Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research.

AIM: This paper revisits the published evidence relating to how nurse staffing levels impact on patient, nurse and service outcomes and considers the implications of this body of research for nurse managers in their quest to determine optimum nursing numbers. BACKGROUND: Within the context of the recognized global nursing shortage and particular local pressures within international health services, questions of appropriate nurse staffing levels and skill mix are once again becoming increasingly important. It would seem that the determination of optimum nurse staffing levels and skill mix is a central issue in relation to health service governance, service user involvement, as well as in the recruitment, retention and well-being of nursing staff across the service sectors. METHODS: A review of published evidence was carried out, applying key principles of the systematic method, in order to facilitate the identification of current factors and issues in nurse staffing levels research. The review did not seek to address a specific research question. The search covered 10 years from 1998 to 2008 and identified more than 500 relevant papers, giving a wide international perspective. KEY ISSUES: The majority of research in the field relates to the acute service sector and there are considerable similarities in issues that transcend international boundaries. Much of the research focuses on the impact on patients and nurses of 'poor' nurse staffing levels. More recent studies have explored the impact of nurse staffing levels on the service organization itself. However, while there may be an association between models of nurse staffing and outcomes, there is insufficient evidence to establish a causal relationship between these factors. In this context it is perhaps time to reconsider how nursing outcomes are defined and measured. IMPLICATIONS FOR NURSING MANAGEMENT AND CONCLUSION: Nurse managers, commissioners of services and workforce planners need to be cognisant of key issues and analyses in the consideration of nurse staffing levels. Not least of these is the need for a healthy degree of caution regarding the supposed objectivity, scientific basis, or evidence base, for rational calculation of optimum nurse staffing levels

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Objective:(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Improving the Culture of Safety on a High‐Acuity Inpatient Child/Adolescent Psychiatric Unit by Mindfulness‐Based Stress Reduction Training of Staff

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109622/1/jcap12091.pd

Flexible nurse staffing based on hourly bed census predictions

Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method that uses hourly census predictions to derive efficient nurse staffing policies. The generic analytic approach minimizes staffing levels while satisfying so-called nurse-to-patient ratios. In particular, we explore the potential of flexible staffing policies which allow hospitals to dynamically respond to their fluctuating patient population by employing float nurses. The method is applied to a case study of the surgical inpatient clinic of the Academic Medical Center (AMC) Amsterdam. This case study demonstrates the method's potential to study the complex interaction between staffing requirements and several interrelated planning issues such as case mix, care unit partitioning and size, and surgical block planning. Inspired by the numerical results, the AMC decided that this flexible nurse staffing methodology will be incorporated in the redesign of the inpatient care operations during the upcoming years

Improving the culture of safety on a high‐acuity inpatient child/adolescent psychiatric unit by mindfulness‐based stress reduction training of staff

ProblemThe purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness‐based stress reduction (MBSR) training program on a highacuity psychiatric inpatient unit.MethodsA one‐group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately posttraining and at 2 months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale.FindingsThe MBSR program reduced staff stress across the 2‐month post‐training period and increased staff mindfulness immediately following the brief training period of 8 days, and across the 2‐month post‐training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call‐ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2 months following the training period.ConclusionsA brief MBSR training program offered to an interprofessional staff of a high‐acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145396/1/jcap12191.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145396/2/jcap12191_am.pd

Creating short-term volume flexibility in healthcare capacity management

It is well-known that unpredictable variations in supply and demand capacity in healthcare systems create the need for flexibility. The main tools used to create short-term volume flexibility in the healthcare system include overtime, temporary staff from internal calling lists, moving staff across units, internal staffing pools, external staffing agencies, queuing patients, and purchasing care from external providers. We study the creation of short-term volume flexibility in healthcare systems to manage short-term capacity losses. A questionnaire was developed and distributed among department managers in the Region V\ue4stra G\uf6taland healthcare system. Respondents were asked to what extent they used each tool to create short-term flexibility in capacity. Data were analyzed using multiple regression analysis. Several significant tendencies were found, including that acute units use overtime and internal staffing pools to a larger extent, and patient queues and external providers to a smaller extent than planned units. The prerequisites and required managerial approaches used to manage aggregate capacity in the system efficiently differ substantially between different parts of the system. These differences must be addressed when, for example, capacity pools are considered. These results serve as a steppingstone towards a more thorough understanding of efficient capacity management in healthcare systems

Mindfulness: An Educational Module to Address Stigmatic and Negative Thoughts Through Mindfulness

