The Role of Nursing Care

The nurse to patient ratio is a factor that affects the care activities. The number of patients a nurse attends to determines the nature of behavior and consistency in care administration. The effects of short staffing a health unit are associated with secondary complications such as the increased rates of heart attacks, several medical errors in acute care sections, and respiratory infections. The problem also affects the levels of morbidity and mortality recorded in the administrative records. There exists an associating between the patients outcomes and burnouts in nursing, and the staffing levels in health facilities. Staff capacity management is an important aspect of managing the labor force in organizations. When implemented in nursing and health sector it creates essential insights into the resources utilized by nurses and health practitioners such as the staff and equipment. This research was conducted to determine the effects of short staffing in nursing, patient outcomes, and the nurse to patient ratio. The research, therefore, outlined the effects emanating from short staffing nursing and present a solution based on supervision, retention, and recruitment of practitioners based on the nature of the facility services offered.

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There are several notions of the problem that need to be understood and analyzed to assist in establishing a sustainable strategy. A long-term organizational commitment is necessary for determining the establishment of a long-lasting solution. In this paper, the problems associated with the low staffing levels in health facilities such as the patient outcomes in acute care units have been highlighted. Knowledge of the effects and the possible solution is required when creating a safe environment for patients and nurses. The research employed a review of the literature related to the topic and conducted a keen study of the hospital administrative data, and produces a clear understanding of the notion of the short staffing in nursing. The results of this research ascertain that there exists and an association between the patient outcomes and nurse to patient ratio; however, using supervision, retention, and recruitment could assist to manage the complications.

Literature Review

McQuide, P. A., Kolehmainen, R. L., & Forster, N. (2003). Applying the workload indicator of

staffing needs (WISN) method in Namibia: Challenges and implication for human resources fpr health policy. Human Resource for Health, 11(1), 64.

The process of restructuring the health sector with the objective of improving the quality of health care delivery in Namibia involved the updating of the staff norms. The Ministry of Health was tasked to ensure that the workload indicators in the sector were used to establish an evidence-based strategy to assist in human resource management. McQuide, Kolehmainen, and Forster conducted research that analyzed the number of health worker and the implication on the workload in the health sector in Namibia. The trio focused their study on doctors, nurses, and pharmacy practitioners in clinics, health centers, and hospitals. The study established a task force, carried out a regional pilot survey, conducted workshops for validity, and a process for feedback communication for policy enactment. The research found put that there exists a shortage of health workers and disparity in the distribution. The gaps existed in the number of practitioners per unit. Therefore, the researchers recommended a clear human resource management strategy that will assist in reducing the shortages.

Elkhuizen, S. G., Bor, G., Smeenk, M., Klazinga, N. S., & Bakker, P.J. (2007). Capacity

management of nursing staff as a vehicle for organizational improvement. BMC Health Services Research, 7(1), 196.

Capacity management is an important aspect of managing the labor force in organizations. When implemented in nursing and health sector it creates essential insights into the resources utilized by nurses and health practitioners such as the staff and equipment. Research conducted by Elkhuizen et al. examined and proposed a comprehensive approach to capacity management that provided the necessary staffing and opportunities to improve utilization in hospital units for efficient performance. The study involved the establishment of a capacity model that was based on a reasonable hospital condition with the low staffing problem, and a keen analysis of the outcomes was noted. The model was designed to reveal the challenges related to the operation, optimization of working processes, and strategic staff management. The study found out that an efficient personnel management system is essential in reducing the stay hospital wards in pediatric patients and reducing the pressure that amounts to working process among the nurses. Using a model based system that calculates the nurse to patient ratio could improve the supervision process with the objective of maintaining the quality of the healthcare services in hospitals.

Beeler, M. F., Aleman, M. W., & Carter, M. W. (2016). A simulation case study to improve

staffing decisions at Mass Immunization Clinics for pandemic influenza. Pp. 190 223. United Kingdom Palgrave Macmillan.

The Mass Immunization clinics serve as centers for pandemic outbreaks management and, therefore, are involved in strategic jurisdictions that assist in mitigating the challenges associated with the outbreaks. The nurses attached to these clinics assist in the mass immunization processes. Short staffing issues because of the level nurse to patient ratios characterize the units. Beeler, Aleman, and Carter conducted a research and published a book related to the factors to be included in the strategic management of such units to improve the service delivered to patients and victims through an adequate staffing approach. In the chapter of their book, they presented a discrete simulation event to determine the effects of staffing decisions on the outcome of event management. The study found out that the marginal benefits accrued when staffs are added to such units are associated with indirect waiting costs as well as the intra-facility infection reduction.

