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Impact of Nurse Staffing on Patient Outcomes

Problem statement

The aim of the study was to examine the relationship between nurse staffing and the observed patient outcomes in hospital settings, paying special attention to acute care, nurse staffing policies and strategies (Penoyer, 2010). In particular, the researcher notes that the relationship between low nurse-patient ratios and desired outcomes has already been established. However, it is clear that the specific relationship between patient outcomes and the factors of nurse-patient ratios and nurse work hours has not been well-documented, especially in acute care hospital settings. In acute care centers, nurse staffing strategies and policies have not been adversely addressed. Therefore, a gap in the existing knowledge was identified because few studies attempted to examine some of these factors. In fact, most studies attempt to examine the general relationship between nurse-patient ratios or nurse work hours and patient outcomes, without paying attention to the specific section of the hospital (such as acute care) or the underlying factors in the staffing approach used. Therefore, the researchers wanted to address this problem using a qualitative approach by examining and reviewing research studies that take into consideration some of these factors.

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To establish the need for the study or the study’s significance in the healthcare sector, the researchers analyzed the mortality rates recorded in the acute or critical care sections, drawing a relationship between the mortality and morbidity rates and the number of patients allocated to individual nurses. The review indicates that high nurse-patient ratios, long working hours and ineffective nurse staffing strategies have the effect of increasing mortality and morbidity rates, especially in acute care hospitals or critical sections. They note the low level of motivation and overworking as the major causes of poor nurse services to patients, which results in high death rates in acute care centers (Kane, Shamliyan, Mueller, Duval & Wilt, 2007).

Purpose of the study and research questions

The researcher clearly indicates that the aim of the study was to determine the relationship between factors of nurse staffing and the observed patient outcomes. Although the researcher fails to clearly state the research question, the discussion at the end of the introduction section of the article indicates that the question to be addressed is “do staffing strategies and policies, which determine the ratio of nurses to patients, have an impact on patient outcomes in critical care units as well as critical patient populations?” Therefore, it is clear that the researcher’s purpose statement (in form of study objective) relates to the identified study problem because it leads to the examination of data from the previous study in order to address this particular problem. In addition, it is clear that a qualitative approach is important in addressing the study problem based on the research objectives, even though the research question has not been stated. For instance, to determine the relationship between nurse-patient ratio and patient outcomes, a number of other factors must be considered, including the staffing policies, strategies and nurse working hours, patient conditions and death rates or rates of recovery in the acute care centers (Seago, Williamson & Atwood, 2006). Therefore, a qualitative study was necessary to examine the results of the previous studies and develop a comprehensive analysis and discussion of the results, thus providing a concise qualitative conclusion (Kane et al., 2007).

Review of Literature

It is worth noting that the study used a concise review of the existing knowledge about the relationship between nurse staffing and patient outcomes in acute care. As such, the researcher’s main study method is to analyze the existing literature in order to extract information that concisely explains the phenomenon in a qualitative approach. The researcher reviewed a wide range of study reports and articles in order to extract information. In this case, the introduction, literature review, and methodology sections were primarily based on the information from previous studies. Besides, the researcher considered both qualitative and quantitative studies relevant to the topic of study. Included in the review were medical reports from credited bodies such as the NIH, American Nursing Association and the Centers for Disease Control and Prevention (CDC). These reports provide evidence-based information regarding the relationship between staffing strategies and models and the observed patient outcomes, mainly supporting the hypothesis that small nurse-patient ratios and short working hours for nurses result in low mortality rates and high recovery rates in acute care hospitals.

Also, the researcher conducted the study between 2009 and 2010, but the studies used in the concise review were published between 1998 and 2008. This means that the researcher focused on research studies conducted within the 10-year period preceding the study, a common strategy in conducting quality studies in conventional research approaches.

In the concise review of literature, the researcher starts by noting the importance, significance and strengths of each article or report reviewed before critically analyzing the outcomes. However, the researcher takes time to note some of the weaknesses in each source, especially when reviewing empirical study articles. This is an important aspect of research because it shows the areas that need additional research, thus revealing the existing study gaps and suggesting some possible approaches to fill them.

In this case, the review of literature develops a comprehensive analysis of the articles based on the themes of nurse staffing (staffing strategies, working hours and staffing methods) and outcomes (mortality rates, hospitalization rates and recovery rates). In this way, the researcher builds a logical argument that shows the relationship between the two sets of themes.

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Conceptual/Theoretical Framework

Although the researcher fails to describe the actual theoretical or conceptual framework from which he developed the study, it is evident that the study question was developed from a comprehensive analysis of evidence-based practice. Evidence-based practice (EBP) is a comprehensive analysis of the evidence obtained from observation, experience and study of the relationships between a phenomenon and the outcomes, primarily by analyzing the events, approaches, and practices used to deal with patients and the observed outcomes.

Although a qualitative approach was used and a conceptual framework (evidence-based practice) used in the study (though not described), the researcher failed to explain the actual grounded theory of the qualitative inquiry, primarily because a substantially large number of previous studies was used. No diagram of the framework or grounded theory has been provided. Nevertheless, the conceptual framework, which is evidently based on EBP, effectively shows the researcher’s expertise and ability to conduct empirical and quality studies that can expound the existing information and lead to effective suggestions and recommendations.


Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007). The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Medical care, 45(12), 1195-1204.

Penoyer, D. A. (2010). Nurse staffing and patient outcomes in critical care: a concise review. Critical care medicine, 38(7), 1521-1528.

Seago, J. A., Williamson, A., & Atwood, C. (2006). Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue. Journal of Nursing Administration, 36(1), 13-21.

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