Applying Theory to a Practice Problem Part 1 (Nurse Staffing)

ApplyingTheory to a Practice Problem: Part 1 (Nurse Staffing)

ApplyingTheory to a Practice Problem: Part 1 (Nurse Staffing)

Eventhough there exist several studies and research that link nursestaffing and workload to nurse satisfaction, financial, and patientoutcome, this research has been broadly ignored. In connection tothis, nurses continually work in over-worked and under-staffedconditions that pose as threat to safety and health care servicesthat they offer to their patients. High levels of dissatisfaction andturnover among nurses often has detrimental impact on the financialperformance of a health care organization. Several nursing theoriescan be applied in solving various issues surrounding nurse staffingin health care organizations. Nursing theory refers to asystematically organized and articulated set of statements that arerelated to various questions in the discipline of nursing (Cho, June,Kim, Yoo, and Sung, 2009). There are several ways in which nursingtheory influence the practice of nursing. It plays a key role increating a provision for the foundations of nursing practice,generation of further knowledge, as well as in giving directiontowards which nursing should develop in the future. A well definedtheory in nursing facilitates better patient care, guidance forresearch and education, improved communication amongst nurses, aswell as enhanced professional status for nurses. Administration andmanagement of nursing care services, direct patient care situations,and educational and research settings are some of the areas thatnursing theory can be applied to resolve any existing and potentialnursing challenges (Cho et al., 2009).

Recently,nursing staffing has been a growing and controversial issue in mosthealth care organizations. According to Frith, Anderson, Tseng andFong (2012), there exists a direct linkage between the outcomes ofhealthcare services extended to patients and nurse staffing. Severalevidence-based practices and studies show that limited nursing staffoften results to poor services to patients. This, in turn, results todeterioration of patients’ conditions and increased hospital stay.Kalisch and Lee (2011) findings show that organizations that haveadequate nursing care have their patients recuperate in a quickermanner and suffer fewer complications. Increase of patients to unsafelevels often result to increased nurse turnover rates, jobdissatisfaction, high incidences of , medical errors, as well asforced overtime among nurses. Inappropriate staffing mostly occur dueto aging population of both patients and experienced nurses,perceived nursing shortages, competing priorities for healthcarebudget, and increased concerns on healthcare spending.

Forseveral decades, researchers in the field of health care havecontinually reported a strong association between nurse staffing andthe outcome of health care extended to patients. Quality of care andsafety extended to patients can be improved in an enormous manner byincreasing the nurse to patient ratios. Nevertheless, the costeffectiveness of increasing registered nurse (RN) raises severalcontroversies. Many states have the freedom of choosing between costbenefit and cost effectiveness with regard to nurse staffing. According to Kalisch et al (2011), allowing minimum nurse staffingleads to employment of more nursing personnel hence, most healthcare organizations suffer huge financial strain. However, Harper(2012) argues that more nurses should be employed in order toadequately meet the needs of all patients thus, reducing bothmedical errors and patient mortality. This, in turn, reduces unwantedlegal issues as well as significantly reduces cost to compensate forturnover rates

NurseStaffing attracts both personal and professional concern appropriatestaffing facilitates the provision of health care and services thatare of high quality. Inappropriate staffing has a high likelihood ofthreatening patient health and safety it further leads to greatercomplexity of care in health care organizations. Inappropriatestaffing often leads to mandatory overtime due to nursing shortage.As a result, patients’ care has been compromised, high rate ofmedical errors witnessed, and many nurses are forced to spend littleor no time at their home. Harper (2012) posits that nursing staffingand advances in technology enormously correlate to medical errors.Most health organizations have widely shifted from paper toelectronic-based work with an aim of improving patients’ safety aswell as effectiveness of health care services given to patients.These organizations have widely embraced computerized physician orderentries, smart pumps, automated medication dispensing systems,medication reconciliation, and bar code administration systems.Prevalence of medical errors has greatly reduced, thanks to theimplementation of the aforementioned measures. Despite this, mostorganizations still struggle with issues related to medical errors.Therefore, nurses play a significant role in preventing theoccurrence of medical errors. They accomplish this role by picking upon changes in patients’ conditions, following unit protocols, aswell as calculating medication dosages (Cho et al., 2009).Nevertheless, more research on the usage of technology in theassessment of adequate nurse staffing need to be carried out.Advanced technologies like EHR need to be incorporated in theestablishment and control of nursing workloads. Additionally, thereare medical database programs that help nurse assess quick datainformation to lab values, pharmacologic interventions, and patientobservation (Frith et al., 2012). Following this, much time spent onindirect nursing tasks is saved. Inconsistence in nursingassignments, workloads demands, and interruptions in continuity ofcare often result to environmental interruptions. Environmentalinterruptions, in turn, leads to ineffective communication among thenursing staff, delayed patient treatment, and medication errors.

