BIO317V University of Tampa Week 4 Staffing Ratios in Healthcare Paper Hi, Below is all the professor’s assignment to my “peer editing”. as he wants us to
BIO317V University of Tampa Week 4 Staffing Ratios in Healthcare Paper Hi,
Below is all the professor’s assignment to my “peer editing”. as he wants us to follwo thru with it. Also you will find the peer’s review paper for your review and to work with it. Im not in my computer and the one im in does not have microsoft word.
I will send it as is tonight for you to start looking into it and then tomorrow will attach the word document from my computer. If you have any questions do not hesitate to contact me.
Thanks!
This weeks assignment covers a very important process in the development of a scientific research paper: the peer-review process. This week you will critically review one of your peers first drafts of their evidence-based research paper. The following criteria must be met:
First off, the more detail you put into your review, the better. The idea of this entire process is to provide the original author with ample information to help them greatly improve their final draft of their evidence-based research paper. The more specific you can be with your comments/revisions, the better it will be for the original author to make the suggested changes/revisions.
Use the Track Changes feature of Microsoft Word, and if feel that specific changes/edits need to be made, make them directly onto the document. The Track Changes function will completely register all changes made to the original document.
Also, if you have any questions to the author, suggestions to them, or comments regarding the formatting/content/writing, use the comment boxes (under the Review tab of Microsoft Word). Again, the more specific you are, the better.
Knowing the requirements of the first draft, if any of those requirements are missing (e.g. definitive hypothesis, missing required sections, improper APA formatting), make sure you comment on them to the author.
Make sure you consider the clarity, conciseness, and organizational clarity throughout your review.
Lastly, make sure you include a detailed summary review at the end of your paper that addresses the 7 required criteria listed in the assignment directions.
Be sure to review the grading rubric prior to creating your paper to ensure that you know what is expected for each section and how each section is weighted in terms of points.
You are not required to submit this assignment to TII, but if you do not I will submit it for you.
Your instructor will send you the first draft submitted by one of your peers through the classroom email system.
Copyedit the other students paper using copyediting marks or the Track Changes editing function in Microsoft Word.
Provide feedback related to the key problems in scientific writing and relevance as described in Lecture 4.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. Abstract
This paper will look at many different studies performed to see if there is a relation
between nurse staffing ratios and patient outcomes. Does having an increased number of
registered nurses have a positive effect on patients? Do patients feel that the quality of care is
better when their nurse has less patients to care for? Many questions were looked at when
performing the studies. Some studies showed positive effects on patient outcomes while others
were inconclusive. Many people believe that the problem is having too many patients per nurse.
Often times the problem may be that the nurses patients have a greater need than she can
provide alone. Some patients need more care than others. There needs to be more than a number
of patients, but more looking at the type of patients the nurse has.
Looking at the level of care each patient needs will help to determine if the patient will
receive quality care based on the nurse that was assigned to them. The unit must look at the
patients needs, the nurses skills and abilities and sometimes the education level of the nurse.
The greater the education level of the nurse the greater the critical thinking skills are, as they
have learned better ways to think through something in order to ensure the best care for the
patient. A registered nurse with a bachelors degree will have a better understanding of what are
some possible ripple effects to an illness, than those with an associates degree.
Staffing Ratios in Healthcare: What is Safe, What is Not
Veronica Sanderson
BIO-317V-0500-Science Communication and Research
May 26, 2019
Staffing Ratios in Healthcare: What is Safe, What is Not
When it comes to healthcare, it can be difficult to determine what is a safe number of
patients for one nurse to have. There is no set number that is safe. Some patients have a higher
acuity than others. Meaning they need a little more one on one care than others. There may be
someone having heart trouble that needs to be put on a special drip to manage their blood
pressure and fluid build-up in their body and there may be another patient that had the flu and is
toward the end of their illness and can go home the next day. Both of these patients need a nurse,
but one can mostly do things that they need and the other needs more help. It would not be ideal
to put four patients that are similar to the first one to one nurse and 4 similar to the second patient
to another nurse. Yes, they both have the same number of patients; however, the first nurse has a
higher acuity level of patients and may need to spend more time with each one to make sure they
are doing ok. They need to be monitored more closely. There should be a way to determine the
acuity of patients and base the patient to nurse ratio on that. If using a one to four scale, rating
patients on the needs and how closely they need to be monitored and how much help they need
can help to determine if each nurse has been given similar acuity to make it safe for the patients.
If they are similar to patient one, then they would be rated a four, and if they were similar to
patient two, then they would be rated a one. Then rated a two or three when needed. This way, if
we divide up staffing based on acuity, we can make it so the highest acuity on a standard
medical-surgical floor a 12. This will help keep staffing at an appropriate level that will keep
patients safe.
