Research Critique, Part 1: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

According to Suzanne Gordon “ whether young or old, nurses are disillusioned because they believe that health care systems guided by bottom-line concerns simply don’t recognize the specificity of their work” (234). Nursing is more demanding than many other professions or occupations, due to the combination of difficult patients, exhausting schedules and arduous physical work (Gordon 235). It can take a significant emotional toll on many, hence the higher levels of burnout. Job dissatisfaction as a result of increased workloads and unreasonable demands, such as inappropriate nurse staffing levels, was cited as the number one reason that drives many experienced nurses to leave the profession (Sanford 38+). Studies have shown that such working conditions also affected the retention of new graduate nurses by leaving their first hospital jobs within two years of graduating (Sanford 38+).

Those of us who graduated from nursing school and started their first job were full of dreams, aspirations, and had every intention of making a difference. Now fast forward five years; these same nurses have been on their feet for 16 hours and have not had time to eat or use the bathroom since leaving their homes this morning. The call lights will not stop going off long enough for them to give report to the oncoming nurses and once again they are late for their children’s dance recitals or soccer games. They can forget about trying to squeeze a yoga class in this week. I understand what it is like to rush to your car feeling as if some important task was forgotten; was Mr. Smith’s tube feed restarted, did room 8 receive their pain medication? Nurses all over the world are experiencing “burnout”. To avoid burnout, nurses must properly care for themselves by separating work from personal life, knowing when to say no, and making time for enjoyable activities to manage stress, because we cannot provide quality patient care if we are neglecting ourselves.

Staff nurses have great responsibilities in caring for patients. Often, these nurses experience heavy workload. Heavy patient load and stress contributes to burnout. Why is burnout important to discuss in relation to nurses? Burnout affects the performance of the nurse and the quality of care he or she provides to the patient. Therefore, it is imperative that staff nurses decrease the possibility of burnout and increase or maintain excitement and enjoyment in the field of nursing. If nurses do so, they will find joy in their work and quality of patient care will be increased. Contributors to burnout and

Nursing to patient ratio can have a direct impact on patient safety. Studies have been done that show that these ratios impact patient outcomes and mortality rates when nurses are understaffed and are given a larger patient load than they can handle safely. Nursing education level has also shown to play a role in patient outcomes. Whether they are an unexperienced nurse or the patients are at a higher acuity and require more time for care, these larger ratios can be detrimental to the nursing quality of care that can be provided. These larger nurse to patient ratios can also play a part in nurse burnout leading to medical errors, negative patient outcomes, and higher health care costs in the future.

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

Nursing is the powerhouse in the delivery of safe, quality patient-centered care in the healthcare industry. To ensure continued safety of the patient and nursing staff, the issue of inadequate staffing must be addressed. Consequently, patient’s mortality rate has been linked to the level of nursing staff utilized in ensuring an utmost outcome (Aiken, 2011). This paper will outline the issue associated with inadequate nurse to patient staffing ratios in the hospital setting; essential factors such as economic, social, ethical and political and legal affecting the issue will be established; current legislature and stakeholders will be ascertained and policy option, evaluation of bill and the results of analysis will be reviewed.

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.

One of the greatest challenges in healthcare, as well as the biggest threat to patient safety, is staffing and the nurse to patient ratio on hospital floors. Studies have shown that low staffing levels lead to increased mortality rates in patients, as well as multiple other adverse effects including falls and pressure ulcers. These adverse effects are all preventable, but policies on staffing must be in place to ensure safety for staff and patients.

Nurses, always involved in patient care, sometimes experience detrimental effects with prolonged stress or “burnout” during their career throughout the years. Burnout is defined as an extended response to physical or emotional stressors. Some examples of these stressors are; memories of witnessing death, patient and family suffering, emotional stress of losing patients, feeling emotionally and physically drained, or emotional disconnect from staff which can all contribute to burnout. As a result, nurses can experience; exhaustion, anxiety, dissatisfaction and low capacity. Overall, burnout can have negative effects not just on the emotional and physical health of nurses but also on; patient satisfaction, outcomes and mortality of nurses and patients. Although, there are ways to reduce or prevent these negative effects of burnout from manifesting. For example, nurses can apply interventions to reduce these risks including; staff support, onsite counselors and psychiatrists for nurses and salary increases and reimbursement opportunities for nurses through clinical ladder programs. Nurses can also start by just saying no to certain requests, being aware of their tolerance level, by taking care of themselves and having fun outside of work. On the other hand, others do not think nursing burnout is fatal and nurses just need a break from their job to initiate change. Although, the issue of burnout is prevalent in nurse’s careers which need to be addressed more in society in

By recognizing that burnout is a serious problem that impacts an organization’s viability, an assembly of staff nurses, nursing supervisors, human resource staff, social services, nurse administrators, and a physician champion will be arranged to construct mission, objectives and strategies to help ameliorate the issues at hand. Researching literature on nursing burnout is essential so that the members of the task force has a solid grasp on potential underlying hardships contributing to nursing burnout within the facility as well as the financial effects on the organization. Furthermore, in order to determine a solution, the nurse’s work environment should be assessed (Nedd, 2006) and measured using the 26-item Brisbane Practice Environment Measure (B-PEM) (Flint, Farrugia, Courtney, & Webster, 2010). The B-PEM instrument was developed to measure nursing satisfaction within the work environment and the perceived facilities inadequacies (Flint et al. 2010; Hayes et al., 2014; Nedd, 2006). Next, the Conditions of Work Effectiveness - Questionnaire-II (CWEQ-II) will also be utilized to measure the nurses’ perceived access to the four job related empowerment structures: opportunity, information, support, and resources will be administered (Laschinger et al., 2003). Then nursing burnout will be assessed and analyzed by using the Maslach Burnout Inventory (MBI) which is a widely used instrument to assess burnout and is considered the gold standard due to its established

One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.

Staffing deficits pose a direct threat of manifesting negative outcomes associated with the delivery of patient care. Anything or anyone that compromises patient care should be eradicated immediately. This author believes that staffing deficits remain a consistent issue due to lack of solutions that actively address the issue. This author believes that inadequate staffing is a major concern due to the degree of harm it can impose on patients. Adverse events associated with