Nursing Research Report: Staffing Challenges and Patient Outcomes

This report delves into the critical issue of nurse staffing challenges and their significant impact on both nurse performance and patient outcomes. It provides a detailed analysis of the adverse effects of inadequate staffing levels, including increased workload, potential for medical errors, and higher rates of healthcare-associated infections. The report identifies nurses as the primary group affected by these challenges and highlights the significance of the issue in terms of quality of care, nursing performance, and the overall profitability of healthcare organizations. It formulates a research question focusing on nurses' expectations regarding attractive work schedules and environments, and proposes a descriptive study using survey questionnaires to gather qualitative data. The report emphasizes the need for healthcare leaders to prioritize improved nurse staffing levels and address job-related burnout to improve patient outcomes and organizational performance.

Running head: NURSING RESEARCH
Nursing research
Name of the student:
Name of the University:
Author’s note

1NURSING RESEARCH
Abstract
The report examines the issue of nurse staffing and the challenges associated with the
issue on nurse performance and patient outcomes. Detailed insight into impact of challenges,
the people affected by the challenges and the significance of the issue has been presented.
The report also formulates a research based on the challenges to find out ways to address the
research question. A discussion on possible research design is also provided to understand
the most suitable research method to get answer to the research question.

2NURSING RESEARCH
Table of Contents
Introduction (Background):........................................................................................................3
Description of the challenge:.....................................................................................................3
People affected by the challenge:...............................................................................................4
Significance of the challenge:....................................................................................................5
Research question and scope:.....................................................................................................5
Type of research design and method:.........................................................................................5
References:.................................................................................................................................7

3NURSING RESEARCH
Introduction (Background):
Appropriate nurse-patient ratio is one of the major predictor of quality of care and
nursing performance. However, the performance of nurse deteriorates due to staffing issues
and lack of appropriate number of nurses available for care of patient. Staffing problems
creates working overload and limits the amount of nursing care given to individual. All this
contributes to many undesirable patient as well as job related outcomes for nurses (Aiken et
al., 2014). The main purpose of this report is to give an overview about the issue, the people
affected by the challenges and the significance of the issue. It also offers the scope to find
solutions to the issue by framing a research question and proposing a research design.
Description of the challenge:
One significant challenge in my current work role is the issue of staffing level.
Staffing level issues is related to low number of staffs available for care delivery compared to
the number of patient in clinical setting. This issue is a critical challenge for nurses because
nurse staffing level has direct impact on the quality and outcome of care. This can be said
because low staffing level contributes to higher workload for existing nursing staff and this
reduces the level of attention that a nurse can pay to a patient on a single day. Heavy work
load causes nurse to become distressed and commit mistakes while delivering (Cho et al.,
2016). Evidence has also showed that a hospital which has low staffing level have higher rate
of adverse event compared to hospitals which maintain good staff patient ratio (Aiken et al.,
2014).
Nurse staffing highly contributes to burnout and such issues leads to many challenges
for nurse in their job. Cimiotti et al., (2012) argued that nursing staffing issues and burnout is

4NURSING RESEARCH
the reason for high incidence of health care associated infection. The study mentioned that
1.7 million hospitalized patient acquire infections in a year. Nurse staffing ratio and number
of nursing hour per patient is regarded as a major cause for the spread of infection. From this
perspective, it can be said that staffing issues is linked to suboptimal medical care and patient
satisfaction. Since this is having an impact on patient safety and health outcome, the issue is
significant. As nurse staffing and burnout is a cause of adverse events like falls and health
care associated infection in hospital, there is a need to take steps to maintain a good staffing
ratio. The health care leaders can reduce cost burden significantly by improving nurse
staffing level, providing appropriate working environment to nurse and alleviating job related
burnout in nurses.
People affected by the challenge:
Although there are many inter-professional staffs who work in health care setting,
however nurses are the main health care staffs, who are affected by the issue. This is because
nurse spends the maximum time with patient and they are directly involved in implementing
the care proposed by clinician. Hence, when a nurses is overloaded with work due to poor
staff level, the likelihood of negative patient outcome and negative job outcome increases.
For instance, nurse reported adverse events such as medication error, fall injury, pressure
ulcer increases (Cho et al., 2016).
Due to staffing level issues, nurses are overworked and stressed out. They do not get
the ideal environment and time to safely provide care to patient. Therefore, high occurrence
of adverse event and burnout also minimizes nurse satisfaction their job. Apart from burnout,
other impact of nurse to patient ratio on nurse outcomes includes poor job satisfaction and
intent to leave the job. Everhart et al. (2016) showed that a nurse with higher patient load
reported more about intention to leave the job or being dissatisfied with their current job.

