Nurse Staffing Ratios Abstract Through a case study
Nurse Staffing Ratios Abstract Through a case study, medical journal articles, and organizations such as the ANA, quality evidence was provided on nurse staffing ratios. Specifically, these sources detailed how the nursing workforce is affected, as well as patient outcomes, and what is being done to alleviate the burden of inefficient ratios, at the state and federal level. This project will examine the factors that contribute to staffing issues, the consequences of poor staffing ratios, statistical information pertaining to aspects of nursing care, and what can be done in order to improve staffing issues Ashlyn Yevchak, Issy Voss, Kelsey Mawyer
What is a nursing staffing ratio? ● These ratios demonstrate how many patients are typically assigned to a nurse during care ● Having 6 patients or less could equate to a 50% reduction in missed care (Ball et al. , 2016) ● Having 4 patients or less could equate to an 85% reduction in missed care (Ball et al. , 2016) ● With lower nurse-to-patient ratios, the mortality rate decreases by more than 50% (Martin, 2015) ● Smaller ratios mean that more patients are assigned to a nurse at some point, which can have an effect on patient outcomes and standards Ball, J. E. , Griffiths, P. , Rafferty, A. M. , Lindqvist, R. , Murrells, T. , & Tishel-man, C. (2016). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 72, 2086– 2097. https: //doi. org/10. 1111/jan. 12976 Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 4– 6.
What are factors that contribute to staffing issues ● Cost-cutting ● Nurse burnout ○ The national turnover rate is 8. 8% to 37 % depending on area and specialty (Haddad, 2020). ● Aging workforce ● Aging population ○ As the large baby boomer generation begins to age, the need for health care grows (AACN, 2019). ● Increased patient complexity and need ● Shortage of nurses entering the workforce ○ According the Bureau of Labor Statistics Employment projections for 2016 -2026, there is a need for 203, 700 new RNs each year through 2026 to fill positions of those retiring or leaving the workforce (AACN, 2019). American Association of Colleges for Nursing. (2019). Nursing Shortage Fact Sheet. Retrieved from https: //www. aacnnursing. org/News-Information/Fact-Sheets/Nursing-Shortage. Haddad LM, Toney-Butler TJ. Nursing Shortage. (2020). In: Stat. Pearls [Internet]. Treasure Island: Stat. Pearls Publishing. Available from: https: //www. ncbi. nlm. nih. gov/books/NBK 493175/
Consequences Healthcare costs due to preventable errors ● Nurses presence and attention at the patient's’ bedside is vital to their ability to ensure patient safety. ● Pneumonia and pressure ulcers related to nursing shortages cost hospitals more than 9 billion dollars a year (Martin, 2015). ● Medication administration errors have been linked to fatigue in overworked nurses Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 4– 6 How staffing affects nurses ● Studies have shown an unrealistic workload can lead to ○ ○ ○ . Chronic fatigue Poor sleep patterns Absenteeism Job dissatisfaction Burnout
What’s being done about staffing issues ● Currently 14 states have addressed nurse staffing ratios through laws and regulations ○ CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA. ● Mandatory overtime for nurses is restricted in 16 states ● California is the leader in nurse staffing ratio mandates ○ In 1999, AB 394 was passed by the CA state assembly that established a minimum nurse to patient staffing ratio (California Healthcare 2009). United Nurses Association of California/ Union offoundation, Health Care Professionals. (2020). California Nurse-to-Patient Ratios. . Retrieved from https: //www. unacuhcp. org/california-nurse-to-patient-ratios/
