Evidence Based Practice Evidence based practice project, nurse to patient ratios. Nurse to Patient Ratios Ferris State University March 2012

Group Members Heather Nowak Sofia Warren Catherine Buckel Jessica Dematio

Introduction Evidence based practice in nursing begins with “clinical problem for which there is not immediately apparent solution. Nurses then seek to find information about the best solution for this specific problem” (Nieswiadomy, 2011, p.368) Evidenced based practice is a cumlination of the best research evidence and is then put into practice to provide care to patients while striving the achieve the best possible out come. According to nieswaiadomy.

Goal Our goal is to identify the correlation of nurse to patient ratios on achieving positive patient outcomes. The goal of our evidenced based research project was to identify…….creating change starts with research.

Facts There is still a nursing shortage nationwide With the current economy many medical institutions are looking at cost saving measures With the current changes in medical reimbursement further cost savings must occur Across the country there seems to be a large focus oh healthcare. There is still a nursing shortage and many new graduates are enterig the workforce every semester. The government and medicare has a large part in how facilitlies will be rimbursed for care and with that there is a huge initiative to reduce spending. While many instittutions are using cost cuttiung measurese by being frugal with supplies and linens there is also a movemennt to increase the nurse to patient ratio. While increasing the nurse to patient ratieo is a cost cutting measure the facts need to be researched and make sure that patient outcomes are not being compromised

Problem Statement Does increased nurse staffing ratios lower adverse patient outcomes?

PICO P -Population or participants of interest I -Intervention needed for practice C -Comparisons of interventions to determine the best for practice O -Outcomes needed for Practice According to burns and grove a systematic review is initiated by a relevant clinical question that is fomulated using th PICO format and included the following elements. Pico can be used to identify rlelvant studies, meta analyses and integrative reviews needed to develop a systematic review.

Question in PICO Format P Patients in an acute care setting. I Lower nurse to patient ratio C Comparison to patient outcomes with a setting with higher nurse to patient ratio O Improved patient outcome, satisfaction and lower mortality The problem for our research project included patient in the acute care setting such as a hospital, The intervention needed is to create a standard of lower nurse to patient ratios. Comparison was done by using recent sholarly studies to determine the best evidence for practice using measurements of paiteint outsomes. The outsome needed for practice was increased patient satidfaction, lower patient mortality and improved patietn outcome.

Research Scholarly articles were selected from professional databases Articles included were current articles written within the last 5 years Articles were narrowed down to include the four best based on criterion The research for this project was compliled from professional databases. The articles were narrowed t=down to current artilces published iwthin the las 5 yeaqrs. Four articles were then selected based on our criterion to include the best data on nurse to patient ratios and patient outcomes.

Article #1 The Association of Registered Nurse Staffing Levels and Patient Outcomes Background: Due to cost saving measures many hospitals are requiring nurses to have higher nurse to patient ratios and this affecting patient outcomes. Methods: Systematic review of literature according to the recommendations for Met-Analysis Of Observations Studies in Epidemiology (MOOSE). Conclusion: The results of this study indicated that there was a correlation between RN staffing and patient outcomes.

Article #1 Critical Analysis Systematic review Comprehensive synthesis of quantitative studies Diverse sample Study supports the stated objective and conclusion

Article #2 Nursing Resources and Patient Outcomes in Intensive Care: A Systematic Review of Literature Background: Reviews empirical evidence about the link between nursing resources and patient outcomes in intensive care, assess its strengths and weaknesses, and identifies where further research is required. Methods: studies were chosen based on dependent and independent variables with a risk adjustment and done in an adult ICU Conclusion: Results concluded that there is uncertainty that nurse resources have effects on mortality or adverse effects. All the studies sis point out that there is a link between the two however the associations may have occurred by chance.

