Staffing Ratio Research Proposal

1. Staffing Ratio Research Proposal Erin burdi NURS 450: Capstone Ferris state university

2. Research Problem Nursing Shortage The nursing profession is facing an ever growing threat of a continued nursing shortage. Erenstein and Mcaffrey (2007) estimated “…that by the year 2020, the United States will experience a shortage of 400,000 registered nurses” (p.303). NURSE RETENTION & JOB SATISFACTION Poor nurse retention & job satisfaction is a major contributing factor to the shortage of nursing professionals.

3. Research Problem • Staffing Ratios • Staffing ratios can directly influence the quality of a working environment and nurses’ ability to provide quality patient care, thus influencing job satisfaction. • According to Aiken, Clarke, Sloane, Sochalski, and Silber (2002), “nurses nationwide consistently report that hospital nurse staffing levels are inadequate to provide safe and effective patient care” (p.1987). • Insufficient staffing causes increased patient care workloads for nurses and through time constraints, can inhibit the nurse from developing the necessary nurse-patient relationship needed to provide quality care.

4. Research Problem Staffing Ratios • This barrier to providing quality patient care is a major frustration for nurses due to their desire to provide excellent patient care. • Working environments that impede a nurses’ ability to provide expected levels of patient care due to perceived factors that are beyond individual control, such as staffing, may cause nurses to become overstressed, burned out, and potentially leave the profession. • Cullen (1995) states that when a nurse works in a system where s/he's never allowed to give their best, one of two things happen: either s/he lowers her standards, in which case s/he works apathetically but comfortably for the rest of their career, or s/he continues trying to give their best, constantly bucking a system that doesn't put excellence first, until s/he finally burns out (p.26). • According to Aiken, Clarke, Sloane, Sochalski, and Silber (2002), “job dissatisfaction among hospital nurses is four times greater than the average for all US workers, and one in five hospital nurses report that they intend to leave their current jobs within a year”(p.1987). “If I can't look at myself in the mirror because I'm so ashamed of the level of care I've been reduced to giving, then it's time to get out'“ (Cullen, 1995, p.24).

5. Mandated Staffing Ratios • State mandated staffing ratios has been proposed as a solution to nursing shortage & retention problems. • Healthcare organizations would be mandated by law to staff nursing units on par with a minimum established by the state, in order to provide safe & quality patient care. • In 2002, the State of California pioneered state mandated staffing ratios.

6. Research Question Numerous research studies have been done & are currently in progress to determine the effects of mandated staffing on patient care outcomes. However, there are limited studies available that determine the effects of mandated staffing ratios on nurse job satisfaction and retention. My research idea is to conduct a Qualitative research study to determine the effect of mandated staffing on nursing job satisfaction and retention. I would conduct this study through comparative analysis of nursing job satisfaction scores & staff turn-over rates in hospitals that have mandated staffing ratios & those that do not. What effect does state mandated staffing ratios have on nurse job satisfaction and retention?

7. Research Study • Hospitals that would be selected for study participation would have to meet the following criteria: • Similar institutional size. • Similar healthcare services provided. • Service population. • Geographical location: Rural Vs. Urban. • Anonymous online job satisfaction surveys would be assigned to nursing staff. • Nursing staff turn-over rates would be tracked & compared. • Anonymous online exit interviews/surveys would be given to leaving nursing staff to determine reason for leaving. • Results of surveys would then be compared & analyzed to determine similarities & differences in job satisfaction & retention of both institutions.

8. Research Study Limitations & Variables • Organization & Staff Participation • Cost Effectiveness &available resources • Personal Bias • Tenure &educational level of nursing staff • Adequate time frame for study.

9. Implications for Nursing Practice • With the looming threat of a continued nursing shortage & more states considering mandated staffing ratios as a potential solution, it is important to conduct further research to determine its effect on job satisfaction & nurse retention. • Do mandated staffing ratios really work as a means to improve job satisfaction and nurse retention?

10. References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002, October). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction. Journal of American Medical Association, 1987-1993. Cullen, A. (1995, November). Burnout; Why Do We Blame Nurses? American Journal of Nursing, 95(11), 23-28. Erenstein, C. F., & McCaffery, R. (2007). How Healthcare Work Environments Influence Nurse Retention. Holistic Nurse Practice, 21(6), 303-307.