Nurse Staffing Ratio PICOT By the YELLOW GROUP

Nurse Staffing Ratio: PICOT By the YELLOW GROUP Rajinder Kumar Macdana Lamarre Edward Nyamwembe Judy Ann Torrente Grand Canyon University, NRS-433 V December 18, 2016

Introduction Why is nurse staffing a global problem? What are patient adverse events? Relevance of nurse staffing to patient adverse events

PICOT question Will decreasing the amount of patient to nurse ratio reduce the risks of patient adverse events in the hospital setting?

Article 1: The Relationships of Nurse Staffing Level & Work Environment with Patient Adverse Events A cross-sectional study was done in South Korea in order to determine the relationships of nurse staffing level and work environment with patient adverse events. The study consisted of facility data (58 hospitals), nurse survey data (4, 864 nurses), and patient hospital discharge data (113, 426 patients) (Cho, Chin, et al. , 2015). The study protocol was approved by the authors’ affiliated university institutional review board. Participating nurses completed the survey in private, put in sealed envelopes, and placed into locked boxes in each unit for anonymity. Unopened boxes were mailed to the private investigator by the designated nursing staff from each unit. The study explains that three most commonly nurse-reported adverse events include pressure ulcers, injury from a fall after admission, and administration of the wrong medication or dose to a patient. Descriptive statistical analyses using STATA version 13. 1 software was used for data interpretation. The study looked at incidence of adverse events of wrongful medication administration or dosage, pressure ulcers, and fall injury post admission. Multilevel ordinal logistic regression was employed to explore the relationships of nurse staffing level (number of patients assigned to a nurse) and work environment with patient adverse events after controlling for nurse, hospital, and patient characteristics.

Article 1: The Relationships of Nurse Staffing Level & Work Environment with Patient Adverse Events Results showed that higher quantity of patients per nurse in a poor work environment, the higher the manifestation of adverse events occurring, with 95% rate of wrongful medication administration or dosage, 95% prevalence of pressure ulcers, and 95% patient falls with injury (Cho, Chin, et al. , 2015). Nurses who work in a better work environment reported a decrease in occurrence of adverse events with 45% lower for wrongful medication administration or dosage, 39% reduction of pressure ulcers, and 32% fewer patient falls with injury (Cho, Chin, et al. , 2015). This study proves that there is significant connection between nurse staffing levels, the work environment, and patient adverse events. By reducing the number of patients per nurse per shift and providing a better work environment, incidences of adverse events can be prevented. Limitations found in the study includes the usage of self-report survey for both outcomes, and bias reporting may have occurred as nurses were the ones reporting the adverse patient events. Therefore, data of incidence rates in the study may have been over or under estimated. The study was also based on cross sectional data, no causal connection was determined with nurse staffing level, work environment of nurses, and patient adverse events. The study did not take into consideration nurses’ lack of sleep, fatigue, or burnout during their shift work which can also affect patient adverse events (Cho, Chin, et al. , 2015). Clinical Relevance: Healthcare strategies and efforts to modify adequate nurse staffing levels and better work environments for nurses globally are needed to improve patient outcomes.

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Conclusion How does all of the articles pertain to the PICOT question? Did it answer the picot question? How can we incorporate these findings into nursing practice? Present the proposed practice changes from an integration of the findings.

Reference Cho, E. , Chin, DE. , Kim, S. , & Hong, O. (2015). The Relationships of Nurse Staffing Level and Work Environment with Patient Adverse Events. Journal of Nursing Scholarship, 48: 1, 74 -82. doi: 10. 1111/jnu. 12183