Expert answer:Nursing Research Methodology
Solved by verified expert:write a 1-page paper addressing the sections below of the research proposal.MethodologyData Analysis PlansDescribe plan for data analysis for demographic variables (descriptive statistical tests).Describe plan for data analysis of study variables (descriptive and inferential statistical tests).Here is my data analysis and plans.Parametric and non-parametric tests according to changingminds.org (2016) are two types of ways to test research. Parametric has a standard dissemination that provides more inferences and the design can be statistically defined also known as bell shaped, while those that do not fit the normal bell curve would be classified as non-parametric (changingminds.org, 2016). Changingminds.org (2016) notes that parametric testing tests data that is ratio or interval and measures the mean to draw more deductions while parametric uses ordinal or nominals and measures the median allowing for uncomplicatedness therefore are least affected by variables.Types of parametric tests for correlation is a Pearson test. For independent measures of two groups there is a t-test or for more than two groups the ANOVA measurement. While non-parametric tests for correlation is Spearman testing. For groups of two there is the Mann-Whitney test or the Kruskal-Wallis test for two or more groups (Changingminds.org, 2016). According to Real-Statistics.com (2016) four assumptions are needed. There needs to be a normal or symmetric distribution, the information collected must have the same differences, statistics have a linear correlation, and the figures are independent.My project is does increasing nursing staff on the floor decrease patient’s LOS related to unnecessary errors. The research hypothesis is that nurses who have an increase in patient load also have an increase in patient errors including medications and safety. The data analysis plan for my project is Pearson for correlation and one-sample median test. My null hypothesis is that there were no patient incidents. By ensuring that my sample size is close to 100, by use of the Central Limit Theorem, I will be able to guarantee the normal distribution of my dependent variable.ReferencesChangingminds.org. (2016). Retrieved from http://changingminds.org/explanations/research/analysis/parametric_non-parametric.htm.Real-statistics.com. (2016). Retrieved from http://www.real-statistics.com/descriptive-statistics/assumptions-statistical-test/.Below you will find what I have to this point as far as paper and references. Thank you.
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With the climate today in healthcare, hospitals must seek other ways to cut costs. Staffing
tends to be the first area of cuts to budgets. However; it has been found that patient safety errors
tend to increase when staff is decreased (Frederickson, 2013). Some states have taken it upon
themselves to set up maximum patient to staff ratios. These states have seen lower incidents and
higher staff satisfaction (Tellez & Ann Seago, 2013).
PROBLEM: Increasing patient to staff ratios also increases safety risks to patients.
RESEARCH PURPOSE: To determine if there is correlation between increased patient to staff
ratios and increase in medication errors, treatment errors, falls, cardiac arrests, and deaths.
PIOCT Questions: (P) Do nurses who have higher patient loads (I) make more errors and (O)
potentially have worse patient outcomes (C) than nurses who have smaller patient loads (T) over
the course of 6 months to 1 year.
References
Frederickson, W. (2013). Nurses Are Exposing the Reality: Patients Are At Risk. Minnesota
Nursing Accent, 5-7.
Tellez, M., & Ann Seago, J. (2013). California Nurse Staffing Law and RN Workforce Changes.
Nursing Economic$, 18-26.
Bibliography for Qualitative
Cox Patrick, W. W. (2014). The American Epidemic: The U.S. Nursing Shortage and Turnover Problem.
Marshall Digital Scholar.
Kundson, L. (2013). Nurse staffing levels linked to patient outcomes, nurse retention. AORN Connections.
Mills Jane, C.-S. J. (2016). Retaining early career registered nurses: a case study. Bio Medical Central, 1-6.
Susan Bradley, F. K. (2015). Too few staff, too many patients: a qualitative study of the impact on
obstetric care providers and on quality of care in Malawi. BMC Pregnancy Childbirth. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377843/
References for Quanitative
Fitzsimons, S. M. (2013). Knowing Generation Y: a new generation of nurses in practice. British Journal of
Nursing, 1173-1179.
