Report of the Irish RN4CAST Studey 2009-2011: a nursing workforce under strain.

Foreword: The RN4CAST consortium research study, funded by the European Commission, has provided a unique opportunity to gain insight into both organisational and nurse staffing issues across the acute hospital sector in Ireland. As part of the RN4CAST (Ireland) study, for the first time, both hospitals and medical and surgical units within thirty out of a possible thirty-one acute hospitals (with over one hundred beds) have been surveyed. Data were collected in 2009-2010. The work of the international consortium also enables comparisons of Irish findings with key findings internationally. For example it has proved possible to compare such issues as patient – to - nurse ratios and patient - to health care-staff ratios across the 12 partner countries of the consortium. This is also the case, for example, for nurse burnout levels, job satisfaction and nurse perceptions of safety and quality of care. RN4CAST (Ireland) provides a portrayal of the Irish acute hospital sector as operating in a context of dynamic challenge and change from both internal and external drivers. There is considerable evidence of significant strain on the nursing staff working in the sector. Nursing staff indicate concern regarding aspects of the quality and safety of patient care and the availability of sufficient staff and resources to do their job properly. We are of the view that unless these and a number of other issues raised in this report are managed effectively, there will be detrimental impacts on patient care, patient safety and retention and recruitment of high quality nursing staff for our health service

An examination of nurse practitioners/advanced practice nurses’ job satisfaction internationally

Aim To examine the level of job satisfaction of nurse practitioners/advanced practice nurses in developing and developed countries. Background The nurse practitioner/advanced practice nurse has the advanced, complex skills and experience to play an important role in providing equitable health care across all nations. Introduction Key factors that contribute to health disparities include lack of access to global health human resources, the right skill mix of healthcare providers and the satisfaction and retention of quality workers. Methods The study utilized a descriptive analysis and cross-sectional survey methodology with quantitative and qualitative sections of 1419 job satisfaction survey respondents from an online survey. Results Age, number of hours worked in a week and length of time that nurse practitioners/advanced practice nurses worked in their current jobs were statistically significant in job satisfaction. A key barrier was the lack of respect from supervisors and physicians. Discussion It was clear from the number of comments in the qualitative section of the survey that having a wide scope of practice is rewarding and challenging to the nurse practitioner and advanced practice nurse. Conclusion and implications for health policy The challenges to transform healthcare gaps of access into a better distribution of health care in all countries would constitute a systematic change in policy including providing education and training for doctors and nurses that will match the skills needed in the workplace; emphasizing the right skill mix for the healthcare team; supporting advanced practice nurses in the workplace; and utilizing all healthcare providers to the fullest extent of their abilities

The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis

Background: Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required. Aim: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. Methods: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. Results: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79–0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). Conclusion: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units.This review was supported by the Council of Cardiovascular Nursing and Allied Professionals (CCNAP) and the European Society of Cardiology (ESC). Andrea Driscoll was supported by a Heart Foundation Future Leader fellowship 100472 from the National Heart Foundation of Australia, Melbourne, Australia