Introduction
The American Nurses Association (ANA) has created a guide on how to best staff each
specific type of unit. They identified the main elements that are needed in order to provide the
best staffing that will provide the best quality of care to the patients. It is more than just adding
more nurses to the unit. They should look at the nurses to determine which one is best suited for
the task at hand. The ANA has determined that they need to look at the characteristics of the
healthcare consumer, the registered nurse and other members of the team, the context of the
organization, the overall practice environment, and the evaluation of staffing plans. 1
Methods
Conducting a research of many different journal article and studies of staffing having an
effect on patient care, has resulted in the contents of this paper. The studies performed show
which types of situations were effected with the different staffing. Some studies surveyed the
nurses as well as the patients, some surveyed the patients only. Some studies surveyed the staff
and others looked at the unit. They performed a cross-sectional analysis and a fixed effects
analysis of the samples selected. Another study looked at the mortality rates, pressure injuries
and gastrointestinal bleeds. This one required a retrospective study. Looking back at patient files.
Results
The study from Aiken showed that when it came to nurse patient ratio and the outcome of
the patient, the outcome was the same. She shows us that the study shows a clinical significance
between staffing and patient mortality. They surveyed nurses as well as patients and showed that
the environment along with available interventions with the staff at hand had an impact on the
patients. They were less likely to get a hospital acquired infection. They discussed the
importance of matching the nurse and their skill set with the patients that need the skillset of that
nurse. 2 Another study shows that there is a direct relation between patient care and nurse to
patient ratio, practice environment, and nurse education. This utilized a multi method research
1
American Nursing Association ANAs Principles for Nurse Staffing, 2nd Edition (2012). Retrieved
from https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nurse-staffing–2nd-edition.pdfpi89mo
2
Aiken, Linda H., Consuelo Cerón, Marta Simonetti, Eileen T. Lake, Alejandra Galiano, Alda Garbarini,
Paz Soto, David Bravo, and Herbert L. Smith. 2018. Hospital Nurse Staffing and Patient
Outcomes. Revista Médica Clínica Las Condes 29 (3): 32227. doi:10.1016/j.rmclc.2018.04.011.
into staffing and nurse sensitive outcomes, such as pressure ulcers, catheter associated urinary
tract infections (UTIs), and the use of restraints. This study also showed that the level of a
nurses education also impacted the patients outcome. 3 A study performed in Massachusetts
looked into the intensive care unit (ICU). They did a study on patients prior to and after the state
mandated nurse staffing ratios. The results showed were inconclusive as to whether or not staff
ratios had an effect on patient outcomes. They looked into patients that were admitted to the ICU
for greater than one day. The law mandated that the patient to nurse ratio could be 2:1, but the
unit would need to utilize the acuity tool to determine if the ratio needs to be decreased per
nurse.4
Nineteen teaching hospitals were studied in Ontario, Canada. They followed patients
from an adult medical-surgical and obstetrics inpatient. They evaluated the different nurse
staffing models and the effects they had on patient outcomes regarding functional status, pain
control, and patient satisfaction with the nursing care. In order to measure the patient outcomes,
they utilized a Functional Independence Measure (FIM). The study suggested that with a higher
number of regulated nursing staff on the unit resulted in better FIM scores at the time of
discharge. The patients showed better clinical outcomes at the time of discharge. 5 A crosssectional analysis and fixed-effects analysis was performed in a study of four different staffing
3
Chau, Janita P. C., Suzanne H. S. Lo, K. C. Choi, Eric L. S. Chan, Matthew D. McHugh, Danny W. K.
Tong, Angela M. L. Kwok, W. Y. Ip, Iris F. K. Lee, and Diana T. F. Lee. 2015. A Longitudinal Examination
of the Association between Nurse Staffing Levels, the Practice Environment and Nurse-Sensitive Patient
Outcomes in Hospitals. BMC Health Services Research, no. 1. doi:10.1186/s12913-015-1198-0.
4
Anica C., Law, Stevens Jennifer P., Hohmann Samuel, and Walkey Allan J. 2018. Patient Outcomes
After the Introduction of Statewide ICU Nurse Staffing Regulations. Critical Care Medicine.
doi:10.1097/CCM.0000000000003286.
5
Linda McGillis Hall, Diane Doran, G. Ross Baker, George H. Pink, Souraya Sidani, Linda OBrien-Pallas,
and Gail J. Donner. 2003. Nurse Staffing Models as Predictors of Patient Outcomes. Medical Care 41
(9): 1096. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsjsr&AN=edsjsr.3767601&site=edslive&scope=site.
ratios. Cross-sectional associations were found between higher nurse staffing and mortality are
reduced. Improvements in outcomes were smaller in hospitals with higher baseline staffing ratio.
