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.
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...
References: Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J. & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health Services Research, 45(4), 904-921. Aiken L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993. American Academy of Pediatrics (2006). Child life services. Pediatrics, 118(4); 1757-1763. American Academy of Pediatrics (2004b). Levels of neonatal care. Pediatrics 114(5); 1342-1347. American Academy of Pediatrics (2004a). Guidelines and levels of care for pediatric intensive care units. Pediatrics 114(4); 1114-1125. American Academy of Pediatrics (1998). Facilities and equipment for the care of pediatric patients in a community hospital. Pediatrics 101(6); 1089-1090.
American Nurses Association. (2010). Safe staffing saves lives. Federal legislation: Registered nurse safe staffing act. Retrieved on-line February 13, 2011. http://www.safestaffingsaveslives.org/whatisANAdoing/federallegislation.aspx?css=print American Nurses Association (2008). Pediatric nursing: Scope and standards of practice. Washington DC: Author. American Nurses Association. (2007). Acute care staffing. Nursing’s legislative and regulatory initiatives for the 110th Congress: Appropriate staffing. Retrieved on-line: February 13, 2011. http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/legis/AcuteCare.aspx. American Nurses Credentialing Center. (2003). The magnet recognition program for excellence in nursing service health care organization, instructions and application process. Pub# MAGMAN03. Washington, DC: Author. American Organization of Nurse Executives (2003). AONE policy statement on mandated staffing ratios. Retrieved on-line: January 21, 2011. http://www.aone.org/aone/advocacy/ps_ratios.html. Broome, M. & Rollins, J. (Eds.). (1999). Core curriculum for the nursing care of children and their families. Pittman, NJ: Jannetti Publications. Children’s Defense Fund. (2010). The state of America’s children 2010. Retrieved on line February 13, 2011. http://www.childrensdefense.org/child-research-data-publications/data/state-of-americas-children2010-report.html. Children’s Defense Fund. (2002). Basic facts on poverty. Child Poverty FAQs. Washington DC: Author. Institute of Medicine. (2010). The future of nursing: leading change, advancing health. Report brief: 2010. Washington DC: Author. Institute of Medicine. (1999). To err is human: Building a safer health care system. Washington, DC: Author. Joint Commission. (2010). Joint commission accreditation resources: Accreditation manager plus. Retrieved on-line: February 21, 2011. http://qvcsql01/JCRAMP/Frame.aspx.
Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., Wilt, T. J. (2007). The association of registered nurse staffing levels and patient outcomes. Systematic review and meta-analysis. Medical Care, 45(12): 1195-1204. Kaushal, R., Bates, D.W., Landrigan, C., McKenna, K. J., Clapp, M. D., Federico, F., Goldman, D. A. (2001). Medication errors and adverse drug events in pediatric inpatients. Journal of the American Medical Association, 285(16), 2114-2120. Lewandowski, L. A. & Tessler, M. D. (Eds.). (2003). Family-centered care: Putting it into action: The SPN/ANA guide to family-centered care. Washington DC: American Nurses Publishing. Mark, B. A., Harless, D. W., Berman, W. F. (2007). Nurse staffing and adverse events in hospitalized children. Policy, Politics & Nursing Practice, 8(2): 83-92. Monsen, R. B., Finley, S. (2007). Shortage of nurses and child health. Journal of Pediatric Nursing, 22(3), 231-232). National Association of Children’s Hospitals and Related Institutions. (2003). Clinical practices service program: Benchmark data. Available from www.childrenshospitals.net/nachri. National Association of Neonatal Nurses (2008). Minimum RN staffing in NICU’s. Retrieved online February 11, 2011. http://www.nann.org/pdf/08_3009_rev.pdf. Needleman, J., Buerhaus, P. I., Stewart, M., Zelevinsky, K., Soeren, M. (2006). Nurse staffing in hospitals: Is there a business case for quality? Health Affairs, 25(1): 204-211. Schwalenstocker, E., Bisarya, H., Lau, S. & Adebimpe, O. (2007). Nursing-sensitive indicators for children 's hospital care quality: Indicators are essential, but further testing is needed for use in comparing hospital performance. A white paper prepared by the Pediatric Data Quality Systems (PediQS) Collaborative. September 2007. Retrieved on line: February 8, 2011: http://www.childrenshospitals.net/AM/Template.cfm?Section=Site_Map3&Template=/CM/ContentDisp lay.cfm&ContentID=29730. Society of Pediatric Nurses. (2008). Position statement on family centered care content in the nursing education curriculum. Retrieved on-line: February 21, 2011. http://www.pedsnurses.org/component/option,com_docman/Itemid,222/task,doc_view/gid,193/
Society of Pediatric Nurses. (2007). Position statement on child health content in the undergraduate curriculum. Retrieved on-line: February 21, 2011. http://www.pedsnurses.org/component/option,com_docman/Itemid,222/task,doc_view/gid,102/. Stanton, M. W. (2004). Hospital nurse staffing and quality of care. Agency for Healthcare Research and Quality Research in Action Issue 14. Rockville, MD: AHRQ Pub. No. 04-0029. Stratton, K. M. (2008). Pediatric nurse staffing and quality of care in the hospital setting. Journal of Nursing Care Quality, 23(2); 105-114. Woodring, B. (Ed.). (1998). Standards and guidelines for pre-licensure and early professional education for nursing care of children and their families. DDHS, Bureau of MCH, Document #H112R77. Washington, DC: US Government Printing Office.
Safe Staffing Position Statement initially developed: September 7, 2007 by the Public Policy Committee Revised by: Kathleen Van Allen, MSN, RN, CPN, February 2011 Co-Chair, Public Policy Committee Revisions approved by the Public Policy Committee on April 1, 2011 Approved by the SPN Board of Directors on September 2011
Please join StudyMode to read the full document