Healthcareinstitutions have the role of implementing some changes within theirsystem with an aim of assessing and monitoring effective nursestaffing. Proper assessment and monitoring plays a key role helpinghealthcare organization understand whether their staffing incorporatethe required number of caregivers, who are empowered with effectiveskill mix and significant prowess. Health care organizations canemploy quite a good number of strategies to help overcome the problemof inappropriate staffing (Frith et al., 2012). Firstly, they shouldhave set standards for measuring both the competency and staffing oftheir nurses. The human resource department has the role of settingthe aforementioned standards. Healthcare organizations canincorporate the Joint Commission in assessing the effectiveness oftheir nurse staffing. Alternatively, these organizations can hireskilled nurses from temporary staffing firms. According to Harper(2012) approximately 56 percent of hospitals in America resolve theissue of nurse staffing by making use of travelling nurses oragencies to hire temporary nurses. Nevertheless, this strategy comesalong with some negative effects on staff nurses. Temporary nursesdemand for more salary and they have the freedom of choosing theirown schedule, whereas other nurses in the same healthcare are paidless and cannot choose their own schedule. This strategy discouragesthe latter group thus, increasing their likelihood of deliveringpoor health care services to their patients.

Similarly,healthcare organizations can establish and develop their ownnurse-patients ratios based on past experiences and evidences.Appropriate ratios play a significant role in facilitating adequatenurse staffing and nurse safety. Mandated staffing ratios for nursesconsist of one nurse for every patient suffering from trauma, onenurse to one patient with a critical condition, one nurse to threeemergency patients, one obstetric to two women in labor, onepediatric nurse to three children, and one nurse to three patients onsurgical units. It is of immense significance that healthcareorganizations to have ratios designed specially for operating rooms,intermediate care nurseries, telemetry, psychiatric unit, step downunit, neonatal ICUS, and burn units. This strategy has proveneffective in California it passed …a minimum staffing levellegislation that is used within its health care organizations.Moreover, nursing skill mix come along with various benefits. Kalischet al (2011) findings indicate that registered nurse staffing highlycontribute to the reduction of chronic illness like cardiac arrest.

Adequatelevel of nurse staffing often lead to reduced medical errors,patients’ complications, job satisfaction, decreased mortalityrates, and reduction in levels of burnouts among nurses. Healthcareorganization can calculate their staffing levels within the entireorganization or for an operation level within the organization. It isvital to identify specific time frames with an aim of establishingand reaching a common meaning among those who collect, analyze, andinterpret collected data. Generally, many health care centerscalculate staffing measures for the whole hospital for over a oneyear period. In some cases, it is fairly common to aggregate staffingacross day shifts in a month, quarter, or year in all departments ofhospitals. It is easy to identify organizations that have invested instaffing by looking at the resulting measures they show particularconditions that patients and nurses go through at particular points.Harper (2012) acknowledges that differences in patients’ illnessand populations’ severity, nevertheless, are shown by staffinglevels on different units. Additionally, most organizations managenurse staffing on shift-by-shift, day-by-day, and unit-by-unithence, budget is done on a longer time zone. Following this, someresearchers recommended further research and studies on how staffingcan be measured on a unit-specific and shift-specific basis rather onan annual and hospitawide basis

Healthorganizations may adopt some of the basic types of staffing measures.One of the measures involves the division of a volume of nursingservices or nurses by a certain quantity of patient care services.This measure may incorporate full-time equivalent positions workedwith regard to average patient census for a certain period of time,hours of nursing care that are delivered by different subtypes ofpersonnel per patient day, as well as patient-to-nurse ratios.Another measure incorporates cross examination of staff members’qualifications and credentials, which are then expressed as aproportion of staff with more training versus those with lesstraining or vice-versa (Cho et a., 2009).