Mental health stigma complicates the ability of psychiatric mental health (PMH) nurses to establish an emotional balance stemming from generalized negative perspectives. This educational module aimed to increase PMH nurses’ knowledge of stigmatic negative thoughts contributing to psychological distress in an inpatient setting. PMH nurses’ inability to cope results in absenteeism, high staff turnover, psychotropic medications, and sleep aids. The conceptual framework, ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model, and cognitive theory (CT) change automatic negative thoughts with positive ones. A pre-and post-test was conducted with a 10-question, 5-point Likert scale test on mindfulness meditation for mental health nursing. A paired t-test was used to compare the pre-and-post responses during data analysis. The t-test revealed that the pre-test mean (M= 23.75) was significantly different from the post-test (M=12.94), t (4.934) = 10.813, and p \u3c .001 scores that answered the guiding question that mindfulness meditation decreases automatic negative thoughts. Data analysis was conducted using a Likert scale that measured the knowledge of PMH nurses related to mental health and stigma. The findings and implications revealed that PMH nurses lacked knowledge of mental health stigma and mindfulness. The recommendations would be to offer mindfulness training annually, clinical ladder specific to mental health, and recruit and retain a master’s level nurse educator. The positive social change could enhance job satisfaction and retention, improve nurses’ mental well-being, and create an environment of empowerment

Implementing a Self-Scheduling Model to Decrease Nurse Turnover in Medical-Surgical Nursing

Nurses may experience job stress and burnout due to the amount of hours worked and demanding schedules. At one hospital, nurse turnover rates were high in medical-surgical units. Surveys and interviews conducted by hospital administration found that the bedside nurses were dissatisfied with scheduling practices and that this dissatisfaction could lead to heightened turnover. The purpose of this project was to determine if the implementation of a self-scheduling model would decrease nurse turnover on a medical-surgical nursing unit. This quality improvement project focused on facilitating the empowerment of nurses through a self-scheduling model; it followed the quality improvement steps of the Deming approach of Plan-Do-Check-Act. During the pilot, turnover rates of the unit that implemented the self-scheduling model were reviewed 30 days pre- and 30 days post-implementation. The project results showed a decrease in turnover rates from 12.96% to 10.00% on the unit where the model was implemented. This project has a social impact by allowing nurses to participate in a self-scheduling model to have workâlife balance, because the work environment plays a significant role in encouraging engagement and decrease in turnover. Implementing this model in other units may result in decreased nurse turnover for the hospital

The Influence of Nurse Manager Transformational Leadership on Nurse and Patient Outcomes: Mediating Effects of Supportive Practice Environments, Organizational Citizenship Behaviours, Patient Safety Culture and Nurse Job Satisfaction

The Canadian Adverse Events Study (Baker, et al., 2004) revealed that the rate of adverse events in Canadian hospitals is 7.5% and almost 37% of these are preventable. Given these statistics, it is essential that healthcare organizations develop strategies and engage in leadership practices, which will address the complexity of healthcare processes and ensure that care is provided in a consistent, reliable manner in order to achieve the desired outcomes (Frankel, Gandhi & Bates, 2003). It is equally vital that leaders create supportive practice environments that promote a non-punitive culture of learning, continuous improvement, inter professional collaboration, and professional autonomy, thus engaging nurses in safe practice aimed at improving patient outcomes (Aiken, 2008; Pronovost et al., 2003). In order to understand how nursing leadership affects outcomes, it is important to assess what leadership behaviours are most effective in promoting a patient safety culture. This study tested a hypothetical model which predicted the influence of nurse manager Transformational Leadership behaviour on staff nurse perceptions of supportive practice environments, organizational citizenship behaviours, patient safety culture, job satisfaction and objective measures of selected nurse sensitive outcomes. Findings supported the hypothesized model χ2(df = 22) = 40.72, p = .008 ; CFI = .958; TLI = .916; RMSEA = .079; SRMR = .045 linking transformational leadership to nurse and patient outcomes through supportive practice environments, organizational citizenship behaviours, safety culture and job satisfaction. Transformational Leadership had a significant indirect effect on patient falls (β = -.08, p These results provide a unique contribution to the body of literature and understanding about the role Transformational Leadership might play in optimizing nursing practice environments and patient outcomes. Therefore it has important implications for the professional development of nurse managers and leadership curriculum design. Findings will also potentially influence strategic planning within the organization and broader policy development at a LHIN or provincial level