Vindigni, S. M., Riley, P. L., Kimani, F., Willy, R., Warutere, P, Sabatier, J. F, Rogers, M.

(2014). Kenyas emergency-hire nursing program: A pilot evaluation of the health service delivery in two districts. Human Resources for Health, 12(1), 16.

Kenya has been utilizing the Emergency-hire Nursing Program to deliver healthcare services not limited to outpatients visits child, and maternal health services. The process is attributed to low costs and short-term impacts necessity. The approach, however, has affected the units that employ such a technique. Vindigni et al. used six primary outcomes and conducted a thorough assessment of the data that were collected from the forms of facility-level management activities. The group compared the effects of hiring emergency staffs before and after a disaster occurrence, and they found out that, the placement of nurses has an immediate impact on the intended objective. However, a challenge emanated when the hired practitioners are relieved from duty. The lack of sustainability affects the operation of the emergency services and general health care delivery. The study concluded that the several factors that exist relating to staffing and nurse to patient ratio go beyond increasing the practitioners during a crisis only and affects the health service delivery.

Mueller, M., Lohmann, S., Strobl, R. Boldt, C., & Grill, E. (2010). Patients functioning as

predictor of nursing workload in acute hospital units providing rehabilitation care: A multi-center cohort study. BMC Health Services Research, 10(1), 295.

The management choices on the quality levels and quantity outputs for nurse staffing are determining the nature of hospital budgets. The two factors also determine the baseline to be applied in nursing requirements and patient services within an acute hospital unit. Mueller et al. conducted a study whose objectives were to examine the relationship that existed between the patients functioning and the nursing workloads in an acute healthcare unit. The group also compared the variations in nurse workload with the Barthel Index used in the study and created a predictive system for nurse staffing. The group found out that the workloads of nursing could be predicted using the Core Set Data. The services offered by health practitioners in an acute unit are inclined to the extent of duties performed. A system to determine the workload about quality and quantity was recommended as the efficient method of creating sustainability in the health sector through staffing management and making relevant decisions and policies.

Hugonnet, S., Uckay, I., & Pitet, D. (2007). Staffing leve: A determinant of late-onset ventilator-

associated pneumonia. Critical Care, 11(4), R80.

The levels of Ventilator-Associated Pneumonia (VAP) have been registered as critical and scholars have been studying the factors that increase the prevalent cases in health facilities. Trio conducted a scientific study to examine whether the nurse to patient ratio contributed to the increase of VAP. Short staffing in nursing has been associated to poor health services causing hospital-acquired infections thus increasing the risks on patients. The study conducted by Hugonnet, Pitet, and Uckay sampled a single-center cohort in University of Geneva Hospital where the ICU patients records were studied to find the existence of any secondary infections developed while undergoing treatment before discharge. The study utilized the data collected through statistical and scientific analysis to provide information correlating with the late-onset VAP. The data related to patient characteristics, diagnosis, physiological evaluations, and number of nurses on duty each day and the analysis involved a multivariate Cox regression technique with hazard ratio of 0.42 and confidentiality of 95%. The study found out that the less number of nurses when compared with the patients in ICU units posed a high risk of VAP hospital in-patient infections.

Dubois, C. A., DAmour, D., Pomey, M. P., Girard, F., & Brault, I. (2013). Conceptualizing

performance of nursing care as a prerequisite for better measurement: A systematic and Interpretive review. BMC Nursing, 12(1), 7.

The role of nursing care is to provide health interventions to patients with varied needs. The concept of performance science is critical to the service provided. The theoretical frameworks of such services are associated with the aspects of quality and quantity. However, nursing contributions incorporation has been limited because of the neglect of the circumstances that surrounds their daily activities and service delivery such as burnouts and short staffing. The study involving the conceptualization of performance in nursing included an analysis of different components of operation and development of several indicators relating to nursing care. The study used the information in databases such as MEDLIE, EMBASE, and CINAHL. The study found out that acquiring, utilizing, and retaining nurses and resources used in carrying out duties is a subsystem that should be used to ensure that the quality of service is improved, short staffing mitigated and efficient use of resources. The research concluded that a framework based on the concept of performance is relevant to managing nursing effectiveness.

Namaganda, G., Oketcho, V., Maniple, E., & Viadro, C. (2015). Making the transition to

workload-based staffing: Using he workload in...