King Saud UniversityCollege of Nursing

Nurse staffing and it is impact on quality of care

Student Name:Amer Mane AL-Rishan

426104574

Prepared to:

Dr. Mohammad AL Momani

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Nurse staffing and it is impact on quality of care

Introduction:

Patient safety and quality improvement efforts have

grown impressively in recent years. Despite these gains,

though, questions remain about the value of improving

quality from both societal and hospital perspectives. (1)

The relationship between hospital nurse staffing and quality of

care continues to be a significant concern for health services

researchers, health care executives, policymakers, and consumers.

Several early studies that included nurse staffing as a hospital

characteristic found that higher levels of nurse staffing were

associated with reduced mortality. (2)

Research on the relation between the level of

staffing by nurses in hospitals and patients’ outcomes

has been inconclusive. Whereas some studies have

reported an association between higher levels of staffing

by nurses and lower mortality, as well as lower rates of

other adverse outcomes. (3)

A shortage of registered nurses, in combination

with increased workload, has the potential to threaten

quality of care. Increasing the nurse to patient ratios has

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been recommended as a means to improve patient

safety. (4)

Research questions:

Is there a relationship between nurses staffing and quality care in KKHU?

Justification of the problem:

The results of this study can benefit healthcare policymakers and

especially, nurse administrators who need evidence-based information

for making decisions about staffing nursing personnel in each nursing

unit and developing policy regarding nursing personnel in the future.

(5)

Literature review:

Needleman J. et al (2002) examined the relation between the

amount of care provided by nurses at the hospital and patients'

outcomes. They used administrative data from 1997 for 799 hospitals

in 11 states (Arizona, California, Maryland, Massachusetts, Missouri,

Nevada, New York, South Carolina, Virginia, West Virginia, and

Wisconsin). The study covered 5,075,969 discharges of medical

patients and 1,104,659 discharges of surgical patients. The results

show that higher proportion of hours of nursing care provided by

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registered nurses and a greater number of hours of care by registered

nurses per day are associated with better care for hospitalized patients.

(3)

Slutsky J. et al (2007) assessed how nurse to patient ratios and

nurse work hours were associated with patient outcomes in acute care

hospitals, factors that influence nurse staffing policies, and nurse

staffing strategies that improved patient outcomes. In European

countries, the findings revealed that the higher registered nurse

staffing was associated with less hospital-related mortality, failure to

rescue, cardiac arrest, hospital acquired pneumonia, and other adverse

events. The effect of increased registered nurse staffing on patients

safety was strong and consistent in intensive care units and in surgical

patients. Greater registered nurse hours spent on direct patient care

were associated with decreased risk of hospital-related death and

shorter lengths of stay. (4)

Kunaviktikul W. et al. (2008) identified the relationships between

nurse staffing, including nursing working hours per patient day; and

patient outcomes of patient falls, pressure ulcers, and UTIs.

Descriptive correlational design was used and stratified random

sampling. There were 98 nursing units of 15 public hospitals located

in the northern region of Thailand that participated in this study. The

finding show statistically positive relations between nursing working

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hours per patient day and three adverse patient outcomes – patient

falls, pressure ulcers and UTIs. (5)

Linda H. et al (2002) examined the effects of nurse staffing and

organizational support for nursing care on nurses dissatisfaction with

there jobs, nurse burnout, and nurse report of quality of patient care in

an international sample of hospitals. Multisite cross-sectional survey

was used in this study. Adult acute- care hospital in the United States

(Pennsylvania), Canada (Ontario and British Columbia), England, and

Scotland. The response rates ranged from 42 to 52% out of 10319

nurses working on medical and surgical units in 303 hospitals across

the five jurisdictions. The findings revealed that dissatisfaction,

burnout, and concern about quality of care were common among

hospital nurses in all five sites. Organizational /managerial support for

nursing had a pronounced effect on nurse dissatisfaction and burnout,

and both organizational support for nursing and nurse staffing were

directly, and independently, related to nurse – assessed quality of care.

