The Effects of Staffing Levels on Nursing Quality and Care

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The Effects of Staffing Levels on Nursing Quality and Care

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer personnel. The resulting struggle between the nursing staff and management has been an ongoing one. The issues related to this have been documented in many studies, and all seem to come to the same conclusion: nurse staff levels have a substantial impact on care received. The studies vary in focus from patient mortality to job dissatisfaction and nurse burnout. These studies show a direct correlation between the amount of patients nurses are assigned, and the quality of care they are able to provide.

A study conducted by the Harvard School of Public Health Human Subjects Committee studied the correlation between staff levels of registered nurses, and six outcomes. The outcomes were comprised of length of hospitalization, rates of urinary tract infections, upper gastrointestinal bleeding, hospital acquired pneumonia, shock or cardiac arrest, and failure to rescue. Researchers used statistics from 799 hospitals in 11 states from different regions of the country. They were careful to limit their consideration to hospitals with average staffing levels, excluding hospitals with unusually high or low staff levels. The conclusion of the study showed a positive association between the number of hours that a patient received direct care from a registered nurse, and the rate in which they experienced any of the six outcomes. A higher proportion of hours dedicated to a patient’s care resulted in lower occurrence of each of the six measured outcomes. (Needleman et al., Nurse-staffing Levels)

Another study, conducted by some of the same researchers from the Harvard study previously mentioned, examined another aspect of this issue. In this study, the researchers examined a large academic medical center, involving 197,961 admissions and 176,696 nursing shifts within 43 hospital units. The purpose of this study was to examine the association between patient mortality and their exposure to understaffed nursing shifts. Researchers also examined the association between mortality rates and patient turnover rates, including admissions, transfers and discharges. Researchers concluded that there was a substantial association between increased mortality and increased exposure to understaffed nursing shifts. According to the study, the association between increased mortality and patient turnover rates was also substantial; concluding that the higher the intake and discharge level of the hospital, the higher the chance that someone will be neglected. A reduction in the ratio of Registered Nurses to patients will result in a decrease in the level of patient care which causes an increase in patient mortality rates. This retrospective observational study helps to reinforce the necessity for adequate staffing. (Needleman et al., Nurse Staffing and Inpatient) Another study, listed in the Journal of the American Medical Association, conducted research within 168 hospitals located in Pennsylvania. Their findings reinforced the association between patient to nurse ratios and patient mortality rates. It also inquired into how the patient to nurse ratio relates to nurse retention, nurse burnout, and job dissatisfaction. Within the 168 hospitals considered, once again, patient mortality rates were...
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