Frederickson, W. (2013). Nurses Are Exposing the Reality: Patients Are At Risk. Minnesota Nursing
Accent, 5-7.
Rep. Schakowsky, J. D.-I.-9. (2017, May 5). H.R.2392 – Nurse Staffing Standards for Hospital Patient
Safety and Quality Care Act of 2017. Retrieved from Congress.gov:
https://www.congress.gov/bill/115th-congress/house-bill/2392
Tellez, M., & Ann Seago, J. (2013). California Nurse Staffing Law and RN Workforce Changes. Nursing
Economic$, 18-26.
Theories explaining the impact of nursing work and staffing in care organizations are
limited. Additional theories are required to assist the management in making effective decisions
concerning nurse staffing in the organizations. Despite the limited number of theories that
explain the concept of nurse staffing, the few that are available staffing leads to the establishment
of the global duties placed on nurses within care organizations (Duffy, 2013). Nurses are
essential within the care organizations as they help increase the quality of care offered to the
patients.
The nursing services delivery theory, for instance, acts as a guide in research to help the
management identify the nursing services within care facilities. The theory allows organizations
to determine aspects in care organizations such as nurse staffing and nursing work and their work
environment. Further, the theory tries to identify the connection between the work of nurses,
their environment, and staffing with the global responsibilities placed on nurses in care
organizations (Meyer and O’Brien‐Pallas, 2010). Thus, the theory claims that staffing contributes
to the work and responsibility given to nurses and their coordination at work.
This theory can be applied to the current study on staffing of nurses within care
organizations. For instance, the management within care facilities can rely on this theory during
research to establish how the aspects such as nursing work, staffing, and work environment
influence the duties of the nurses. Also, the theory can allow leaders within care facilities to
establish how staffing can be utilized to increase the quality of care provided to the patients.
Also, the theory can be integrated into the current study to establish how nursing work influences
the outcome of care services provided to clients in the medical organizations.
References
Duffy, J. R., & Duffy, J. R. (2013). Quality caring in nursing and health systems:
Implications for clinicians, educators, and leaders. New York, NY: Springer Pub.
Meyer, R. M., & O’Brien‐Pallas, L. L. (2010). Nursing services delivery theory: an open system
approach. Journal of Advanced Nursing, 66(12), 2828-2838.
Literature Review
Introduction
This section will provide a review of the literature on the different studies done on
staffing and the effect on retention and patient care. Patients were more concerned about the cost
of healthcare services as opposed to quality. However, most of the studies done after the
enactment of the Affordable Care Act emphasizes on quality at a minimal cost. These trends
indicate a shift to patient-centered care that incorporates the needs of the patient.
Literature Review
According to a study done by Aiken et al. (2012), the inadequate nursing levels in
American hospitals have made it difficult for nurses to provide safe and effective care. The
shortage in nursing leads to workload which increases nursing burnout. There is an increased
level of job dissatisfaction among the nursing profession as compared to other professionals. The
nurse-patient ratio in most of the hospitals causes burnouts which influences the retention rate.
These trends have led to healthcare institutions losing their skilled and experienced workforce
hence affecting the quality of healthcare services. Mortality rate and ability to save patients
depends on the nurse-patient ratio. In a healthcare institution where there is a nursing shortage,
the rescue of patients admitted for inpatient acute care within the first days of admission is
limited.
Nurses have a responsibility of monitoring patient condition, early detection, and prompt
intervention to save the lives of their patients. However, to achieve all these functions nurses
need to have the required skills and a reduced nurse-patient ratio to meet the needs of the patients
and facilitate the recovery process. The discussed four variables; nurse staffing, patient mortality,
nurse burnout, and patient mortality. The study used a cross-sectional survey to analyze data of
10184 registered nurses and 232342 patients discharged from the hospital between the year 1998
and 1999 in Pennsylvania. It was evident from the study that hospitals with high-patient ratio
have an increased mortality rate and inability rescue patients. Also, nurses work for longer hours,
hence increasing burnout which causes an increase in job dissatisfaction.