Linkageof nurse staffing with the outcome of services extended to patientsincorporate both a unit or departmental and a temporal timecomponent. Frith et al (2012) argues that many of such outcomesreflect compounded errors as well as omissions over a particularperiod of time across various departments of healthcareorganizations. The fact that most patients are often exposed to morethan one area of a hospital hugely complicate the attribution ofoutcomes among the patients. For instance, a patient may be initiallytreated in an emergency department, undergoes surgery, and sometimesstay in an intensive care unit before being given some health care ata general unit. If such a patient develops a certain complication,then it will be extremely hard to establish the point at which lowstaffing or poor quality facilitates the occurrence of such acomplication. This is a clear indication that hospital-level datasetsrarely offer medics and other physicians the chance to pinpointlocations, and times of the errors for a clinical outcome.

Inmost cases, unsafe nurse to patient ratios pose significant effectson healthcare budgeting and spending, not forgetting their impact onthe overall satisfaction of nursing staff. Harper (2012) acknowledgesthe significant of emotional distress and ethical conflicts amongnurses and their association to experienced burnouts

Supportivepersonnel further facilitate the adequacy of nurse staffing. Suchsupportive personnel include but not limited to availability ofagency nurse and float, proper understanding of nurse managers, andnursing care assistance. Sometimes float pool nurses have proveneffective when hired to compensate for the shortages of regular staffnurses. This, in turn, lead to improved patient care and limitedstress on staff nurses. The supportive personnel play a key role inminimizing budget cost of employing more registered nurses. Despitethis, assistive personnel involve delegation

Properdistribution of care activity enhances the establishment ofsupportive staff. Following this, it is vital to separate nursingtasks into personal time, unrelated tasks, direct care, and indirectcare. According to Cho et al (2009), indirect tasks incorporate teammeetings, documentation, and telephone calls, unrelated tasks consistof placing an order for supplies management for clean clinicaldirect tasks incorporate wound care and administering meds, whilepersonal time incorporate staff appraisal and lunch breaks. In mostcases, nurses play the role of accomplishing the aforementionedtasks if they are delegated to other personal, then nurses will haveadequate time to perform necessary patient care.

Thestudy of nurse staffing and patient outcomes is one of the legitimateand strategically vital topics of both inquiry and study. There is nosingle solution to the issue of nurse staffing. Inappropriate nursestaffing is evident in most health care organizations. Severalstudies and research show a direct linkage between nurse staffing andthe outcome of health care services extended to patients. Adequatestaffing leads to positive patient outcomes whereas inappropriatestaffing leads to negative impacts on patients, burnout anddemoralization among nurses. Healthcare facilities, therefore, shouldbe at the forefront in addressing this issue they should encourageand embrace positive changes within their organization. They shouldalso ensure appropriate nurse-to-patient ratios as well carry outnurse skill mix in an effective manner. Additionally successfulpromotion of maintenance of health and restoration for illness safeworking conditions for all staffs should be advocated for. Hospitalsand other healthcare agencies should be mandated to adhere tostaffing guidelines through introduction staffing plans and stateregulations. As a result, decreased nurse burnout, adverse patientoutcomes, as well as increase quality nurse care will be achieved.Nevertheless, healthcare organizations need to find a method ofcompensating for increased spending that may result from additionalnurse staffing. A possible solution, for instance, may incorporatethe exploration of nursing care as separate activity for generatingrevenue to increase nursing budgets.


Cho,S., June, K., Kim, Y., Yoo, C., Y, S., and Sung, Y.&nbsp (2009).Nurse staffing, quality of nursing care and nurse job outcomes inintensive care units. Journalof Clinical Nursing,18, 1729-1737.

Frith,K., Anderson, E. F., Tseng, F., and Fong, E. (2012). Nurse Staffingis an Important Strategy to Prevent Medication Errors in communityHospitals. NursingEconomics,30, 5,288-292.

Harper,E. (2012). Staffing Based on Evidence: Can Health InformationTechnology Make it Possible? NursingEconomics,30, 5,262-269.

Kalisch,B., and Lee, K.H. (2011). Nurse Staffing Levels and Teamwork: ACross-Sectional Study of Patient Care Units in Acute Care Hospitals.Journalof Nursing Scholarship, 43,1, 82-88.