What are theeffects of staffing ratios on safety and satisfaction of patients in the hospital?

Jessica RileyFerris State University

What are theeffects of staffing ratios on safety and satisfaction of patients in the hospital?

Hi, my name is Jessica Riley. I would like to present to you a presentation on the effects of staffing ratios on safety and satisfaction of patients in the hospital.

1Determine risks of patient outcomes related to lack of adequate staffing.Understand causative factors to risks of safety and satisfaction.To increase staff ratios according to patient needs.Acknowledge barriers that hinder larger staff to patient ratios.

Learning Objectives

2Adverse OutcomesUrinary Tract Infections Medication ErrorsProcedure ErrorsNosocomial PneumoniaFalls/InjurySkin BreakdownInfectionHospital StaysRe-admissionsShockMortality(Vantage Point, 2009)

A study conducted by Stanton (2004) showed that higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes.

Risks That Threaten Patient Safety

Inadequate care given due to insufficient staffing may lead to unintentional harm. Lawsuits of malpractice and neglect may threaten the licenses of many nurses. The advantage of standardizing nursing practice is that patients receive the same care from institution to institution. Listed on this slide are documented adverse outcomes related to decreased staff to patient ratios. In addition to risks to patients, threats to safety of staff increases as well. A study conducted by Stanton (2004) showed that higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes. This collection of data is essential to justify changes necessary to staffing practices.

Increased staffing ratios would allow nurses to be available to administer prescribed medication and safer care to their patients. The goal would be to increase time to critically think, assist, and connect with their patients to bring them to their optimal health. 3A hour increase in LPN hours per patient day was associated with a 15% increase in the odds of death and a 27% increase in the odds of sepsis (Glance et al., 2012, p. 4).Nurse aide staffing increases of hour decreased pneumonia odds by 8% (Glance et al., 2012).

Evidence Article

The number of hours per patient day were estimated using previous studies for RNs, LPNs, and nurses aides determined that a hour increase in LPN hours per patient day was associated with a 15% increase in the odds of death, and a 27% increase in the odds of sepsis (Glance et al., 2012, p. 4). It was also found that NA staffing increases of hour decreased pneumonia odds by 8% (Glance et al., 2012). It was believed that even though nurse aides have a lower education level, they are less likely than LPNs to be substituted for RNs because of the difference in responsibilities. the study found that when more of the nursing care is provided by LPNs, increased rates of infection and mortality are observed.4THEORIES

Maslows Hierarchy of Needs

Nurses need to be available to provide these needs!

Maslows hierarchy suggests that people are motivated to fulfill basic needs before moving on to other essentials. Patient Implications of Maslows Hierarchy of Needs applies to this topic as nurses supply basic necessities to their patients. In order of importance, a pyramid was created to help visualize the demand of these needs. The five categories include: physiological (which include: breathing, food, waters, sex, sleep, homeostasis, excretion), next is safety. (safety includes: security of body, employment, morality, family, health, and property). The third category is belonging. Friendship, family, and intimacy are examples of belonging. The fourth category is esteem (which includes: self-esteem, confidence, achievement, and respect), and the final category is self-actualization (which includes: creativity, problem solving, and acceptance) (Cherry, 2013).

Photo credit retrieved from: http://donaldclarkplanb.blogspot.com/2012/04/maslow-1908-1970-hierarchy-of-needs-5.html

5Nightingales Environment TheoryTHEORIESStatements from Nightingale include:

"Poor or difficult environments led to poor health and disease.""Environment could be altered to improve conditions so that the natural laws would allow healing to occur.Also, that the goal of nursing is to put the patient in the best condition for nature to act upon him.

(Nursing Theories, 2012)

A statement from Nightingale was that the goal of nursing is to put the patient in the best condition for nature to act upon him (Nursing Theories, 2012, para 1). Nightingale encouraging nurses to be involved in providing optimal health care settings.

Photo credit retrieved from: http://bozosapiens.blogspot.com/2013/05/florence-nightingale-statistics.html

6Kurt Lewins Change Theory THEORIESUnfreezing

Movement

Refreezing.

Kurt Lewins Change TheoryLewin's theory helps to assess barriers to change, how to help become more accepting to the change, and ultimately completing the changeUnfreezing" - interventions to let go of old habitsmovement -Facilitates actions towards a goal because they are more productive"Refreezing" - complying with the new behaviorDriving forces are things that push in a direction to cause changes to occur. An example of this would be: threats to safetyRestraining forces counter driving forces to hinder change. The most abundant restraining force pertaining to this topic is finances.And finally, we are working toward an equilibrium in which driving forces equal restraining forces and pushes people towards change or staying the same.

Photo credit retrieved from: http://psych-your-mind.blogspot.com/2011/03/what-kurt-lewin-can-teach-us-about-our.html

7Assessment of the Health Care Environment

Current PracticeLack of PoliciesFinancial InfluenceCurrent Satisfaction RatingsMichigan vs. National ratings

In the Current PracticeMany facilities vary their staffing policies and protocols. Some base their staffing on acuity, others base on their units census. There are positive and negative effects of each method. Currently, only one state (California) has a law forcing hospitals to implement these minimum staffing ratios or face fines.

Recently 15 states,(which include: CA, CT, IL, Maine, MN, NV, NJ, NY, NC, OH, OR, RI, TX, VT, and WA plus the District of Columbia) wish to address nurse staffing as a law (Schultz, 2013). The bills would, for example, require hospitals to have one nurse for every patient in critical care units and one nurse for every four patients in pediatric units. It also would ban mandatory overtime for nurses except in emergencies.

