Evidence Based Practice

1. Evidence BasedPractice Nurse to Patient Ratios Ferris State University March 2012

2. Group Members • Heather Nowak • Sofia Warren • Catherine Buckel • Jessica Dematio

3. Introduction • Evidence based practice in nursing begins with “clinical problem for which there is not immediately apparent solution. Nurses then seek to find information about the best solution for this specific problem” (Nieswiadomy, 2011, p.368)

4. Goal • Our goal is to identify the correlation of nurse to patient ratios on achieving positive patient outcomes.

5. Facts • There is still a nursing shortage nationwide • With the current economy many medical institutions are looking at cost saving measures • With the current changes in medical reimbursement further cost savings must occur

6. Problem Statement • Does increased nurse staffing ratios lower adverse patient outcomes?

7. PICO P -Population or participants of interest I -Intervention needed for practice C -Comparisons of interventions to determine the best for practice O -Outcomes needed for Practice

8. Question in PICO Format P Patients in an acute care setting. I Lower nurse to patient ratio C Comparison to patient outcomes with a setting with higher nurse to patient ratio O Improved patient outcome, satisfaction and lower mortality

9. Research • Scholarly articles were selected from professional databases • Articles included were current articles written within the last 5 years • Articles were narrowed down to include the four best based on criterion

10. Article #1The Association of Registered Nurse Staffing Levels and Patient Outcomes • Background: Due to cost saving measures many hospitals are requiring nurses to have higher nurse to patient ratios and this affecting patient outcomes. • Methods: Systematic review of literature according to the recommendations for Met-Analysis Of Observations Studies in Epidemiology (MOOSE). • Conclusion: The results of this study indicated that there was a correlation between RN staffing and patient outcomes.

11. Article #1Critical Analysis • Systematic review • Comprehensive synthesis of quantitative studies • Diverse sample • Study supports the stated objective and conclusion

12. Article #2Nursing Resources and Patient Outcomes in Intensive Care: A Systematic Review of Literature • Background: Reviews empirical evidence about the link between nursing resources and patient outcomes in intensive care, assess its strengths and weaknesses, and identifies where further research is required. • Methods: studies were chosen based on dependent and independent variables with a risk adjustment and done in an adult ICU • Conclusion: Results concluded that there is uncertainty that nurse resources have effects on mortality or adverse effects. All the studies sis point out that there is a link between the two however the associations may have occurred by chance.

13. Article #2Critical Analysis • Purpose is clearly defined • Methods of collection decrease bias • Backgrounds on reviews of research

14. Article #3Nurse Dose: Linking Staffing Variable to Adverse Patient Outcomes • Background: Variables in nurse staffing and educational level would affect positive patient outcomes is a valid question related to clinical nursing practice. • Methods: Examining the acute care setting in which nurse to patient ratios were greater than 1:1. This was a convenience sample. • Conclusion: The study could not claim that the staffing variables directly caused a reduction in adverse outcomes, although the researchers were able to demonstrate a significant relationship between staffing variables and outcomes.

15. Article #3Critical Analysis • No discernible framework • Strong objective statement • Resources were current

16. Article #4Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes • Background: Care environment, nurse staffing and nurse education are crucial to improved outcomes and mortality. The study was to determine whether better care environments are associated with improved outcomes. • Methods: Surveys from nurses involved in direct care from 168 hospitals. Hospitals were not allowed to opt out. Data was derived from the practice environment scale of the Nursing Work Index (PES-NWI). • Conclusion: The research implies that better care environments, a 4:1 patient/nurse ratio and a staff of greater that 60% BSN prepared nurses, have a significant impact on patient mortality and failure to rescue rates.

17. Article #4Critical Analysis • Strong problem statement • Strong framework • Scholarly although classic • Limited in scope

18. Integrations • EBP in nursing is a key concern for a positive experience for nurses as well as patients. • Nurse to patient ratios are dependent also on education level, skill set, and environment. • Patient experience is not necessarily dependant on patient outcomes.

19. Conclusion • Research on nurse to patient ratios does support the evidenced based practice, although weakly according to selected studies. • Positive preference for nursing and patients alike. • More research needs to done.

20. Quality is free--Philip Crosby .

21. References: • Aiken, L., Clarke, S., Sloane, D., Lake, E., & Cheney, T. (2008). Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes. Journal of Nursing Administration, 38(5):223-229. doi:10.1097/01.NNA.0000312773.42352.d7. • American Nurses Credentialing Center. Magnet Recognition Program Model. Retrieved from web, March 21, 2012 from, http://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model.aspx • Burns, N., & Grove, S. K. (2011). Understanding Nursing Research. In N. Burns, & G. S. K, Understanding Nursing Research (p. 4). Maryland Heights: Elsevier Saunders. • Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007, December). The Association of Registered Nurse Staffing Levels and Patient OUtcomes. Medical Care, pp. 1195-1204. • Nieswiadomy, R. (2011). Foundations of Nursing Research. Pearson/Prentice Hall. Upper Saddle River, New Jersey • Manojlovich, M., Sidani, S., Covell, C. L., & Antonakos, C. L. (2011). Nurse Dose: Linking Staffing Variables to Adverse Patient Outcomes. Nursing Research, 60(4), 214-220. doi:10.1097/NNR.0b013e31822228dc

22. References (cont’d): • Minnick, A., & Mion, L. (2009). Nurse labor data: the collection and interpretation of nurse-to-patient ratios. Journal of Nursing Administration, 39(9), 377-381. doi:10.1097/NNA.0b013e318b3b656 • Seago, J., Williamson, A., & Atwood, C. (2006). Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue. Journal Of Nursing Administration, 36(1), 13-21. • Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2009). The relationship between nurse staffing and patient outcomes: A case study. International Journal of Nursing Studies, pp. 986-992. • Sochalski, J., Konetzka, T., Zhu, J., & Volpp, K. (2008, June). Will Mandated Minimum Nuse Staffing Ratios Lead to Better Patient OUtcomes? Medical Care, pp. 606-613. • West, E., Mays, N., Raferty, A. M., Rowan, K., & Sanderson, C. Nursing resources and patient outcomes in intensive are: A systematic review of the literature. International Journal of Nursing Studies 46 (2009) 993–1011.