Evidence Based Practice Do Nursing Shortages Affect Patient

Evidence Based Practice: Do Nursing Shortages Affect Patient Outcomes? Karilyn Bufka Jennifer Edgell Jessica Riley

Problem Statement Do nurse shortages affect patient outcomes?

Evidence – Article 1 �Failure to rescue rates (patients that died in the hospital after complications) were lower in the units where patient to nurse ratios were lower. �Decubitus ulcers in hospitals that had initial low patient to nurse ratios actually showed higher rates of ulcers over time (Cook, Gaynor, Stephens, & Taylor, 2012).

Evidence – Article 2 � Data was compiled collecting errors that resulted from prescription, transcription, dispensing, and administration including if a wrong medication, method, dosage, inappropriate continuation, inadvertent omission, wrong time/delay or administration of medication despite a known allergy had not been intercepted. � A significant relationship between RN staffing levels and medication errors was not indicated, although, findings do indicate that "a supportive practice environment is associated with a higher quality of nursing care" (Flynn, Liang, Dickson, Xie, & Suh, 2012) � (Limitations to the study include: under-reporting, perception of error and items used to measure error. )

Evidence – Article 3 �“A ¼ hour increase in LPN hours per patient day was associated with a 15% increase in the odds of death and a 27% increase in the odds of sepsis” (Glance et al. , 2012, p. 4). �Nurse aide staffing increases of ¼ hour decreased pneumonia odds by 8% �Increased rates of infection and mortality were observed (Glance et al. , 2012).

Evidence – Article 4 Staffing with RNs was compared with staffing with LPNs and NAs as hours per patient day in relation to patient falls. Noted staffing differences included higher RN staffing ratios and lower fall rates in ICUs, where it was identified that the patients are a lower fall risk because the patients are critically ill and often sedated. LPNs and NAs care for less ill patients who are able to move, particularly in rehabilitation units, resulting in a higher fall risk. An additional consideration identified is that Magnet hospitals had higher RN staffing than non-Magnet hospitals. � Limitations in the study have been identified as: age of data, convenience of the sample and inability to establish causality, it is suggested that management can reference values in the article to support staffing decisions (Lake, Shang, Klaus & Dunton, 2010). �

Experience � The effect of patient to nurse ratios is of concern to the authors as they are all registered nurses working in the patient population. � When there are higher patient to nurse ratios, nurses experience an increase in job related stress, job dissatisfaction and job related burnout. Burnout results in more nurse turnover which affects patient safety. Patient to nurse ratios also impact patients’ level of satisfaction with their experience and perceived quality of care. A lower patient load allows the nurse to spend more time with each patient, making them feel more important and that they are receiving a higher level of care.

Recommendations �Critique studies to decrease limitations and variables to conduct further studies/clinical trials (document errors, length of hours worked, nurse to patient ratios, varying levels of education and acuity). �Individual units and management need to take the information at hand into consideration while determining appropriate staffing levels for their facility to create a safer patient environment.

Recommendations �Implementation of safety programs should be put into place or enforced to minimize the risk to our patients. ▪ Scanning medications against an electronic medical record ▪ Increase frequency of monitoring ▪ Co-signatures of potentially harmful medications ▪ Fall risk bands to notify members of the healthcare team that a patient needs more assistance with ambulation because they at higher risk for falling.

References Cook, A. , Gaynor, M. , Stephens Jr. , M. , & Taylor, L. (2012). The effect of a hospital nurse staffing mandate on patient health outcomes: Evidence from California’s minimum staffing regulation. Journal of Health Economics, 31, 340 -348. � Flynn, L. , Liang, Y. , Dickson, G. L. , Xie, M. and Suh, D. -C. (2012), Nurses’ Practice Environments, Error Interception Practices, and Inpatient Medication Errors. Journal of Nursing Scholarship, 44, 180 – 186. doi: 10. 1111/j. 1547 -5069. 2012. 01443. x � Glance, L. G. , Dick, A. W. , Osler, T. M. , Mukamel, D. B. , Li, Y. & Stone, P. W. (2012). The association between nurse staffing and hospital outcomes in injured patients. BMC Health Services Research, 12(247), 1 -8. doi: 10. 1186/1472 -6963 -12 -247 � Lake, E. T. , Shang, J. , Klaus, S. , & Dunton, N. E. (2010, July 10). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in Nursing & Heath, 33, 413 -425. � �