Healthcare Quality through Staff Optimization

Introduction

In recent years, the topic of nurse staffing and its impact on healthcare quality has garnered significant attention within the medical community. From 2015 to 2020, a comprehensive examination of literature in this field was conducted, revealing critical insights into the dynamics of nurse staffing, perceptions of safety, and the broader implications for patient care. This essay aims to explore the complexities surrounding nurse staffing, with a particular focus on the perceived adequacy of staffing levels, the challenges posed by staffing shortages, and the intricate balance between cost-effectiveness and patient safety.

By utilizing the PESTEL framework, this analysis seeks to provide strategic insights that healthcare leaders can employ to address these persistent challenges.

Nurse Staffing Dynamics

Nurse staffing is a multifaceted concept that encompasses the total nursing care hours per patient day and the composition of the staff mix. The American Nurses Association (ANA) defines the staff mix as the proportion of registered nursing care hours relative to the total nursing care hours, which includes registered nurses (RNs) and licensed practical nurses (LPNs) (ANA, 2014). The concept of total nursing hours per patient day refers to the aggregate of productive hours worked by nursing staff with direct patient care responsibilities within a given day (ANA, 2014).

One of the most pressing concerns highlighted in the literature is the looming shortage of registered nurses, with predictions of a nationwide job vacancy of 1.2 million nurses by 2020 (Fallatah & Laschinger, 2017). This anticipated shortage underscores the complexities that hospitals face in maintaining appropriate staffing levels and ensuring high-quality care. The situation is particularly dire in Canada, where nurse staffing continues to present intricate challenges for healthcare institutions.

Perceptions of Safe Staffing

The concept of safe nurse staffing revolves around achieving a balance between meeting patient needs and ensuring the availability of competent nursing staff. For the purpose of this literature review, the term "nurse" will specifically refer to registered nurses (RNs), while other nursing personnel will be identified by their respective roles or tasks.

Numerous studies have explored nurses' perceptions of safe and adequate staffing. A significant association has been observed between an increased nursing skill mix—characterized by a higher prevalence of registered nurses—and perceptions of adequate staffing. Conversely, increased nurse workload and larger unit sizes have been linked to perceptions of inadequate staffing. Patient acuity level, which refers to the extent of illness and the amount of nursing care required, has also been significantly associated with perceptions of inadequate staffing levels. Kalisch et al. conducted a survey involving ninety-two nurses across surgical, intermediate, and rehabilitation units in eleven hospitals, revealing that nurses perceived adequate staffing in units with a higher proportion of nurses holding Bachelor of Science in Nursing (BSN) degrees or higher. In contrast, staffing adequacy was perceived to be lower in units with insufficient assistive personnel (Kalisch et al., 2011).

Gaps in Literature and Policy

Efforts to address safe staffing issues have encompassed a range of strategies, from federal legislation to healthcare facility budget adjustments. However, a universal dilemma persists regarding the tension between healthcare funding constraints and labor costs. In many healthcare facilities, staffing ratios are determined by nurse union contracts and institutional policies. Notably, Ontario lacks federal legislation mandating specific nurse-to-patient ratios (Hall et al., 2006). In the United States, California stands as the sole state with enacted minimum nurse staffing ratios (Serratt et al., 2011). The influence of legislative and federal policies on safe nurse staffing varies across provinces, with staffing levels often contingent upon organizational structure.

Harrington et al. examined staffing regulations and policies in nursing homes across several countries, including Canada, England, Germany, the United States, Sweden, and Norway. The study found that standards set forth without mandated nurse-patient ratios were not always aligned with actual staffing practices, which were influenced by factors such as facility size, number of residents, and profit status (Harrington et al., 2012). The ongoing struggle between cost-benefit and cost-effectiveness poses a recurring challenge for healthcare organizations, as they weigh the advantages of safe staffing against the risks associated with increased healthcare expenditures. Thungjaroenkul et al. (2007) identified that a nurse-to-patient ratio of 8:1 was deemed cost-effective, but it was also associated with a higher level of patient mortality. Conversely, as the nurse-to-patient ratio decreased, labor costs rose, leading to a decline in patient mortality. This exemplifies the complex interplay between healthcare spending and patient safety, prompting the question: Where should priorities and limits be set?

Inadequate nurse-to-patient ratios have been shown to present significant challenges not only in terms of healthcare spending but also in relation to the overall satisfaction of nursing staff. A study examining the importance of emotional distress and ethical conflicts revealed that nurses acknowledged the contribution of these factors to work-related stress and emotional burnout, leading to increased absenteeism and intent to leave the profession (Guadine & Thorne, 2012).

Theoretical Framework

This research study employs the PESTEL framework, an analytical tool that encompasses political, economic, sociocultural, technological, environmental, and legal factors. Business leaders utilize this framework to assess the environment in which a healthcare facility operates and to anticipate potential circumstances and situations in the future (Issa et al., 2010). The PESTEL framework provides a strategic lens through which healthcare leaders can develop strategies to address staffing shortages and enhance patient care (Mehdaova, 2017). By integrating this framework into the analysis of nurse staffing issues, this study seeks to offer actionable insights that can inform decision-making processes and improve the overall quality of care.

Conclusion

In conclusion, the complexities surrounding nurse staffing and its impact on healthcare quality necessitate a comprehensive approach that balances patient needs, staff availability, and financial considerations. To safeguard against the potential consequences of inadequate staffing, interventions must prioritize safe working conditions and support the well-being of nursing staff. This study contributes to the growing body of literature by providing valuable insights into nurses' experiences with unsafe staffing patterns, thereby addressing the problem statement and research questions. By leveraging the PESTEL framework, healthcare leaders can develop strategies that not only alleviate staffing shortages but also enhance the quality of care provided to patients. Ultimately, the goal is to create a healthcare environment where both nurses and patients can thrive, ensuring the maintenance of health and the restoration of well-being.

Did you like this example?

804

33