Nurse staffing levels and the quality of care in hospitals

NUR 351Z                                                                                                   Jennifer Liu, RN

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Needleman, J., Buerhaus, P., Mattke, S., Zevelinsky, K. (2002). Nurse staffing levels and                the quality of care in hospitals. The New England Journal of Medicine, 346(22),   1715-22. Retrieved September 24, 2010.

The authors conducted a regression analyses to examine the relationship between the amount of care provided by nurses in hospital’s and the patients’ outcome.  The regression analyses was conducted by  obtaining data from 1997 and 1998 on hospital discharges (5,075,969 discharges of medical patients and 1,104,659 of surgical patients) and the staffing by nurses (registered nurses, licensed practical nurses, and nurses’ aides) from 11 states (Arizona, California, Maryland, Massachusetts, Missouri, Nevada, New York, South Carolina, Virginia, West Virginia, and Wisconsin.  From this collection of data, the authors determined that among medical patients, a higher proportion of hours of care per day provided by registered nurses were associated with short length of stay and lower incidence of iatrogenic illnesses. Among surgical patients, the same outcome applied.  There was no correlation found between increased staffing by licensed practical nurses or nurses’ aides and the rate of adverse outcomes.

            This study is applicable to practice, and is a great basis in determining the cause and effect of staffing and patient care as it shows that higher nurse staffing levels can minimize the length of stay for a patient. However, some factors that were not considered are; the education level and experience of these nurses, the available equipment involved in patient care along with many other factors that may possibly play a role in improving the quality of care.  Further research would help solidify the correlation between low nurse staffing levels and poor quality of care in hospitals.

Cucuolo, D.F., Perroca, M.G. (2010).  Monitoring performance indicators regarding the    length of care by the nursing team. Rev Esc Enferm USP, Jun;44(2),497-503.

The purpose of this study was to investigate the duration of care the nursing team delivers to the patients.  A quantitative research method was carried out during a 30-day period in four medical-surgical units in a philanthropic hospital in Sao Paulo State.  These units represented 60% of the bed capacity with a total of 2291 patients being classified. The author compared the performance of six different wards that each consisted of three nurses but different average number of patients per day.  Care hours were calculated by using an equation proposed by the Hospital Commitment Quality, which supports decision making by assessing the quality of care and nursing professionals’ workload.  The results show that wards that had a respective nurse to patient ratio of 3:14 had one hour of nursing care for their patients.  Wards that had a respective nurse to patient ratio of 3:28 had only half hour of nursing care for their patients.  The authors concluded that maintaining a small number of nurses can jeopardize service supervision and nursing care quality.

            This research is applicable to practice as it puts in perspective the end result of nursing shortages.  With nursing shortages, less care hours are available to respond to patients’ care and needs.  These findings can then be used to help hospital units to re-evaluate workload and nursing staff.

 

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