to 2.6 percent of patients undergoing surgical procedures (Stanton, 2004). The studies also indicated that hospitals with higher nurse staffing rates had between two to twenty five percent record reduced rates of occurrence of adverse health outcomes (Stanton, 2004). Hospitals with low levels result in patients suffering negative health outcomes that are avoidable and it also results in higher healthcare costs generally.
Implementation of a project that increases staffing levels to about 30% of nurses in hospitals with low levels of staffing is necessary (Stanton, 2004). In accomplishing the purpose of this project, it is necessary to conduct necessary research to determine the underserved hospitals and establish a mechanism of availing more nursing workforce to those hospitals. It is also necessary that policy makers also engage the necessary resources to attain adequate staffing of nurses in an equitable way to all hospitals and nursing units. They will also require reviewing the relevant laws and endorsing a systematic way of providing ongoing nurse workforce supply.
Research question
The question that will be used in the implementation of this project is one that entails the people involved in the problem, one that details the suggested intervention, one that strikes a comparison between other alternatives to resolving the problem and lastly one that addresses the desired outcomes of the intervention. In resolving the problem of inadequate and safe staffing levels of nursing workforce it will be important to address the question stated as follows;Will increased levels of staffing supply of nurses informed at policy level compared to better management of existing staff decrease the negative health outcomes?
Literature review
The selected research articles present research findings that showing that poor nurse staffing is directly related to poor patient outcomes. This in turn supports the need for increasing staffing levels in the health sector as a means of improving patient safety and quality of care services. In the article "Literature Review: Safe Nurse Staffing," the author discusses the negative effects of understaffing the healthcare sector (Armstrong, 2000). Nurse staffing has a direct effect on patient satisfaction, patient mortality, medical errors, and nurse satisfaction and burnout (Kovach, 2006). Through a review of the literature, the author found out that deficiencies in nurse staffing leads to adverse effects on patients, such as increased mortality levels, low satisfaction, and wrong diagnosis due to physician errors due to the high pressure. Physician errors are attributed to nurse burnout due to working for long hours (Camphor, 2012). Overworking also has the negative effect of discouraging nurses and killing their morale. These findings support the need to create a working environment that will motivate nurses by making their job easier and flexible (Macfarlane, 2011). One way of achieving this is by creating a sufficient workforce to handle increasing patient needs. Stanton (2004) in "Hospital Nurse Staffing and Quality of Care" presents a similar view by noting that patient needs have increased over the years while the number of nurses continues to decrease. This trend shows that nurse shortage is a real and serious problem that needs to be addressed urgently before it translates into a national health crisis.
Another point that the author identifies is the influence of organizational and economic concerns on nurse staffing. Healthcare providers usually operate within a predetermined budget, and the level of services they offer is determined by the available resources. Understaffing of nurses, therefore, may be a result of working within a deficient budget. The financial constraints that healthcare providers face (Camphor, 2008) often compels them to implement cost-cutting measures, such as decreasing the number of workers (nurses) and doing away with some patient-centered services that are not directly related to medical care, but critical to patient outcome, such as counseling patients and their families.
A striking fact identified by Camphor (2008) is that a large section of the American population is getting old. This could only mean one thing; the number of old persons requiring special care is poised to multiply in the coming years. Add this to the projected number of people who will have weight-related health problems, and America's "in-need-of medical care" population will be very overwhelming unless the healthcare sector is equipped sufficiently (Schuller, 2007).