Multivariate results imply that nurse reports of low quality were three

times as likely in hospitals with low staffing and support for nurses as

in hospital with high staffing and support.(6)

Linda H. et al (2002) determined the association between the

patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths

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following complications) among surgical patients, and factors related

to nurse retention. Cross-sectional analyses of linked data from 10,184

staff nurses surveyed, 232,342 general, orthopedic, and vascular

surgery patients discharged from the hospital between April 1, 1998,

and November 30, 1999. The results show that in hospitals with high

patient-to-nurse ratios, surgical patients experience higher risk-

adjusted30-day mortality and failure-to-rescue rates, and nurses are

more likely to experience burnout and job dissatisfaction .(7)

Linda H. et al (2007) examined the characteristics of

supplemental nurses, as well as the relationship of

supplemental staff to nurse outcomes and adverse

events. Data from the 2000 National Sample Survey of Registered

Nurses were used to determine whether the qualifications of

supplemental nurses working in hospitals differed from permanent

staff nurses. Data was taken from Pennsylvania state. The findings

revealed that the temporary nurses have qualifications similar to

permanent staff nurses. Deficits in patient care environments in

hospitals employing more temporary nurses explain the association

between poorer quality and temporary nurses. (8)

Numata Y. et al. (2006) reported a review of the literature on the

association between critical care nurse staffing levels and patient

mortality. The findings revealed that the impact of nurse staffing

levels on patients’ hospital mortality in critical care settings was not

evident in the reviewed studies. Methodological challenges that might

have impeded correct assessment of the association include

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measurement problems in exposure status and confounding factors,

often uncontrolled. The lack of association also indicates that hospital

mortality may not be sensitive enough to detect the consequences of

low nurse staffing levels in critical care settings. (9)

Mary A et al (1998) described at the level of the nursing care unit,

the relationships among total hours of nursing care, registered nurse

(RN) skill mix, and adverse patient outcomes. The finding revealed

that the higher the RN skill mix is, the lower the incidence of adverse

occurrences on inpatient care units is. (10)

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Methodology:

Research design:

The design of this study will be a descriptive/correlation study.

Study site:

The study will be conducted at King Khaled Hospital University at Riyadh, Saudi Arabia. Teaching hospital has a total of 800 bed and approximately 1,300 registered nurses.

Population of the study:

This cross-sectional descriptive study was conducted all nurses

employed in King Khaled Hospital University at Riyadh at the time

of study. A total of 1,300 nurses working in different departments

were surveyed.

The instrument:

Two recording forms were used to collect data. The details of each

recording form and questionnaire were as follow:

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1. Daily Working Record Form was developed for the purpose of

collecting daily nurse staffing data and daily patient census in

each unit.

2. Selected Patient Outcomes Record Form was created to record

the quality of care incidences for each nursing unit.

Validity of the Instrument:

To establish content validity the questionnaire will be review by

qualified nurse educators.A pilot study among the nurse who work in

king Abdul-Aziz hospital university at Riyadh.

Ethical consideration:

Ethical codes of conduct were strictly adhered to at all

stages of the project.

Data analysis:

The data will be entered and analyzed on a personal

computer using the Statistical Package for Social Science

(SPSSPC).

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References

1- Needleman, J et al. (2006), Nurse staffing in hospitals: is there a

business case for quality? Health Affairs; 25 (1): 204-211.

2- Barbara, A et al. (2004), A longitudinal examination of hospital

registered nurse staffing and quality of care. Health Services

Research; 39(2): 279-300.

3- Needleman, J et al. (2002), Nurse-staffing levels and the quality

of care in hospitals. New England Journal of Medicine; 346

(22): 1715-1722.

4- Slutsky, J et al. (2007), Nurse Staffing and Quality of Patient

Care.

www.ahrq.gov/downloads/pub/evidence/pdf/ nursestaff / nursestaff .pdf

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5- Kunaviktikul, W et al. (2008), Nurse staffing and adverse

patient outcomes. Chiang Mai University Journal; 7 (1): 59-72.

6- Linda, H et al. (2002), Hospital staffing, organization, and

quality of care: cross-national findings. International Journal for

quality in health care; 14 (1): 5-13.

7- Linda, H et al. (2002), Hospital nurse staffing and patient

mortality, nurse burnout and, job dissatisfaction. JAMA; 288

(16): 1987-1993

8- Linda, H et al. (2007), Supplemental nurse staffing in

hospitals and quality of care. Journal of Nursing

Administration; 37 (7/8): 335-342.

9- Numata, Y et al. (2006), Nurse staffing levels and hospital

mortality in critical care settings. Literature review and meta-

analysis. Journal of Advanced Nursing; 55 (4): 435-448.

10- Mary, A et al. (1998), Nurse staffing and patient outcomes. The

Official Journal of the Eastern Nursing Research Society & the

Western Institute of Nursing; 47(1): 43-50.

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