5NURSING RESEARCH
Significance of the challenge:
The significance of the staffing level challenges is understood from the fact that it not
only influences quality of care and nursing performance, but also affects the overall
profitability of health care organization. This implies that nursing staffing level has direct
relationship with patient outcome as well as financial performance of hospital. Therefore, the
issue of staffing level should be given top priority to achieve competitive advantage within
health care industry.
Research question and scope:
Evidence has shown that nurse staffing issue is associated with nursing burnout, high
turnover and dissatisfaction with the job (Khamisa et al. 2015). All this occurs because nurses
do not get work flexibility to manage their workload and other priorities. Hence, health care
providers have the highest responsibility for bringing changes in the system of recruitment as
well as work environment at the hospital. The possible solution is to provide attractive work
schedule and attractive work environment to existing nurses in health care setting (Wright &
Bretthauer, 2010). Before proceeding with this initiative, there is a need to find out nurse’s
view about work environment and flexibility in work. This would help to develop appropriate
protocol to bring changes on work environment in the hospital. Hence, the research question
that is of importance to engage in proper planning for addressing nurse staffing issue is ‘What
are the expectations of nurse regarding an attractive work schedule and work environment at
the hospital?’
Type of research design and method:
To get answers to the formulated research question, deciding the best research design
is necessary to ensure that relevant data is obtained. As the research question is looking to
analyse the view of nurses regarding work environment of the hospital, it means the aim of

6NURSING RESEARCH
the research is to get descriptive data related to the research question. Hence, qualitative
research approach is most suitable to address the research question as qualitative research
process can help to get detail insight related to an event. There are many research designs that
can be done by means of qualitative research approach. This includes cross-sectional study,
randomized controlled trial, descriptive and cohort based study. Descriptive research design
has been chosen for the research question.
Descriptive research design with the use of survey questionnaires will help to
collected data related to nurse’s perspective on desired work environment in hospital.
Adhering to the descriptive study design would bring in a number of benefits to the study.
Firstly, the participants can provide information in an unchanged and natural environment.
Further, such a research would be a pre-cursor for future research as useful variables can be
identified. Since the data collection method is simple in nature, multifaceted approach for
data analysis is applicable. With such a research, rich data can be extracted that is huge in
volume. The attitudes, habits and beliefs of the participants can be studied adequately
(Parahoo, 2014).
25 nurse participants are to be recruited with the help of purposeful sampling. The
participants are to be employed as registered nurses at healthcare units. They are to have an
experience of at least two years. Survey questionnaires with close open ended questions are
to be distributed to the respondents and one week time is to be given for data collection. The
transcribed data is to be coded and categorisation is to be done. Key themes are to be
highlighted from the paper, and the analytical process comparison between the questionnaires
would be pivotal. Ethical consideration is to be given by not involving invasion of integrity of
individuals (Kieft et al., 2014).
Conclusion

7NURSING RESEARCH
Study of relevant literature points out that the performance of nurses is guided by staffing and
skill mix of nurses. A major challenge in my current work role is the issue of staffing level.
There is evidence to support that staffing level issues relates to low number of staffs available
for care delivery compared to the number of patient in clinical setting. The issue is prominent
since it influences quality of care and nursing performance, apart from the overall
profitability of health care organization. The research that is to be carried out would be based
on the research question of “what are the expectations of nurse regarding an attractive work
schedule and work environment at the hospital?’. A descriptive study with survey
questionnaire is to be carried out in this regard.

8NURSING RESEARCH
References:
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., ... &
McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine
European countries: a retrospective observational study. The Lancet, 383(9931),
1824-1830.
Cho, E., Chin, D. L., Kim, S., & Hong, O. (2016). The relationships of nurse staffing level
and work environment with patient adverse events. Journal of Nursing
Scholarship, 48(1), 74-82.
Cho, E., Lee, N.J., Kim, E.Y., Kim, S., Lee, K., Park, K.O. and Sung, Y.H., 2016. Nurse
staffing level and overtime associated with patient safety, quality of care, and care left
undone in hospitals: a cross-sectional study. International journal of nursing
studies, 60, pp.263-271.
Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and
health care–associated infection. American journal of infection control, 40(6), 486-
490.
Everhart, D., Neff, D., Al-Amin, M., Nogle, J., & Weech-Maldonado, R. (2013). The effects
of nurse staffing on hospital financial performance: Competitive versus less
competitive markets. Health care management review, 38(2), 146.
Khamisa, N., Oldenburg, B., Peltzer, K. and Ilic, D., 2015. Work related stress, burnout, job
satisfaction and general health of nurses. International journal of environmental
research and public health, 12(1), pp.652-666.

9NURSING RESEARCH
Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and
their work environment affect patient experiences of the quality of care: a qualitative
study. BMC health services research, 14(1), 249.
Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.
Taylor, S. J., Bogdan, R., & DeVault, M. (2015). Introduction to qualitative research
methods: A guidebook and resource. John Wiley & Sons.
Wright, P. D., & Bretthauer, K. M. (2010). Strategies for addressing the nursing shortage:
Coordinated decision making and workforce flexibility. Decision Sciences, 41(2),
373-401.