Introduction
Nurse understaffing is an important healthcare problem that is associated with poor patient outcomes, burnout, high turnover, and other problems faced by healthcare organizations. The objective of the change project is to test whether increasing staffing levels will have a positive outcome on employee retention, the incidence of medical errors, and patient satisfaction. This literature review evaluates how current research supports the PICOT question.
A Comparison of Research Questions
Different studies have attempted to link nurse understaffing with various health outcomes. Beltempo, Blais, Lacroix, Cabot, and Piedboeuf (2017) hypothesized that there was a positive correlation between nurse staffing, overtime, and unit occupancy with healthcare-associated infections (HCAIs). The research question in this study was whether there was an association between nurse workforce attributes and HCAIs. Cho et al. (2016) proposed that nurse understaffing and overtime decrease nurse-perceived quality of care. Therefore, the authors evaluated the influence of understaffing and nurse overtime on patient safety, quality of care, and incomplete care as recognized by nurses (Cho et al., 2016).
Rochefort, Rathwell, and Clarke (2016) asserted that rationing of nursing care interventions impaired nurse-reported patient outcomes and embarked on a study to determine the impact of rationing nursing care intervention on patient outcomes in the neonatal unit. Similarly, Driscoll et al. (2017) determined how nurse staffing levels affected nurse-sensitive patient outcomes. Specific nurse-sensitive outcomes that were investigated included mortality rates, medical errors, and infections in acute care units (Driscoll et al., 2017). On the other hand, Cimiotti, Barton, Gorman, Sloane, and Aiken (2014) questioned whether hospitals that provided pediatric care lacked adequate resources leading to poor care outcomes. This uncertainty compelled the researchers to identify probable gaps in nurse resources in hospitals that cared for children with acute illness (Cimiotti et al., 2014).
To address the problem of nurse staffing and its associated problems, researchers need to have a clear outlook on the intricate relationships between different factors. However, researchers continue to face challenges when conducting investigations, which has hampered efforts to address the issue of nurse understaffing. Shang, Stone, and Larson (2015) pondered over the major challenges faced by researchers who study the relationship between nurse staffing and HCAIs. Therefore, the investigators conducted a study to look into possible challenges in such investigations and provide possible solutions to circumvent the challenges (Shang et al., 2015).
Adequate staffing calls for additional spending for healthcare organizations (salaries for the additional staff members), an unwelcome for many organizations. There is a need to highlight the benefits of adequate nurse staffing to encourage healthcare institutions to increase their staffing levels. Shin and Hyun (2015) hypothesized that there was a positive correlation between nurse staffing and the quality of care in nursing homes and analyzed the link between nurse staffing levels and health outcomes such as falling, depression, and cognitive decline. Even with adequate staffing levels, it is important to ensure that the working conditions allow nurses to provide optimum care. Wendsche, Hacker, and Wegge (2017) inquired whether regular rest breaks could mediate the relationship between understaffing and turnover of registered nurses. Therefore, they sought to investigate the impact of regular breaks on nurse turnover in nursing units with inadequate staffing levels.
A Comparison of Sample Populations
Beltempo et al. (2017) used a sample comprising 2,236 infants admitted to a 51-bed tertiary care facility located in Canada during a 2-year period. Cho et al. (2016) used a sample consisting of 51 hospitals in South Korea and a total of 3037 nurses. Similarly, Cimiotti et al. (2014) conducted their study in a setting that encompassed 498 hospitals with pediatric units and 3,819 pediatric nurses. However, Driscoll et al. (2017) conducted a systematic review of 35 articles that included data from intensive care and cardiac units and 175,755 patients. Similarly, Shang et al. (2015) reviewed 45 articles and abstracts. Rochefort et al. (2016) gathered data from 125 nurses working in Canadian NICUs, whereas Shin and Hyun (2015) collected information from 19 nursing homes with over 60 beds. Wendsche et al. (2017) conducted their investigation in 80 German geriatric nursing units with 597 registered nurses.
A Comparison of the Limitations of the Studies
Some of the reviewed studies did not report their limitations (Shang et al., 2015; Shin & Hyun, 2015; Wendsche et al., 2017). The reliability of the data in all the studies is evident by the backing of conclusions with statistical data and large samples in most studies. However, Cimiotti et al., (2014) acknowledged that actual patient outcomes would have been more accurate than nurses’ quality reports and that they did not control for case-mix. It was also difficult to distinguish between adult and pediatric patients within the facility. Driscoll et al. (2017) admitted heterogeneity in the computation of NPRs, while Rochefort et al. (2014) acknowledged non-response bias and a small sample size attributed to the population of NICU nurses in Quebec.
Conclusion
The overall conclusion of the entire review is that nursing understaffing has adverse effects on patient outcomes. For example, it increases the incidence of HCAIs, reduces the quality of care, and causes incomplete care, rationing of care, and high mortality rates. Most cases of understaffing are linked to poor surveillance, which causes nurses to miss changes in patients’ conditions. Additionally, inadequate breaks between work shifts lead to job dissatisfaction, burnout, and high rates of nurse turnover. On the other hand, adequate nurse staffing is linked to improved health outcomes such as decreased rate of fall incidents, a better range of motion, decreased aggressive behaviors, and reduced tube feeding. Therefore, hospitals should ensure adequate staffing to promote better health outcomes. Further research should assess the influence of staffing on other health outcomes and evaluate the impact of care rationing on post-discharge and pain assessment outcomes.
References
Beltempo, M., Blais, R., Lacroix, G., Cabot, M., & Piedboeuf, B. (2017). Association of nursing overtime, nurse staffing, and unit occupancy with health care-associated infections in the NICU. American Journal of Perinatology, 34(10), 996-1002. Web.
Cho, E., Lee, N. J., Kim, E. Y., Kim, S., Lee, K., Park, K. O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International Journal of Nursing Studies, 60(2), 263-271.
Cimiotti, J. P., Barton, S. J., Gorman, K. E. C., Sloane, D. M., & Aiken, L. H. (2014). Nurse reports on resource adequacy in hospitals that care for acutely ill children. Journal for Healthcare Quality, 36(2), 25-32.
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I.,… Astin, F. (2017). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6-22.
Rochefort, C. M., Rathwell, B. A., & Clarke, S. P. (2016). Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: A cross-sectional survey. BMC Nursing, 15(1), 46-53. Web.
Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and health care-associated infection: Methodologic challenges and potential solutions. American Journal of Infection Control, 43(6), 581-588.
Shin, J. H., & Hyun, T. K. (2015). Nurse staffing and quality of care of nursing home residents in Korea. Journal of Nursing Scholarship, 47(6), 555-564.
Wendsche, J., Hacker, W., & Wegge, J. (2017). Understaffing and registered nurses’ turnover: The moderating role of regular rest breaks. German Journal of Human Resource Management, 31(3), 1-22. Web.