However, the findings also suggest that the nurse shortage is not a problem that will be solved by quick fixes. The vacancy rate in America in 2002 was at 13 percent, and it has increased over the years. A 2002 report commissioned by the American Hospital Association showed a trend whereby more and more nurses are dissatisfied with their work environment and have bigger expectations that what their profession offers. This has led to negative attitudes and higher rates of nurse attrition into other careers (American Hospital Association, Commission on Workforce for Hospitals and Health Systems, 2002). Predictions for future trends also paint a bleak picture for the healthcare sector in terms of nurse staffing (Welton, 2007). Statistics from a Federal Government study in 2008 showed that the number of qualified nurses is expected to increase by just 6 percent, while patient needs are projected to increase by 40 percent by 2020 (Stanton, 2008). A more serious problem is posed by the increasing number of about-to-retire nurses while majority of people are unwilling to enter into the nursing profession. This is especially the case among young women who do not consider nursing as a worthwhile long-term profession leaving the profession with less practitioners. The PICO is solving general medical concerns using appropriate number of nurses rather than using ordinary number of nurses to improve medical care (Buerhaus, Stagier, & Auerbach, 2003, p. 192).
In "Current Issues in Quality of Care" (Lohr, Yordy, & Thier, 2008), the authors seek to offer a definition of quality care that reflects the needs of patients, whilst emphasizing the connection between nurse shortage and "malpractice crises." Quality of care is concerned with establishing appropriate processes of care delivery and achieving desirable patient outcomes. Creating good physician-patient relationships is one of the care processes for achieving the desired patient outcomes (Lee, 2013). They observe that good physician-patient relationship is an important component of care delivery since it increases patient satisfaction. The focus on physician-patient relationship is informed by the changing nature of patient needs, which requires a patient-centered approach to identify them and offer the relevant services to satisfy them. In nurse shortage environment, however, it is not easy to create effective physician-patient relationships (Hernandez, 2009). This is because nurses are often forced to multitask and attend to many patients at a given time, which denies them the opportunity to spend enough time with one patient. In addition, the authors point out that nursing is both an art and a science. It is the art aspect of nursing that emphasizes the need for an adequate supply of nurses. This is because it requires human skills (rather than technology) to interact with patients to learn their problems and provide the required medical care. Towards this end, it is necessary to train a sufficient workforce of nurses with the relevant skills to handle different patient needs.
In "Defining Patient Safety and Quality Care," the author asserts, "patient safety is indistinguishable from the delivery of quality health care" (Mitchell, 2008). The article highlights the positive indicators developed by the American Academy of Nursing Expert Panel on Quality Health for assessing the quality of care and patient safety. Among these are demonstrations of health-promoting behaviors by nurses, making patients feel well cared for, and managing symptoms effectively to improve the patients' well being. In addition, patient safety is reflected in the ability to avoid and prevent errors, as well as building a culture of safety involving health care professionals, patients, and organizations Stanton (2008).
The need to minimize and avoid errors as part of ensuring patient safety and improving quality of care reflects the concerns of this paper; that nurse shortage is a big factor in adverse patient outcomes, such as high mortality rates.
The findings of the study by Stanton (2008) indicating that more trained nurses are dissatisfied with their careers and therefore moving into other disciplines indicate that better management of the existing nursing staff will not improve patient outcomes if the numbers are not added. This is because the problem is not about lack of skills on the part of nurses or poor management of human resources, the ratio is a very critical point in all this.However, increasing patient needs and an increasing gap between nursing shortage and the number of qualified nurses to fill the shortage. In this regard, the best solution is to ensure that a sufficient number of nurses are trained to cater for the increasing patient needs, more so in the near future when majority of nurses will retire and more Americans (older persons and those suffering from weight-related problems) will be in need of healthcare services.
Theoretical Framework
The Roper-Logan-Tierney Model of Nursing which is a model of nursing care based on upon activities of living.
This theory of nursing is based on assessing quality of care in terms of how it helps the patient to become independent as a result of his or her improving health. The theory is based on the assumption that quality health care should improve the patient's health and make him/her capable of performing daily activities independently (Roper, Logan, & Tierney, 2000, p. 15). In this regard, this theory is based on patient outcome. It supports interventions that lead to the desired patient outcomes, such as alleviating pain and complete recovery.
The theory is relevant with the problem identified in this paper (nursing shortage) because lack of enough nursing staff is responsible for negative patient outcomes, such as prolonged stay in hospitals, delays in getting medical car...