Aiken et al. (2012) sought to investigate the effects that nursing staffing has on three
variables; job dissatisfaction, nurse burnout, and quality of patient care services. The study used
a cross-sectional survey to analyze 10319 nurses working under the surgical unit in 303
hospitals. The study analyzed nursing staffing in terms of the shifts of the nurses and number of
patients under their care. According to the study, nursing practice is dependent on the working
environment which is influenced by the organizational support of the nursing practice.
Organization management influences the decision-making process and attributes that impact on
the practice of nursing. For example, an organization that supports the nursing practice will
implement strategies aimed at improving the nursing working environment.
The study used a four-point scale to determine the satisfaction of the nurses. The scale
ranged from highly dissatisfied to highly satisfied nurses. Furthermore, the Maslach Burnout
Inventory (MBI) was used in the study to measure the burnout level. It was evident that majority
of the nurses indicated scores between 0 and 54. For nursing practitioner score above 27 are
considered as high from the scale. In analyzing the quality of patient care was analyzed using a
four-point scale from poor to excellent. Majority of the nurses indicated the fair or poor quality
of patient care services. However, nursing burnouts scores differed according to the jurisdiction.
Pennsylvania indicated the highest scores of 54% compared to Scotland with 34%. In all the
jurisdictions, it is evident that nursing shortage and quality of services affects the nursing
practice hence increasing the dissatisfaction of nurses.
It is the responsibility of the nurses to identify critical issues and the use of the evidencebased practices in the treatment of patients (Barton, 2013). The quality of services according to
the article is dependent on the best research and the ability of the nurses to deliver these services
in an effective manner. All the stakeholders such as policy makers, patients and family members,
and nurses have a role to play in promoting quality of patient care. Developing a positive
relationship and collaboration of all the stakeholders is an essential factor in improving the
quality of patient care services. This process may lead to decreased fatigue and stress among the
nursing profession hence improving the job satisfaction which increases the retention rate of
nurses.
The quality of patient care services and improvement of the working environment is
dependent on the culture of the health institutions. If the management supports the nursing
practice, they will put in place strategies to improve the working conditions of nurses. A better
working environment will motivate nurses hence increasing the skills and experience. Quality of
patient care is achieved when nurses are fully motivated. There are technological changes in the
field of medicine. Therefore, continuous training is essential in improving quality of services in
nursing practice. It enables the registered nurses to keep abreast with the changing needs and the
application of current technology to enhance the quality of services.
McHugh & Ma (2014) conducted a study to determine how compensation, working
environment, and staffing levels on the outcome of nurses. The study analyzed nurses from
different healthcare institutions to determine how the different variables impact on the outcome
in nursing practice. The study found out that health institutions with adequate staff and improved
working environment had best nursing outcomes. Nursing in such environment indicated reduced
burnout, increased job satisfaction, and increased ability to continue working for the institution
over a long period of time. The study employed a cross-sectional survey to investigate how the
variables impact on the nursing outcome.
According to the findings of the study, it was evident that compensation plan adopted by
the hospital has an influence job satisfaction and retention rate. For example, nurses working in
health institutions with competitive wages and benefits indicated a high level of satisfaction and
ability to continue working for the hospital in future as compared to the hospital with fewer
benefits and wages. However, wages did not have an effect on the burnout rate. Therefore, wages
have an influence on nurses’ outcome but do not impact on the working environment and
staffing outcomes. The working environment and reduced nurse-patient ratio have an effect on
the nurse outcomes.
Koy et al. (2017) provided empirical evidence on the relationship between nursing care
quality, nurse satisfaction, and burnout in the turbulent environment. The current industry of
health demands that hospitals should be a learning institution in order to keep up with the trends
and technological changes. The nursing practice in the current environment is seen as multidimensional and multi-facet. Therefore, the complexity in the nursing practice has led to the
evolvement in the nursing practice to improve the quality of patient care. Quality of care has also
become complex due to globalization.