The large argument from hospital administrators is that the new staffing practice is not financially feasible. Nurses are advocating that jeopardizing their patient safety is much more detrimental to the facility. In order to ensure an improvement for patient safety and satisfaction, a change in staffing methods is necessary.Financially, hospitals say a decreased revenue/reimbursement calls for downsizing. Saving money includes pulling staff from floor nursing positions: Daily Lay-offs, forced On-call shifts, or the Elimination of Positions and are becoming the norm due to financial reasons. The risks of these absences may outweigh the benefits when safety is risked.Current Satisfaction RatingsMichigan received a score of 69% in reference to timely staff response to patient needs and 71% for adequate pain control. Even though scores are above average or comparable to the National ratings of 67% and 71%, they could be increased with implementation of policies (Hospital Compare Quality of Care, 2013)

8Implications and ConsequencesNursingPatientHospital

Assuming that a facility is understaffed, Nursing Implications, such as:Decreased Job satisfactionStressInattention which commonly leads to medication or procedure errorIncreased Job Turnover ratesLack of Job SecurityIncreased risk for InjuryBehavioral issues such as: absences, bad-mouthing facility, arguments between staff membersPatient Implications:Risk to Satisfaction, including complaints or non-returning customersRisks to safety, Complications or Threats to outcomes as stated in slide 3Hospital Implications:The need to recruit new customers and employeesLoss of RevenueThreats of Legal actionDecreased Satisfaction Ratings as discussed previously

9Root Cause AnalysisRevenue Unsatisfactory Staff RatiosLead to Threats to Patient Outcomes/SafetyPoliciesResearchRounding FrequencyStaffingAbsencesPatient Acuity OutdatedBudget cutsLack ofFall Precaution Measures

Ive created my own root cause analysis to determine how unsatisfactory staff ratios lead to threats to patient outcomes and safety.The first causative factor is: Staffing. Absences caused from call ins, vacations, or medical leaves lead to lack of staff necessary for the amount of patients. In addition, a fluxuation of acuity on a shift to shift basis can vary related to procedures/admissions/discharges. And whether staff meets qualifications (ADN vs. BSN or RN vs. LPN)Policies. This includes a Lack of: Rounding/assessment frequencies, Fall Precaution measures (including: Bed or chair alarms or fall risk identification) Research: Outdated material or lack of research related to this topicThe last is Revenue. Budget cuts can be due to: Loss of assistance programs such as Critical Access for rural hospitals or Loss of reimbursement from Medicare/Medicaid may be linked to decreased revenue.Conclusion: Unsatisfactory staffing ratios lead to threats to patient outcomes and safety.

10

(Yale, n.d.)Root Cause Analysis

This is another root cause analysis I found that shows possible causative factors related to poor quality of care.11Recommendations

Quality and Safety Education for Nurses (QSEN)

ANA StandardsStandard 5B. Health Teaching and Health PromotionStandard 10. Quality of PracticeStandard 16. Environmental Health

Implementation of safety programs to minimize the risk to our patients. Scanning medications against an electronic medical recordIncrease frequency of monitoringCo-signatures of potentially harmful medications Fall risk evaluations

The Quality and Safety Education for Nurses (QSEN) project prepares nurses to have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work (QSEN, n.d., para 1).Provisions set forth by the ANA are stated to describe a competent level of behavior in the professional role, including activities such as quality of practice, education, professional practice evaluation, communication, collaboration, ethics, evidence-based practice and research, resource utilization, environmental health and leadership (2010, p. 10). Listed are three ANA standards that apply most to this topic. Standard 5B. Health Teaching and Health Promotion, is defined as a registered nurse employs strategies to promote health and a safe environment (ANA, 2010, p. 10).Standard 10. Quality of Practice, which is defined by striving for excellence in delivering care through nursing standards through professionalism, competence and expertise (ANA, 2010, p. 11).Standard 16. Environmental Health, which is defined as a registered nurse practices in an environmentally safe and healthy manner (ANA, 2010, p.11)The recommendation for each institution is to embrace the minimum staffing ratio practice. In recent studies, changes to staffing methods have been proven to be beneficial to nursing care. By adding standards and protocols, facilities should be able to provide improved safety and satisfaction of their customers. A change in staffing methods should allow for patient needs to be met, improve safety and satisfaction ratings.

12ReferencesReferences (Seminar)American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring, Md: American Nurses Association.American Nurses Association. (2013). Policy & Advocacy. Nurse staffing plans and ratios. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatiosGlance, L.G., Dick, A.W., Osler, T.M., Mukamel, D.B., Li, Y. & Stone, P.W. (2012). The association between nurse staffing and hospital outcomes in injured patients. BMC Health Services Research, 12(247), 1-8. doi:10.1186/1472-6963-12-247 Hospital Compare Quality of Care (2013). West Shore Medical Center: Hospital profile. Retrieved from http://www.medicare.gov/hospitalcompare/profile.aspx#profTab=1&ID=231335&loc=49660&lat=44.2205682&lng=-86.1344697&AspxAutoDetectCookieSupport=1Nursing Theories (2012) Theories of Florence Nightingale. Retrieved from http://currentnursing.com/nursing_theory/Florence_Nightingale_theory.htmlQSEN. (n.d.). About QSEN. Retrieved from http://qsen.org/about-qsen/ReferencesReferences (Seminar)Stanton, M. W. (2004). Hospital Nurse Staffing and Quality of Care: Research in Action, Issue 14. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.htmlThe Health Foundation (2011). Research scan: Does improving safety culture affect patient outcomes? Retrieved from http://www.health.org.uk/public/cms/75/76/313/3078/does%20improving%20safety%20culture%20affect%20outcomes.pdf?realName=7b1J1q.pdfYale Case (n.d.). Root Cause Analysis Tools. Retrieved from http://nexus.som.yale.edu/ph-tanzania/?q=node/131