Some states were looking at mandating nurse staffing ratios in hospitals, but were needing more
sufficient data in order to come to a conclusion. 6
Results
A retrospective study was performed going over a two-year span looking at electronic
reimbursement claims. It appeared that lower level of hospital nurse staffing was connected to
more adverse outcomes, especially mortality. There was not much significance in other areas of
patient outcome. This study showed evidence of the relationship between nurse staffing levels
and six nursing sensitive outcomes. They performed this study to help inform patients of the
better staffed hospitals in order to enable them to make an informed decision about their care. 7
Nurse staffing is at the center of hospitals efforts to keep true to their promise on value.
Having high quality nursing care depends on more than the number of nurses on the job. It also
depends on other factors, such as nurses skills and education, availability of supplies and
equipment, staff training, facilities and the use of best nursing practices. The study was
performed using a cross-domain analytic and data integration. It shows that there needs to be
more done than simply adding nurses to the floor. They need to make sure that all nursing staff
are following best practices and ensuring they have the right resources and training to promote
6
Julie Sochalski, R. Tamara Konetzka, Jingsan Zhu, and Kevin Volpp. 2008. Will Mandated Minimum
Nurse Staffing Ratios Lead to Better Patient Outcomes? Medical Care 46 (6): 606. https://searchebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsjsr&AN=edsjsr.40221709&site=edslive&scope=site.
7
Kim, Yunmi, Jiyun Kim, and Soon Ae Shin. 2019. Relationship between the Legal Nurse Staffing
Standard and Patient Survival after Perioperative Cardiac Arrest: A Cross-Sectional Analysis of Korean
Administrative Data. International Journal of Nursing Studies. doi:10.1016/j.ijnurstu.2018.09.012.
consistency. 8 A study showing the relationship between registered nurse staffing and patient
outcomes in acute care hospitals. They studied patient outcomes of those patients meeting the
inclusion criteria. The study showed that with an increase in the registered nurse staffing, there
was a decrease in hospital mortality rates in the intensive care units. They also determined the
length of stays in the ICU and surgical units were shortened with an increase in the number of
registered nurses staffing the unit at the time. Having an increase in the number of registered
nurses showed lower odds of hospital related mortality and adverse patient events. They also
determined that the patient and hospital characteristics also likely contribute to the actual causal
pathway. 9
Discussion
One article discusses what is already known regarding nurse to patient ratios and better
patient outcomes. It also discusses what is not known about the outcomes. It helps to determine
what needs to be done in order to reach a final conclusion of what safe staffing ratios should be,
and if there should ever need to be a staffing ratio guideline. It discusses the influence of nurse
staffing and patient safety; the strengths and weaknesses of current studies being performed and
what any future studies will need to look at. It helps to develop safe staffing ratios and if there
is enough evidence in order to make that determination. 10 By looking into patient outcomes after
8
Buhlman, Nell. 2016. Nurse Staffing and Patient-Experience Outcomes: A Close Connection:
Combining NDNQI[R] and Patient-Experience Data Yields Insight into How Key Variables
Relate. American Nurse Today, no. 1: 49. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsgao&AN=edsgcl.444942457&site=edslive&scope=site.
9
Robert L. Kane, Tatyana A. Shamliyan, Christine Mueller, Sue Duval, and Timothy J. Wilt. 2007. The
Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and MetaAnalysis. Medical Care 45 (12): 1195. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsjsr&AN=edsjsr.40221602&site=edslive&scope=site.
10
Jane, Ball. 2017. Evidence on the Effect of Nurse Staffing Levels on Patient Outcomes. Nursing
Times, no. 1: 48. https://search-ebscohost-
a hospital stay to help determine if there were any adverse effects will help determine if staffing
ratios have an effect on patient outcome.
Conclusion
The results to the many different studies performed have had many different results.
Some studies showed no real connection between staffing levels and patient outcomes. Some
studies showed a positive impact of greater nurse staffing per unit for patients. They showed that
there were less adverse effects or poor patient outcomes when there were more registered nurses
available to the unit to provide an increase in patient care. Some studies showed that the level of
the nurses education also had an impact on the patient outcomes. The studies showed that the
higher the nurses education the less likely there was to be an adverse event to occur for the
patients in that nurses care. Another factor influencing patient outcomes along with nurse
staffing was if the nurses had adequate access to resources needed in providing quality care.
