Pediatric Nursing Shortage

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LITERATURE REVIEW ON SAFE STAFFING FOR PEDIATRIC PATIENTS
Kathleen Van Allen, MSN, RN, CPN Chairperson, SPN Public Policy Committee

The Society of Pediatric Nurses (SPN) has been instrumental in advocating for high quality, culturally sensitive, and comprehensive care for children and families. The healthcare needs of pediatric patients present unique challenges due to different developmental stages, limited communication skills, and differences in epidemiology and approaches to treatment as compared to adults. Nurse staffing is a focus of major concern because of the impact of staffing patterns on patient safety and quality of care. The advent of managed care, shortened hospital stays, and public reporting of quality measures demand that healthcare organizations objectively define and assess the quality of care delivered to children and families. Registered Nurses are the primary caregivers within the healthcare setting and are the essential link in assisting patients and families with navigating and humanizing a highly technical and impersonal healthcare system. An organization’s commitment to high quality pediatric care is dependent upon appropriate staffing levels with adequately prepared nurses and the implementation of collaborative, evidence-based practice (Schwalenstocker, Bisarya, Lau, & Adebimpe, 2007). In 2007, members of the Public Policy Committee developed the Safe Staffing Position Statement. This document outlined recommendations for safe and effective nursing care for children and their families. The position statement was recently updated and is intended to serve as the framework to assist organizations providing care to children in the implementation of evidenced based staffing plans to promote high-quality care. It is imperative that schools of nursing, healthcare institutions and pediatric nurses utilize this document as a resource to ensure that appropriate education, training, resources and effective staffing plans are provided to ensure the provision of safe, quality, customer focused care to pediatric patients and their families.

Problem Statement
Following a Congressional request in 1993 for the Institute of Medicine (IOM) to study the adequacy of nurse staffing in hospitals and nursing homes, a 1996 IOM report recognized the importance of determining the appropriate nurse-patient ratios and distribution of skills to ensure patients receive quality care. A September 1999 IOM report first called the public’s attention to the problem of increased patient morbidity and mortality related to errors occurring within healthcare delivery systems. Since that time there has been a growing emphasis on patient safety, process improvement and the potential effects of adequate staffing.

Rationale and Supporting Information
Research has continued to show the association between nursing staffing and improved patient outcomes (Aiken, et al, 2010; Kane, et al, 2007; Needleman, et al, 2006; Stanton, 2004; American Organization of Nurse Executives, 2003; Aiken, et al, 2002). In 2007 the Child Health Corporation of America is association with the National Association of Children’s Hospitals and Related Institutions (NACHRI) and Medical Management Planning/BENCHmarking Effort for Networking Children's Hospitals found increased nurse staffing was associated with improved patient/family experience with care and a reduced incidence of adverse outcomes. NACHRI also reported that The Joint Commission found staffing levels had been a critical factor in 20 percent of sentinel events occurring over a ten year period from 19952005 (Schwalenstocker, Bisarya, Lau & Adebimpe, 2007). Stratton (2008) found a reduction in the rate of pediatric central line blood stream infections with an increase in nursing staffing hours. Research conducted by Mark, Harless and Berman (2007) showed a statistically significant reduction in postoperative cardiopulmonary complications, pneumonia and infections in the pediatric population...
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