Abstract
The study investigates the relationship between nurse staffing ratios to patient outcomes in Emergency Departments. I will approach 54 registered nurses who are employed in different health care organizations and educational facilities. The study will adopt the descriptive correlation, grounded theory based on Delphi approach. The correlation is expected to be greater than the alpha coefficient of 0.05 hence leading me to accept the hypothesis that there is a positive correlation between nurse staffing ratio and patient outcome in the emergency department. Hospital administrators are often faced with the challenge of determining the nursing staff ratio for quality health care while maintaining the budget. The study provides a peer review indicator for an administrator to assess nursing care.
Background
The work of nurses in the Emergency Department involves assessment of perceived, actual or potential, sudden or urgent, and physical or psychosocial problems that are mainly episodic or acute (Hall, 2004; Wise, Fry, Duffield, Roche, & Buchanan, 2015). Besides dealing with acute and episodic patients, nurses have family problems. The unique dimension of emergency nursing consists of the limited availability of patient information and situations that deal with a wide range of ages (Hall, 2004). Emergency Departments lack established patient load limits, and nearly all patients present diseases that are either diagnosed or in the acute phase. The evolving nature of emergency nursing practices has transitioned into a complex system with the increased use of point of care testing and protocols in acute illness (Hall, 2004). The evolving and broad nature of emergency services means that emergency nurses’ workloads are also changing.
The relationship between nursing care and the patient outcome can be interpreted in terms of nurse-patient ratio and nursing skills (Greene, Harrinton, & Hongsoo, 2009). Nurse-patient ratio concerned with nursing staff to the number of the patient while the nursing mix relates to the percentage of non-registered nurses to registered nurses. Studies have highlighted a positive relationship between patient outcome and nurse-patient ratio. Aiken, Clarke, Sermeus, Van den Heed and Vleugals, (2007) noted that 50% increment in hours of registered nurse per patient in a day decreased the vulnerability of urinary tract infection by 4. % and reduced risk of developing pneumonia (4.2%), Thrombosis (2.6%) and pulmonary compromise (1.8%).A high ratio of registered nurses is positively related to reduced patient falls, length of stay, patient complaints, and medication errors, as well as the development of decubiti (Aiken et al., 2007). Studies have also used organizational databases to demonstrate reduced infection rate, mortality rates and high quality due to increased number of registered nurses.
Organizational data is readily available in hospital databases and highlights the effects on individual patients of inadequate staffing in the emergency setting through laboratory results and health reports (Aiken et al., 2007). The use of organizationally based data has supported the benefits of high registered nurse staffing ratio in producing positive patient outcomes. Hall (2004) asserts that patients’ outcomes may ensue when nurse staffing is below a certain threshold or when there are too many nurses who are unfamiliar with the unit. Hodge, Asch, Olson, Kravitz and Sauve (2002) found a positive correlation between nurse staff ratios to patient outcome. According to their study, high nurse ratio resulted to adjusted mortality, patient satisfaction, pain management, and reduced length of stay.
This study seeks to determine the relationship between nurse staffing ratios to patient outcome in Emergency Departments. Hospital administrators are often faced with challenge of determining nursing staff ratio for quality health care while maintain the budget. The study will investigate whether nursing staff ratio is an effective intervention.
Research method
The study seeks to determine whether nurse staffing ratio impacts patient outcome. The study adopted the descriptive correlation method, a grounded theory based on Delphi approach. The Delphi approach is an iterative primary research approach that distils and assembles various views from experts using a series of the questionnaires (Cresswell, 2003). This approach used expert opinion to determine the relationship between independent variable (nurse staffing ratio) and the outcome variable (patient outcome). The researcher applied the Delphi model to predict consensus among the experts regarding the impacts of nurse staffing ratio on patients’ outcome. Hodge et al. (2002) modified Delphi approach to examine measures of nursing quality for assessment of nurse staff ratio. They examined seventy indicators of validity, feasibility, and overall suitability. Validity was defined as the sensitivity, feasibility, and certainty to measure nursing care. Feasibility was the ease of collecting indicator data while the suitability was the subjective decision by the experts on whether the indicator should be used.
The researcher approach 54 registered nurses who are employed in different health care organization and academic institution. The researcher specifically recruited those registered medical practitioners who had at least a master’s degree and minored in one field of practice like staff development, health care education and clinical practice. The participants were invited to the interview through the use of email highlighting the confidentiality and volunteer in participation. The participants signed a consent form before taking part in the interview and the researcher informed them that there were no consequences if they fail to participate. Those selected to participate received full information on the research questions so to prepare themselves for the research. The reseacher utilized a Likert scale of 1 to 5 items in which the panelists were asked to categorize and provide opinion.
