NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

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Capella University

NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner

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Date

Evidenced-Based Literature Search and Organization

Staffing shortages in healthcare have been a persistent issue, leading to significant concerns about patient safety and the quality of care delivered. When there aren’t enough nurses to meet patient needs, the risk of adverse events such as patient falls, catheter-associated urinary tract infections (CAUTIs), and pressure ulcers (HAPIs) increases. Moreover, inadequate staffing levels can lead to lower patient satisfaction scores, as nursing tasks are often delayed or eliminated due to time constraints. This article delves into the evidence surrounding optimal nurse-to-patient ratios and explores how maintaining adequate staffing levels can improve patient safety and satisfaction.

The Importance of Safe Staffing Ratios

Safe nurse staffing ratios are crucial for delivering quality patient care. For instance, a staffing ratio of 1:6, where one nurse is responsible for six patients, is considered safe. When the ratio falls below this, patient safety is jeopardized. With fewer nurses available, the likelihood of medical errors, patient neglect, and reduced care quality increases. Staffing shortages force nurses to prioritize tasks, sometimes eliminating essential elements of care that could prevent harm or enhance patient experience.

Research has shown that higher nurse-to-patient ratios are linked to improved outcomes in patient safety. A study conducted over six months highlighted that maintaining a safe staffing ratio of 1:6 led to reduced falls and pressure injuries, as well as improved patient satisfaction scores. This underscores the importance of addressing staffing concerns to not only ensure safety but also to enhance overall patient experience.

Formulating the PICOT Question

In the context of healthcare research, the PICOT (Population, Intervention, Comparison, Outcome, and Time) framework is widely used to investigate clinical questions. For this article, the following PICOT question was developed:

In hospital patients, how do safe staffing ratios of 1:6 compared to unsafe staffing ratios of less than 1:6 affect patient safety and satisfaction over six months?

Population (P): Hospitalized patients
Intervention (I): Safe staffing ratios (1:6)
Comparison (C): Unsafe staffing ratios (less than 1:6)
Outcome (O): Improved patient satisfaction and reduced safety issues
Time (T): Six months

This PICOT question was instrumental in guiding the literature search and research process, helping to identify key studies that support the effectiveness of safe staffing ratios.

Literature Search: Gathering Evidence for Staffing Ratios

The first step in evidence-based research is identifying a pressing issue—nurse staffing ratios. Staffing impacts both nurses and patients daily, influencing care quality and safety. To answer the PICOT question, keywords such as “nursing ratios,” “patient satisfaction,” “patient safety,” and “six months” were used in the search process.

To gather relevant information, databases such as CINAHL Complete and Nursing & Allied Health were utilized. The search employed advanced techniques, including truncation (e.g., nurse*) and Boolean connectors like “AND” to refine results. This allowed the retrieval of articles related to both nursing and patient outcomes. Additionally, the search criteria included only peer-reviewed studies published within the last five years, ensuring that the findings were current and reliable.

Inclusion and Exclusion Criteria

During the literature search, careful attention was given to the inclusion and exclusion criteria to ensure the relevance of the articles. Inclusion criteria focused on peer-reviewed studies published between 2019 and 2024, addressing nurse staffing ratios and their impact on patient outcomes. All studies had to be conducted in hospital settings to provide the most applicable insights for the PICOT question.

Exclusion criteria ruled out articles older than five years, non-peer-reviewed studies, and those involving patient populations with mental health or cognitive impairments. These groups were excluded to avoid data variability that could skew the findings. In total, five articles met the inclusion criteria and were selected for in-depth analysis.

Key Research Findings

The five selected studies provided robust evidence supporting the importance of safe staffing ratios in healthcare. Here are some key findings:

Workload and Job Demands: A study by Van Den Oetelaar et al. (2021) revealed that excessive nurse workload due to low staffing levels increased job stress, leading to higher rates of burnout and turnover. These staffing pressures directly impacted patient care, reducing nurses’ ability to attend to patient safety needs.
Dual Roles and Service Delivery: Fildes et al. (2022) explored how nurses managing both Intensive Care Unit (ICU) and Rapid Response Team roles struggled with service delivery when staffing was insufficient. The study found that better staffing ratios allowed for more focused, high-quality care.
Nursing Productivity: Disch and Finis (2022) emphasized that rethinking nursing productivity required addressing the underlying issue of staffing. Adequate staffing not only improved patient safety outcomes but also led to higher satisfaction among nursing teams.
Effective Nursing Practice: Kowalski et al. (2020) noted that hospitals with appropriate staffing levels enabled nurses to practice more effectively. The research showed that safe staffing ratios facilitated better care coordination and more patient-centered care, ultimately improving satisfaction.
Missed Nursing Care: In a cross-sectional study in Saudi Arabia, Al Muharraq et al. (2022) found that missed nursing care was significantly reduced when staffing ratios were adequate. Missed care, such as delayed medication or skipped patient assessments, was a direct consequence of nurse shortages, negatively impacting patient outcomes.

PRISMA Diagram and Article Selection

A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram was utilized to document the literature selection process. The diagram traced the identification, screening, and inclusion of studies, ensuring transparency in the research. Of the 44 initial studies identified, five met the stringent inclusion criteria and were incorporated into the review.

Conclusion:

In conclusion, the evidence overwhelmingly supports the need for safe nurse staffing ratios. A 1:6 nurse-to-patient ratio significantly improves patient safety, reduces adverse events, and enhances satisfaction. Addressing staffing shortages is not just about meeting operational demands but about ensuring that patients receive the quality care they deserve.

Healthcare leaders and policymakers must prioritize safe staffing ratios as part of broader efforts to improve healthcare outcomes. By investing in adequate staffing, hospitals can reduce safety risks, improve patient satisfaction, and create a more supportive work environment for nurses.

References

Al Muharaaq, E. H., Alallah, S., M., Alkhayrat, S. A., & Jahlan, A. G. (2022). An overview of missed nursing care and it’s predictors in Saudi Arabia: A cross-sectional study. Nursing Research and Practice, 2022. https://doi.org/10.1155/2022/4971890

Disch, J., & Finis, N. (2022). Rethinking nursing productivity: A review of the literature and interviews with thought leaders. Nursing Economics, 40(2), 59-71. Fildes, C., Munt, R., & Chamberlain, D. (2022). Impact of dual intensive care unit and rapid response team nursing roles on service delivery in the intensive care unit. Critical Care Nurse, 42(5), 23-31. https://doi.org/10.4037/ccn2022540

Kowalski, M. O., Basile, C., Bersick, E., Cole, D. A., McClure, D. E., & Weaver, S. H. (2020). What do nurses need to practice effectively in the hospital environment? An integrative review with implications for nurse leaders. Worldviews on EvidenceBased Nursing, 17(1), 60-70. https://doi.org/10.1111/wvn.12401

NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

McHugh, M. D., Aiken, L., H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-1913. https://doi.org/10.1016/50140-6736(21)00768-6

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffman, T. C., Mulrow, C. D., et al. The PRISMA 2020 statement an updated guideline for reporting systemic reviews. BMJ, 2021. https://doi.org/10.1136/bmj.n71

Wilhelmina, F. J. M. van den, Oetelaar, Roelen, C. A. M., Grolman, W., Stellato, R. K., & Willem, v. R. (2021). Exploring the relation between modelled and perceived workload of nurses and related job demands, job resources and personal resources; a longitudinal study. PLoS One, 16(2). https://doi.org/10.1371/journal.pone.0246658