Introduction
The current paper is a literature review related to the issue of nurse staffing and nurse collaboration in hospitals. It is known that understaffing is a common problem in hospitals, which may lead to adverse patient outcomes. It is also known that low-quality nurse collaboration may also negatively affect the patients. Therefore, it is possible to formulate the PICOT question as follows: “Does organizing different kinds of collaborative events for nurses (I) for three months (T) improve the quality of healthcare (O) by decreasing mortality rates among surgical patients (P) when comparing these rates to those present in facilities in which collaborative events were not organized (C)?”
A Comparison of Research Question
The study by Gagliardi et al. (2016) was aimed at exploring the impact of certain features of neonatal intensive care units pertaining to their organization; the research question was approximate as follows: “Which factors are the nurse-to-patient ratio influenced by in neonatal intensive care units?”
The article by Lake et al. (2015) studies the impact of hospital nursing characteristics on the hospital level disparities in very low birth weight (VLBW); the research question could be formulated as follows: “Can poorer hospital nursing characteristics explain VLBW infant outcomes?”
Rogowski et al. (2013) investigated the impact of nurse staffing in neonatal intensive care units (NICU); the research question can be formulated as follows: “Is the nurse staffing adequate in NICU in the U.S., and how is the staffing associated with infant outcomes?”
Twigg, Gelder, and Myers (2015) explored the impact of nurse understaffing on nurse-sensitive outcomes (the negative patient outcomes which can be utilized as signals of related to the quality of nursing care); the approximate research question was: “How does nurse understaffing influence the patient outcomes when it comes to nurse-sensitive outcomes?”
In their study, Wise, Fry, Duffield, Roche, and Buchanan (2015) explored nursing care in all the emergency departments of New South Wales (Australia); the research question could be formulated as follows: “What are the staffing levels, patient presentations, and skill mixes in all the emergency departments in the state of New South Wales?”
On the whole, the presented studies explored various issues pertaining to the nurse staffing and quality of nursing care, and the impact of these on the quality of patient care.
A Comparison of Sample Populations
The study by Gagliardi et al. (2016) utilized a sample of 63 neonatal intensive care units (NICU), which were sampled from the Italian NICUs; 702 reports pertaining to 11,082 infants were collected. It should be noted that out of these infants, 75% were non-intensive.
The research by Lake et al. (2015) utilized the sample of nurses from the neonatal intensive care units in Vermont Oxford Network, nationwide; 5,773 nurses were asked to complete the survey; the response rate was 77%.
Rogowski et al. (2013) utilized a sample of inborn very low birth weight infants from neonatal intensive care units in Vermont Oxford Network; all the infants who were discharged from all such units in 2008 (N=5,771) and 2009 (N=5630) after staying there for at least 3 days were included into the study.
Twigg et al. (2015) studied administrative documents pertaining to 36,529 patients who were admitted to a major acute care medical facility in Western Australia during the period starting in October 2004 and ending in November 2006.
In their research, Wise et al. (2015) researched patient presentation data and nurse rosters, which were collected in New South Wales emergency departments during three randomly chosen census days; out of 44 responses, 26 valid responses were retained and used for the study.
It is easy to see that the discussed studies used data collected from a variety of populations; they researched reports, administrative documents, and so on. Also, several surveys were administered to nurses.
A Comparison of the Limitations of the Studies
The study conducted by Gagliardi et al. (2016) featured several limitations; for instance, there existed a problem with research instruments, because valid and reliable measures of nursing workload in neonatal ICUs do not exist, and it is difficult to assess these in relation to nurse-to-patient ratios.
The limitations of the research by Lake et al. (2015) pertain to the cross-sectional study design, which adversely impacts the possibility to draw causal inferences, and to the sampling; the sampled neonatal ICUs were from more teaching hospitals and were mostly larger and of higher level.
The study of Rogowski et al. (2013) had limitations related to the use of Vermont Oxford Network hospitals for sampling; these provide high-quality nursing care and are not representative of all the neonatal ICUs in the U.S. hospitals. Also, causal references were limited by the study design (cross-sectional).
The limitations of the study by Twigg et al. (2015) pertains to the use of a sample from only one hospital, as well as to the assumption that the hospital was normally staffed adequately to minimize nursing-sensitive outcomes, due to which the researchers only investigated the problems arising when the staffing was below the normal levels.
The research by Wise et al. (2015) had limitations related to the limited sample (only three census days may not be representative; the low quantity of usable responses also limits the external validity of the study) and to the conservative approach to counting beds (in fact, more patients could have been present than was estimated in the study, resulting in underestimated workload).
Conclusion and Recommendations
Thus, the reviewed studies investigated the impact of nursing practices on patient outcomes. The studies mainly supported the statement that nurse understaffing adversely affects patient outcomes. However, limited information was collected on nursing skills and collaboration (Lake et al., 2015; Wise et al., 2015). Therefore, it is possible to recommend investigating the impact of increasing nurse collaboration on patient outcomes.
References
Gagliardi, L., Corchia, C., Bellu, R., Coscia, A., Zangrandi, A., & Zanini, R. (2016). What we talk about when we talk about NICUs: Infants’ acuity and nurse staffing. The Journal of Maternal-Fetal & Neonatal Medicine, 29(18), 2934-2939.
Lake, E. T., Staiger, D., Horbar, J., Kenny, M. J., Patrick, T., & Rogowski, J. A. (2015). Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care. Health Services Research, 50(2), 374-397.
Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. T. (2013). Nurse staffing and NICU infection rates. JAMA Pediatrics, 167(5), 444-450.
Twigg, D. E., Gelder, L., & Myers, H. (2015). The impact of understaffed shifts on nurse‐sensitive outcomes. Journal of Advanced Nursing, 71(7), 1564-1572.
Wise, S., Fry, M., Duffield, C., Roche, M., & Buchanan, J. (2015). Ratios and nurse staffing: the vexed case of emergency departments. Australasian Emergency Nursing Journal, 18(1), 49-55.