Research hypothesis
Some researchers (Wise et al., 2015) support nurse to patient ratios as a way of ensuring adequately registered nurse staffing. According to these researchers, an increase in nurse staff ratios in emergency setting will improve patient safety as well as improving nurse retention while reducing costs. However, some researcher question complexities such as severity of illness, complexity of nursing work, nursing skill mix, and environmental concerns. According to these researchers, there are no enough nurses available to meet demands of the higher nurse to patient ration. Based on these debates, I developed the following hypothesis:
- H0: There is positive correlation between nurse staffing ratio and patient outcome in emergency departments.
- H1: There is negative correlation between nurse staffing ratio and patient outcome in emergency departments.
Statistical analysis
I used the statistical package SPSS for window application to develop all the data analysis. The SPSS software provides the capabilities for the data to be flexible and fully assessed. Before using this software, I categorized and coded the data so as to simplify data entering procedure. I used the independent-Samples T-Test. This tool uses a measure of the score to assess the significant mean difference between two samples. The concept statistical significance is used if the mean of the two sample is below a probability of 0.05 (Saunders, Lewis, & Thornhill, 2003). Therefore independent sample t-test involves sampling from a population and assessing the mean difference with the assign mean value. I used the sample t-test to assess the significant correlation between the independent variables and outcome variables. Having established the independent existence of the two samples, I made the comparison by testing the mean. The null hypothesis is excluded when the sig. (2 tailed) Value is less than or equal to 0.05 and accepted when it is greater than 0.05. Although other techniques such ANOVA test exists to address the aim and objective of the study, I considered Independent sample t-test to be suitable. Although these techniques are used to identify the mean score of independent variables, the ANOVA is only used for those values with more than three independent variables.
Expected results
An expected 54 panelist will participate in the study. The correlation is expected to be greater than the alpha coefficient of 0.05 hence leading me to accept the hypothesis that there is positive correlation between nurse staffing ratio and patient outcome in the emergency department. I expect my study result to be consistent with Greene, Harrinton, & Hongsoo’s (2009) study. According to their study, the registered nurses to total nursing staff were negatively related to total deficiencies. As the ratio of registered nurses to Licensed or second nurse increased, regulatory deficiencies decreased. I also expect teaching hospitals to have a lower admission rates with high rates of patient satisfaction. I expect non-teaching medical centers to have higher rates of admissions. Increased staffing ratios are positively related to reduced medical errors, reduce nurse turnover, lower mortality rate and shorter length of stay.
The study provides a peer review indicator for an administrator to assess nursing care. The significance of using the Delphi strategy is to determine evidence-based nurse staffing ratio variables and patient outcome variable from an expert point of view. The study will help administrators make an informed decision concerning nurse staffing ratio as well as contributing to the existing field of study. However, the study is subjected to bias since it depends on opinion and word of mouth from the expert.
References
Aiken, L., Clarke, S., Sermeus, W., Van den Heed, K., & Vleugals, A. (2007). International experts’ perspectives on the state of the nurse staffing and patient outcomes literature. Journal of Nursing Scholarship, 39(4), 290-297.
Cresswell, J. W. (2003). Research Design: Qualitative, quantitative and mixed method approach. London: Sage Publications.
Greene, W., Harrington, C., & Hongsoo, K. (2009). Registered nurse staffing mix and quality of care in nursing homes: a longitudinal study. The Gerontologist, 49(3), 81-90.
Hall, D. (2004). The work-related stress of registered nurses in a hospital setting. Journal of Nurses in Staff Development, 20(1), 6 -14.
Hodge, M. B., Asch, S. M., Olson, V. A., Kravitz, R. I., & Sauve, M. J. (2002). Developing indicators of nurse quality to evaluate nurse staffing ratios. Journal of Nursing Administration, 32(6), 338-345.
Saunders, M., Lewis, P., & Thornhill, A. (2003). Research Methods for Business Students. London: Prentice Hall.
Wise, S., Fry, M., Duffield, C., Roche, M., & Buchanan, J. (2015). Ratios and nurse staffing: The vexed case of emergency departments. Australian Emergency Nursing Journal, 18(1), 49-55.