The issue of nurse understaffing is a major problem in many healthcare facilities in the country and around the world. This problem is detrimental as it affects the quality of care that nurses can offer, especially when they are tired due to excess workload. A correlation has been established between nurse understaffing and high incidences of hospital-acquired infections (HAI). Therefore, this study seeks to establish how the presence of strict nursing ratios or the lack thereof affects the incidences of HAI. Five articles were used for the literature review.
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Comparison of Research Questions
Wise, Fry, Duffield, Roche, and Buchanan (2015) sought to estimate average staffing levels, skill mix and bed occupancy in New South Wales Emergency Departments, while West, Barron, Rafferty, Rowan, and Sanderson (2014) aimed at determining whether the size of nurses has an impact on the survival chances of critically ill patients. On the other hand, van Oostveen, Mathijssen, and Vermeulen (2015), looked to obtain an in-depth insight into the perceptions of nurses regarding current nurse staffing levels, while Ball et al. (2018) sought to examine if missed nursing care mediates the association between nurse staffing levels and mortality. On their part, Choo et al. (2015) sought to examine the effects of nurse staffing, work environment, and education on patient mortality.
Comparison of Sample Populations
Wise et al. (2015) collected data from three randomly selected census days. Out of the 44 responses, 26 were valid and thus were used as the study sample. In the study carried out by West et al. (2014), data was collected from 65 ICUs and the information obtained was for 38,168 patients. van Oostveen et al. (2015) collected data from four focus groups of 44 nurses. Additionally, 27 interviews were conducted using purposive sampling. Therefore, the sample size entailed 71 participants. In the study by Cho et al. (2015), the study sample involved 1,024 staff nurses and discharge data on 76,036 patients. Finally, Ball et al. (2018) collected data from a sample of 422,730 surgical patients and 26,516 registered nurses.
Comparison of Study Limitations
In the study by Wise et al. (2015), one of the limitations is that patient presentations in the emergency department were highly variable and thus the data collected in the three days of the study may not have been representative. The limitation of the study by West et al. (2014) is that cross-sectional data was used, and thus causal claims could not be made. The study by van Oostveen et al. (2015) was limited because data was collected from only one hospital and thus the results were not generalizable in other populations. Similarly, the study by Cho et al. (2015) used data from 14 teaching hospitals, which is not representative of the situation in different hospitals at the national level. One of the limitations of the study by Ball et al. (2018) is that it used nurses’ missed care as a single construct, which might have provide biased results.
The relationship between nursing understaffing and HAIs should be studied comprehensively to generate evidence-based data in a bid to improve patient outcomes and quality of care. Five articles were reviewed for this study. Further research is needed specifically to address the common limitations of the available studies. For instance, some studies used small sample sizes, and thus future research should focus on large sample sizes for the generalization of the results in different populations. Furthermore, one study was limited due to using a single construct. Therefore, further research should incorporate multiple constructs to avoid biased results.
Ball, J. E., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane D.M., Rafferty, A. M., … Griffiths, P. (2018). Post-operative mortality missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies, 78, 10-15.
Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, Y., … Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies, 52(2), 535-542.
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van Oostveen, K. J., Mathijssen, E., & Vermeulen, H. (2015). Nurse staffing issues are just the tip of the iceberg: A qualitative study about nurses’ perceptions of nurse staffing. International Journal of Nursing Studies, 52(8), 1300-1309.
West, E., Barron, D. N., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing, and mortality in Intensive Care: An observational study. International Journal of Nursing Studies, 51(5), 781-794.
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.