1. King Saud University
College 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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2. 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 been recommended as a means to improve
patient safety. (4)
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3. 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
registered nurses and a greater number of hours of care by registered
nurses per day are associated with better care for hospitalized patients.
(3)
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4. 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
hours per patient day and three adverse patient outcomes – patient
falls, pressure ulcers and UTIs. (5)
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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
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
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6. 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
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)
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7. 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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8. 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:
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.
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9. 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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10. 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
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.
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11. 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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