Case Study- “Effects of Increasing Nurse Staffing on Missed Nursing Care” ● ● ● ● Enforced a policy (January 2013) improving ratios from 1: 17 to 1: 7 Cho, Kim, Yeon, You, & Lee (2015), conducted a MISSCARE Survey between 115 nurses in the 1: 7 nursing units, and 117 nurses in the 1: 17 units 4 Point Scales ○ Rarely-1, Occasionally-2, Frequently-3, Always-4 ○ Not a reason-1, Minor reason-2, Moderate reason-3, Significant reason-4 Overall: High Staffing (M=1. 39) vs. Low Staffing (M=1. 51) Turning (0. 77 difference), mouth care (0. 51 difference), bathing/skin care (0. 44 difference), patient assessments in each shift (0. 13 difference), assistance with toileting (0. 23 difference), feeding and setting up meals (0. 33 difference) (Cho et al. , 2015) With averages calculated… ○ There was a 0. 136 difference between missed interventions, which proved to be significant with a P-value of 0. 020 (Cho et al. , 2015) Labor resources remained the most prevalent reason for missed interventions! Especially involving the subcategory, Inadequate staff (Cho et al. , 2015) ○ High staffing- M=3. 12; M=2. 58 ○ Low staffing- M=3. 54; M=3. 62 Cho, S. H. , Kim, Y. S. , Yeon, K. N. , You, S. J. , & Lee, I. D. (2015). Effects of increasing nurse staffing o missed nursing care. International Nursing Review, 62(2), 267– 274. https: //doi. org/10. 1111/inr. 12173
Cho, S. H. , Kim, Y. S. , Yeon, K. N. , You, S. J. , & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing care. International Nursing Review, 62(2), 267– 274. https: //doi. org/10. 1111/inr. 12173
Systematic Review Griffiths P. , Recio-Saucedo A. , Dall'Ora C. , et al. (2018) The association between nurse staffing and omissions in nursing care: a systematic review. J Adv Nurs 2018; 74: 1474– 87. doi: 10. 1111/jan. 13564
Solutions ● Focus on improving nurse retention rates ○ ○ Provide professional development opportunities Reduce overtime Reward accomplishments and years of work Create a positive work environment ● Federal or state nurse staffing ratios ○ With these factors in mind (ANA, 2019) ■ The patients level of complexity, severity of condition, and stability ■ Number of admissions, discharges, and transfers ■ Skill level and expertise of nursing ■ Physical space and layout of nursing facility ■ Technical support ■ Resources ● Loan forgiveness for student nurses ○ Incentivizes entering and staying in workforce American Nurses Association. (2019). Nurse Staffing Advocacy. Retrieved from https: //www. nursingworld. org/practice-policy/nurse-staffing-advocacy/
References Alvernia University Staff. (2017). Nurse Retention Strategies. Retrieved from https: //online. alvernia. edu/articles/nurse-retention-strategies/ American Association of Colleges for Nursing. (2019). Nursing Shortage Fact Sheet. Retrieved from https: //www. aacnnursing. org/News. Information/Fact-Sheets/Nursing-Shortage. American Nurses Association. (2019). Nurse Staffing Advocacy. Retrieved from https: //www. nursingworld. org/practice-policy/nurse-staffing/nursestaffing-advocacy/ Ball, J. E. , Griffiths, P. , Rafferty, A. M. , Lindqvist, R. , Murrells, T. , & Tishel-man, C. (2016). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 72, 2086– 2097. https: //doi. org/10. 1111/jan. 12976 Cho, S. H. , Kim, Y. S. , Yeon, K. N. , You, S. J. , & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing care. International Nursing Review, 62(2), 267– 274. https: //doi. org/10. 1111/inr. 12173 Griffiths P. , Recio-Saucedo A. , Dall'Ora C. , et al. (2018). The association between nurse staffing and omissions in nursing care: a systematic review. J Adv Nurs 2018; 74: 1474– 87. doi: 10. 1111/jan. 13564 Haddad LM, Toney-Butler TJ. Nursing Shortage. (2020). In: Stat. Pearls [Internet]. Treasure Island: Stat. Pearls Publishing. Available from: https: //www. ncbi. nlm. nih. gov/books/NBK 493175/ Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 4– 6. United Nurses Association of California/ Union of Health Care Professionals. (2020). California Nurse-to-Patient Ratios. . Retrieved from https: //www. unacuhcp. org/california-nurse-to-patient-ratios/
- Slides: 10