Safe Staffing/Patient Outcomes
Safe staffing and its relation to patient outcomes is a major topic in today’s health care environment. You may hear people talk about “nurse-patient ratios” or “safe staffing” or “appropriate staffing” or “quality of care” or “adverse patient outcomes” or a number of other terms. All of these terms are used often and to some extend inappropriately.
Explaining the terms to be used is often useful. “Nurse patient ratios” refers to the number of patients each nurse has to care for. For instance, in intensive care units the nurse-patient ratio is usually 1:1 or 1:2, one nurse for one patient or one nurse for two patients. Different ratios may apply to different units based upon patient need.
Safe or appropriate staffing is used to indicate whether there are enough nurses and the correct mix of nurses to care for the number of patients and their care needs. Theoretically, one must have safe staffing first, and then appropriate staffing. The same is true with quality of care: first, safe care; next, appropriate care; and only, then quality care. The tendency, however, is to speak only of quality of care, which theoretically, can only come after it is considered safe and appropriate.
“Adverse outcomes” or “adverse indicators” are a term used to serve as an indirect measure of the “quality” of patient. For instance, adverse outcomes seen very commonly in the research are: pressure ulcers, falls, pneumonia, satisfactions with several specific topics, failure to rescue, medication errors and many more. Currently, many, if not most, of the outcomes (i.e. indicators) being measured are negative----failures. There are some researchers arguing that “positive outcomes/indicators” are needed because they will reflect adverse outcomes avoided. Some “positive” indicators are being tried to see if they are valid and reliable.
Research to find the link between staffing and outcomes
Research into the factors which influence patient outcomes has been formally conducted for about 35-40 years. Florence Nightingale, of course, recognized the linkage between having nurses on the battle fields during the Crimean Wars, but the more rigorous discipline found in current research has advanced our understandings about the reasons staffing makes a difference in outcomes. Since the 1980’s, tremendous public and private efforts and monies have been put into the study of the American health system due to undulating but continuously rising consumption of the gross domestic product (GNP) by health care
Research has been trying to identify indicators which have meaning to health care professionals and to patients, as well as, the insurers. Most indicators focus on the utilization of reimbursable medical procedures, treatments and visits. The American Nurses Association along with nursing specialty organizations has worked to develop nursing-sensitive indicator (i.e., indicators sensitive to nursing input). The American Nurses Association National Database for Nursing Quality Indicators (NDNQI) developed and maintains a database of the nursing-sensitive indicators. All hospitals participating through placement of their hospital and unit-specific data into NDNQI do so voluntarily.
An area of more recent research is that of nurse fatigue and patient outcomes. As mandatory overtime plus the use of voluntary overtime became an issue for practicing nurses, the question arose for researchers as to the effect of prolonged nursing work hours and the impact fatigue “might” have on patients and the nurses themselves. Groundbreaking work by Dr. Ann Rogers, RN, PhD and Dr. Linda Scott, RN, PhD and their team demonstrated that as worked hours increase past 8 hours, but most dramatically past 12.5 hours, the probability of errors and near misses rise. In addition, the rate of the nurses having accidents or near misses when out of work increases.
These findings are no different than previous research done with airline pilots, truck drivers, boat pilots, and physicians. In other words, human physiology decreases the individuals to make critical decisions, attend to details and to problem solve when the person is overly tired. Now the challenges are two: 1) convince nurses that working overtime, whether voluntary or mandatory, endangers patients and themselves; and 2) convince managers that demanding or allowing nurses to work greater than 12.5 hours in a day endangers patients and nurses. Drs. Rogers and Scott found additional fascinating and important information which will be presented in a number of articles over the next year.
One of the great challenges for nursing is to convince the government, health systems, patients and others that nurses’ contributions to patient care are so significant that collection of nursing-sensitive indicators is mandatory and the re-evaluation of staffing habits are imperative.
References
Available at health sciences libraries.
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