Workforce Issues And Patient Safety

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Workforce Issues And Patient Safety

Workforce Issues And Patient Safety

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WEEK2/Discussion Question 2


Suggested References:

Ko, E., Nelson-Becker, H., Park, Y., & Shin, M. (2013). End-of-Life decision making in older Korean adults: Concerns, preferences, and expectations.Educational Gerontology, 39(2), 71–81.

Roulston, A., Bickerstaff, D., Haynes, T., Rutherford, L., & Jones, L. (2012).  A pilot study to evaluate an outpatient service for people with advanced lung cancer. International Journal of Palliative Nursing, 18(5),225–233.

Sandvik, A., Melender, H., Jonsén, E., Jönsson, G., Salmu, M., & Hilli, Y. (2012). Nursing students’ experiences of the first clinical education: ANordic quantitative study. Nordic Journal of Nursing Research & Clinical Studies /Vård I Norden, 32(3), 20–25.

Shisana, O., Rice, K., Zungu, N., & Zuma, K. (2010). Gender and poverty in South Africa in the era of HIV/AIDS: A quantitative study. Journal of
Women’s Health (15409996), 19(1), 39–46.

Based on your research, select an article and complete the following tasks:

· Identify and describe the research problems, purpose, objectives, and hypothesis of the research.

· Evaluate the credibility and validity of the study.

APA format references needed.

The importance of nurse staffing to the delivery of high-quality patient care was a principal finding in the landmark report of the Institute of Medicine’s (IOM) Committee on the Adequacy of Nurse Staffing in Hospitals and Nursing Homes: “Nursing is a critical factor in determining the quality of care in hospitals and the nature of patient outcomes”1 (p. 92). Nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level (that nurses are an important component of the health care delivery system and that nurse staffing has impacts on safety), much less agreement on exactly what research data have and have not established, and active disagreement about the appropriate policy directions to protect public safety.

The purpose of this chapter is to summarize and discuss the state of the science examining the impact of nurse staffing in hospitals and other health care organizations on patient care quality, as well as safety-focused outcomes. To address some of the inconsistencies and limitations in existing studies, design issues and limitations of current methods and measures will be presented. The chapter concludes with a discussion of implications for future research, the management of patient care and public policy.

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For several decades, health services researchers have reported associations between nurse staffing and the outcomes of hospital care.2–4 However, in many of these studies, nursing care and nurse staffing were primarily background variables and not the primary focus of study.5 In the 1990s, the National Center for Nursing Research, the precursor to the National Institute of Nursing Research, convened an invitational conference on patient outcomes research from the perspective of the effectiveness of nursing practice.6 It was hoped that as methods for capturing the quality of patient care quantitatively became more sophisticated, evidence linking the structure of nurse staffing (i.e., hours of care, skill mix) to patient care quality and safety would grow. However, 5 years later, the 1996 IOM report articulating the importance of nurses and nurse staffing on outcomes concluded that, at that time, there was essentially no evidence that staffing exerted an effect on acute care hospital patients’ outcomes and limited evidence of its impact on long-term care outcomes.1

There has been remarkable growth in this body of literature since the 1996 IOM report. Over the course of the last decade, hospital restructuring, spurred in part by a move to managed care payment structures and development of market competition among health care delivery organizations, led to aggressive cost cutting. Human resources, historically a major cost center for hospitals, and nurse staffing in particular, were often the focus of work redesign and workforce reduction efforts. Cuts in nursing staff led to heavier workloads, which heightened concern about the adequacy of staffing levels in hospitals.7, 8 Concurrently, public and professional concerns regarding the quality and safety of patient care were sparked by research and policy reports (among them, the IOM’s To Err is Human9), and then fueled by the popular media. A few years ago, reports began documenting a new, unprecedented shortage of nurses linked to growing demand for services, as well as drops in both graduations from prelicensure nursing education programs and workforce participation by licensed nurses, linked by at least some researchers to deteriorating working conditions in hospitals.10, 11 These converging health care finance, labor market, and professional and public policy forces stimulated a new focus of study within health services research examining the impact of nurse staffing on the quality and safety of patient care. An expected deepening of the shortage in coming years12 has increased the urgency of understanding the staffing-outcomes relationship and offering nurses and health care leaders evidence about the impacts of providing care under variable nurse staffing conditions. This chapter includes a review of related literature from early 2007.
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Identifying Nurse-Sensitive Outcomes
The availability of data on measures of quality that can be reasonably attributed to nurses, nursing care, and the environments in which care is delivered has constrained research studying the link between staffing and outcomes. While nurse leaders have been discussing the need to measure outcomes sensitive to nursing practice back to at least the 1960s, widespread use of the terms “nurse/nursing-sensitive outcomes” and “patient outcomes potentially sensitive to nursing” is a relatively recent development. Nurse-sensitive measures have been defined as “processes and outcomes that are affected, provided, and/or influenced by nursing personnel, but for which nursing is not exclusively responsible.”13, 14 While some scholars feel the term “nurse-sensitive measure” is fundamentally incorrect because patient outcomes are influenced by so many factors, health care is practiced in a multidisciplinary context, and few aspects of patient care are the sole purview of nurses, there is a broad recognition that some outcomes reflect differences in the quality of nursing care patients receive and therefore presumably respond to the characteristics of the environments in which care is provided (including staffing levels).

No matter what label these measures are given, measures that have conceptual and clinical links to the practice of nursing and are sensitive to variations in the structure and processes of nursing care are an essential ingredient in this area of research. Data sources from which to construct these measures must be identified, and exact definitions indicating how measures are to be calculated must be drafted. This is particularly critical if different individuals or groups are involved in compiling quality measures. There have been calls for standardization of measures of the quality of health care for some time,1, 15 along with outcome measures related to the quality of nursing care. Inconsistent definitions have slowed progress in research and interfered with comparability of results across studies. A paper, now under review, examines and compares common measures of adult, acute care nurse staffing, including unit-level hospital-generated data gleaned from the California Nursing Outcomes dataset, hospital-level payroll accounting data obtained from the California Office of Statewide Health Planning and Development, hospital-level personnel data submitted to the American Hospital Association, and investigator research data obtained from the California Workforce Initiative Survey. Findings reveal important differences between measures that may explain at least some inconsistencies in results across the literature (Spetz, Donaldson, Aydin, personal communication February, 2007)

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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