Extraneous variables are defined as variables that exist in all studies and can affect the measurement and relationship among the study variables (Grove, Burns, & Gray, 2013, p. 694). For the current study on hourly rounding, one of the extraneous variables identified is the staffing ratio. If the unit being studied on encounters a staffing issue (short staffed), it would mean that the nurse-to-patient would be higher. To address and control this variable, the two medical surgical units selected have a fixed nurse-to-patient ratio of 1:6, based on their policies and procedures. If a nurse calls in sick, the hospital’s staffing department has a pool of resource nurses who float to units which are short staffed. Furthermore, a common practice is to offer a bonus/incentive to other staff nurses on their day off to come in and work to fill the staffing problems. Another possible extraneous variable to the current study is that some of the staff (nurse or patient care technician) could just be signing the log without actually adhering to the standards of hourly rounding (addressing 4Ps). ...
In the case of nurse staffing, the more nurses there are the better outcome of patient safety. When there enough staff to handle the number of patients, there is a better quality of care that can be provided. The nurses would be able to focus on the patients, monitor the conditions closely, performs assessments as they should, and administer medications on time. There will be a reduction in errors, patient complications, mortality, nurse fatigue and nurse burnout (Curtan, 2016). While improving patient satisfaction and nurse job satisfaction. This allows the principle of non-maleficence, do no harm, to be carried out correctly. A study mentioned in Scientific America showed that after California passed a law in 2014 to regulate hospital staffing and set a minimum of nurse to patient ratios, there was an improvement in patient care. Including lower rates of post-surgery infection, falls and other micro emergencies in hospitals (Jacobson,
Supposedly, the national average occupancy rate of hospitals is lower than it should be because of rising costs of hospital care. Factors causing variations in occupancy rates are hospital size, product diversification, and urgent versus non-urgent
Ford, B. M. (2010). Hourly rounding: a strategy to improve patient satisfaction scores. MedSurg Nursing, 19(3), 188-191.
Needleman, J., Buerhaus, P., Pankratz, S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. England Journal of Medicine, Retrieved from http://www.nejm.org/doi/full/10.1056/nejmsa1001025
Needleman, J., Buerhaus, P., PKankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse Staffing and Inpateint Hospital Mortality. The New England Journal of Medicine , 364, 1037-1045.
Implications of what quality can stand for include the company reputation, product liability, and global implications (Nguyen, 2015). In the case of understaffing, product or service liability is the culprit when discussing a quality implication. It is imperative for an operations manager to deliver healthy, safe, and quality service and products to their customer (Nguyen, 2015). Nurses are being pulled away from their duties to fulfill the demands of another position that is lacking in the support system of patient care (Kalisch, 2006). While fulfilling other jobs rather than their own, nurses are losing valuable time with their patients resulting in ineffective nursing practices, charting, and a lack of team work as there is barely time to finish their duties (Kalisch, 2006). To acceptably perform to the standards set by the firm, the total quality management that emphasizes the quality of the entire organization, from the supplier to the customer, needs to be committed to and met in every prospect of the job (Nguyen,
Without participating in a longitudinal study, it is difficult to truly assess the efficacy in mandating nurse staffing ratios. It is difficult to measure the benefits of mandated staffing due to numerous confounding variables. These confounding variables include the resources available at specific hospitals in addition to the populations that they serve. Hospital volume, RN job satisfaction and the relationship between physicians and nurses have also been shown to affect patient outcomes (Duval et al., 2007).
...staff would not be required to put in the overtime to compensate for the lack of workers. Patients would no longer have to suffer the neglect of the staff because he or she was too busy. Making sure the patient gets the best quality care reduces the time spent for recovery. Reducing the time spent for recovery increases the organization’s finances. Providing a safe facility also reduces the expenses on the private hospital’s budget. Ensuring a patient is safe can reduce potential use of ongoing treatment and services. Hiring the appropriate nursing staff needed can save the organization money. Instead of cutting back on staff, more staff needs to be hired to fulfil the needs of the patient. In the economy today, private hospitals need to focus on the overall long term effects of each action opposed to quick reactions resulting in financial strain for the facility.
An activity report can provide operational statistics such as occupancy rate, average daily census, and average length of stay (Finkler, Jones & Krover, 2013). Though these numbers are important and have a great influence on the operational budget, a nurse leader needs more information in order to justify staffing. Nurse leaders can obtain additional information from workload reports. Patient classification system measure workload by assigning each patient a classification level based on his or her unique care needs and then determine the number of care hours required per patient per day. Many organizations express this in hours per patient day (HPPD) or relative value units (RVU) (Finkler et al., 2013). Workload reports are useful because they can identify changes in patient mix that can increase or decrease the need for nursing personnel. Bi-weekly fulltime equivalent (FTE) reports are also useful because they convey to nurse leaders exactly how many man-hours were used by each FTE (Liberty University, 2015). Furthermore, the report provides a breakdown of productive time; contract hours, paid time off (PTO), and overtime. It also accounts for nonproductive time such as time spent on education, training, and orientation (Liberty University,
Witkoski Stimpfel, Amy , Douglas M. Sloane, and Linda H. Aiken. "The Loger the shifts for hosital nurses, the higher the levels of burnout and patient disstisfaction." Health Affairs 31.11 (2012): 2501-2509. Proquest. Web. 11 Mar. 2014.
This article is a comprehensive look at staffing on hospital units. It used a survey to look at characteristics of how the units were staffed – not just ratio, but the experience and education level of the nurses. It evaluated several different categories of hospital facilities – public versus private, academic medical centers versus HMO-affiliated medical centers, and city versus rural. It is a good source because it shows what some of the staffing levels were before the status quo of the ratio legislation passed in California. It’s main limitation as a source is that it doesn’t supply any information about patient outcomes.
There are a couple of problems affecting the surgical services department. One of them is that the unit /hospital pays a lot of money for surgical supplies and equipment. The second problem is labor and productivity. The two problems are included in the operational and personnel budget. These types of budgets are the highest cost to the department; personnel budget being the highest then the operational budget (Marquis & Huston, 2012).
Notably, having higher proportions of nurses working shorter shifts—8–9 hours or 10–11 hours—resulted in decreases in patient dissatisfaction” (Stimpfel et al.). This is essentially saying that the longer the shift length, the more negative outcomes result. This study proves that eight to nine-hour shifts are more effective, and should, in turn, be worked more than longer shifts. This is a problem because hospitals are likely to continue to schedule nurses for twelve hours shifts out of
Furthermore, individuals involved in flexible working hours such as, remote working or telecommuting (when an employee is able to work away from the
They also claim that the facility would not be able to afford such costs: "The American Hospital Association opposes mandated ratios for a variety of reasons.... would have to spend millions of dollars more per year" (Rajecki 2009). They may argue that the extra expenses would have to be deducted from other sources. The administrators may also say that they would have to increase the prices of procedures/ provided to clients. Health care facilities/ the corporation make a reasonable point; however, reducing the ratio of nurse to patient would decrease the costs spent on adverse patient outcomes. Per Keller et al. (2013), when the nursing staff is compromised, patients experience adverse outcomes such as pressure ulcers and nosocomial infections (an infection that is acquired during stay in a health care facility). Adverse patient outcomes are not reimbursed to the facility treating these