Patients were less likely to get hospital acquired infections when nurses were adequately staffed
and had access to all necessary tools to properly care for their patients. Staffing should be built
based upon the environment they are practicing in, the type of patients they will be taking care
of, and the types of nurses available to the team. An intensive care unit would require less patient
per nurse than a medical-surgical unit. This is due to those patients in the intensive care unit need
to be more closely monitored, they have a higher acuity need and require a more one on one
nursing approach. They need to have their nurse available to them should something happen in
their health. The patients in the medical-surgical unit may be ready to discharge home, so they do
not need as close of monitoring as those in the intensive care. Some patients in intensive care are
unconscious and are unable to tell their nurse when they feel something is not right, that
com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsovi&AN=edsovi.00006203.201701000.00022&site
=eds-live&scope=site.
something is happening. Many studies showed that inpatient units with a greater number of
registered nurses had better clinical outcomes at the time of discharge for the patients.
Being able to show the effect of not only the number of registered nurses available but
also of the education level of the nurses will help to determine not only safe staffing ratios for
patients, but also for nurses. It will help get nurses to the greater education level that has been
proven to have a positive impact on patient outcome. The studies will help come up with a way
to determine safe staffing levels based on the type of unit and patient needs. Having the safest
patient to nurse staffing levels will not only benefit the patients, but it will also benefit the
facility that is providing the care. The patient is more likely to come to that facility with any
future medical issues and recommend their family and friends to them based on the quality of
care they received.
Bibliography
Aiken, Linda H., Consuelo Cerón, Marta Simonetti, Eileen T. Lake, Alejandra Galiano, Alda
Garbarini, Paz Soto, David Bravo, and Herbert L. Smith. 2018. Hospital Nurse Staffing
and Patient Outcomes. Revista Médica Clínica Las Condes 29 (3): 32227.
doi:10.1016/j.rmclc.2018.04.011.
American Nursing Association ANAs Principles for Nurse Staffing, 2nd Edition (2012).
Retrieved from
https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nurse-staffing–2nd-edition.pdfpi89mo
Anica C., Law, Stevens Jennifer P., Hohmann Samuel, and Walkey Allan J. 2018. Patient
Outcomes After the Introduction of Statewide ICU Nurse Staffing Regulations. Critical
Care Medicine. doi:10.1097/CCM.0000000000003286.
Buhlman, Nell. 2016. Nurse Staffing and Patient-Experience Outcomes: A Close Connection:
Combining NDNQI[R] and Patient-Experience Data Yields Insight into How Key
Variables Relate. American Nurse Today, no. 1: 49. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsgao&AN=edsgcl.444942457&sit
e=eds-live&scope=site.
Chau, Janita P. C., Suzanne H. S. Lo, K. C. Choi, Eric L. S. Chan, Matthew D. McHugh, Danny
W. K. Tong, Angela M. L. Kwok, W. Y. Ip, Iris F. K. Lee, and Diana T. F. Lee. 2015. A
Longitudinal Examination of the Association between Nurse Staffing Levels, the Practice
Environment and Nurse-Sensitive Patient Outcomes in Hospitals. BMC Health Services
Research, no. 1. doi:10.1186/s12913-015-1198-0.
Jane, Ball. 2017. Evidence on the Effect of Nurse Staffing Levels on Patient
Outcomes. Nursing Times, no. 1: 48. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsovi&AN=edsovi.00006203.20170
1000.00022&site=eds-live&scope=site.
Julie Sochalski, R. Tamara Konetzka, Jingsan Zhu, and Kevin Volpp. 2008. Will Mandated
Minimum Nurse Staffing Ratios Lead to Better Patient Outcomes? Medical Care 46 (6):
606. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsjsr&AN=edsjsr.40221709&site=e
ds-live&scope=site.
Kim, Yunmi, Jiyun Kim, and Soon Ae Shin. 2019. Relationship between the Legal Nurse
Staffing Standard and Patient Survival after Perioperative Cardiac Arrest: A CrossSectional Analysis of Korean Administrative Data. International Journal of Nursing
Studies. doi:10.1016/j.ijnurstu.2018.09.012.
Linda McGillis Hall, Diane Doran, G. Ross Baker, George H. Pink, Souraya Sidani, Linda
OBrien-Pallas, and Gail J. Donner. 2003. Nurse Staffing Models as Predictors of
Patient Outcomes. Medical Care 41 (9): 1096. https://search-ebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsjsr&AN=edsjsr.3767601&site=ed
s-live&scope=site.
Robert L. Kane, Tatyana A. Shamliyan, Christine Mueller, Sue Duval, and Timothy J. Wilt.
2007. The Association of Registered Nurse Staffing Levels and Patient Outcomes:
Systematic Review and Meta-Analysis. Medical Care 45 (12): 1195. https://searchebscohostcom.lopes.idm.oclc.org/login.aspx?direct=true&db=edsjsr&AN=edsjsr.40221602&site=e
ds-live&scope=site.
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