Article #2 Critical Analysis Purpose is clearly defined Methods of collection decrease bias Backgrounds on reviews of research

Article #3 Nurse Dose: Linking Staffing Variable to Adverse Patient Outcomes Background: Variables in nurse staffing and educational level would affect positive patient outcomes is a valid question related to clinical nursing practice. Methods: Examining the acute care setting in which nurse to patient ratios were greater than 1:1. This was a convenience sample. Conclusion: The study could not claim that the staffing variables directly caused a reduction in adverse outcomes, although the researchers were able to demonstrate a significant relationship between staffing variables and outcomes.

Article #3 Critical Analysis No discernible framework Strong objective statement Resources were current

Article #4 Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes Background: Care environment, nurse staffing and nurse education are crucial to improved outcomes and mortality. The study was to determine whether better care environments are associated with improved outcomes. Methods: Surveys from nurses involved in direct care from 168 hospitals. Hospitals were not allowed to opt out. Data was derived from the practice environment scale of the Nursing Work Index (PES-NWI). Conclusion: The research implies that better care environments, a 4:1 patient/nurse ratio and a staff of greater that 60% BSN prepared nurses, have a significant impact on patient mortality and failure to rescue rates.

Article #4 Critical Analysis Strong problem statement Strong framework Scholarly although classic Limited in scope

Integrations EBP in nursing is a key concern for a positive experience for nurses as well as patients. Nurse to patient ratios are dependent also on education level, skill set, and environment. Patient experience is not necessarily dependant on patient outcomes. Nurse to patient ratios have major impacts on the psycological aspect of nursing. As the rate for providing primary care from four patients rises to 6 paients the patient experience suffers because lack of visisble contact with the nurse. The increase in patient ratios may not adversly effct theit care but does have a nehgative effect on the overall patinet experience

Conclusion Research on nurse to patient ratios does support the evidenced based practice, although weakly according to selected studies. Positive preference for nursing and patients alike. More research needs to done.

Quality is free --Philip Crosby .

References: Aiken, L., Clarke, S., Sloane, D., Lake, E., & Cheney, T. (2008). Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration, 38(5):223-229. doi:10.1097/01.NNA.0000312773.42352.d7. American Nurses Credentialing Center. Magnet Recognition Program Model. Retrieved from web, March 21, 2012 from, http://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model.aspx Burns, N., & Grove, S. K. (2011). Understanding Nursing Research. In N. Burns, & G. S. K, Understanding Nursing Research (p. 4). Maryland Heights: Elsevier Saunders. Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007, December). The Association of Registered Nurse Staffing Levels and Patient OUtcomes. Medical Care, pp. 1195-1204. Nieswiadomy, R. (2011). Foundations of Nursing Research. Pearson/Prentice Hall. Upper Saddle River, New Jersey Manojlovich, M., Sidani, S., Covell, C. L., & Antonakos, C. L. (2011). Nurse Dose: Linking Staffing Variables to Adverse Patient Outcomes. Nursing Research, 60(4), 214-220. doi:10.1097/NNR.0b013e31822228dc

References (cont’d): Minnick, A., & Mion, L. (2009). Nurse labor data: the collection and interpretation of nurse-to-patient ratios. Journal of Nursing Administration, 39(9), 377-381. doi:10.1097/NNA.0b013e318b3b656 Seago, J., Williamson, A., & Atwood, C. (2006). Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue. Journal Of Nursing Administration, 36(1), 13-21. Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2009). The relationship between nurse staffing and patient outcomes: A case study. International Journal of Nursing Studies, pp. 986-992. Sochalski, J., Konetzka, T., Zhu, J., & Volpp, K. (2008, June). Will Mandated Minimum Nuse Staffing Ratios Lead to Better Patient OUtcomes? Medical Care, pp. 606-613. West, E., Mays, N., Raferty, A. M., Rowan, K., & Sanderson, C. Nursing resources and patient outcomes in intensive are: A systematic review of the literature. International Journal of Nursing Studies 46 (2009) 993–1011.