Quality patient care demands provision of patient-centered care to patients and family
members. It also requires meeting the needs of the patient in an effective manner. Therefore,
nursing professionals have to deal with the complex cultural practices in the field of nursing. To
achieve this goal, staffing is an essential tool. It was evident from the study that there is a
relationship between nursing staffing, satisfaction, working environment, burnout, and retention
rate. Working environment enhances job satisfaction and reduces nursing burnout while
increasing the ability of nurses to work for the health institution over a long period of time. The
management has a role to play in influencing working conditions through policies that are
essential to improve the motivation of the workforce and increase retention rate.
Conclusion
Kane et al. (2012) in their study found that even though there are different tools used in
the measurement of the quality of patient care, nurse satisfaction, burnout, and retention rate; the
complexity in measuring the quality of patient care is still a challenge to the researchers. It is
hard to quantify the quality of healthcare services to determine the impact that the three
variables; nursing satisfaction, burnout, and retention rate. There are also other factors that affect
the nursing satisfaction which is not covered in the literature review. It is evident from the
literature review that working environment and burnout impacts on nursing practices and quality
of services. However, compensation and benefits increase the motivational level and retention
rate but have no impact on burnout and working condition.
References
Aiken, L. H., Clarke, S. P., Sloane, D. M., & International Hospital Outcomes Research
Consortium. (2012). Hospital staffing, organization, and quality of care: cross-national
findings. International Journal for quality in Health care, 14(1), 5-14.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2012). Hospital nurse
staffing and patient mortality, nurse burnout, and job dissatisfaction. Jamal, 288(16),
1987-1993.
Barton, A. (2013). Patient safety and quality: an evidence-based handbook for nurses. Aorn
Journal, 90(4), 601-602.
Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2012). Nurse staffing and
quality of patient care. Evidence Rep Technology Assess (Full Rep), 151, 1-115.
Koy, V., Yunibhand, J., Angsuroch, Y., & Fisher, M. L. (2017). Relationship between nursing
care quality, nurse staffing, nurse job satisfaction, nurse practice environment, and
burnout: literature review. International Journal of Research in Medical Sciences, 3(8),
1825-1831.
McHugh, M. D., & Ma, C. (2014). Wage, work environment, and staffing: effects on nurse
outcomes. Policy, Politics, & Nursing Practice, 15(3-4), 72-80.
W3-2
Staffing and the Effect on Retention and Patient Care
Background of the Study
Staffing is a critical area not only in retention of nursing practitioners but also the
provision of quality patient care services in the health sector. The enactment of the Affordable
Care Act led to changes in health care practices that require nurses to provide quality care
services that incorporate the needs of the patients. Different factors impact on the outcome of
nurses in their efforts to provide quality care services. Staffing is an essential factor in facilitating
provision of patient-centered care in the field of nursing. Inadequate staffing and nursing burnout
are the two moral ethical dilemma issues that are facing nursing in the healthcare sectors.
Therefore, this factors impact on the job satisfaction of nurses hence affecting the motivational
level and retention of nurses. In many cases, health institutions adopt voluntary or mandatory
overtime practices a factor that leads to nursing burnout and reduced quality of healthcare
services. Maintaining optimal staff levels of a registered nurse can lead to improved patient care
and retention of the nursing staff hence improving the quality of services (Knudson, 2013).
Statement of the Problem
Nursing staffing is a sought-out topic both in the academic field and by industry
practitioners. The introduction of ACA led to the demand of quality patient care services in the
healthcare industry. To meet the industry demands, healthcare institutions have to put in place
strategies for retaining their nurses and reducing the nurse-patient ratio. The nurses have to use
the available resources including personnel to provide the required patient care services. The
standards of practice for nursing practitioners requires that nurses provide all the relevant
material data during the diagnosis process that will aid the patient in making informed consent
on the treatment plan to adopt (Kane et al., 2007). Also, the patients have a civil right to receive
quality services. The changes in technology also have impacted on the patient care. Therefore,
there is a gap for studying the staffing and the effect on retention and patient care services.
Significance of the Study
The study will not only contribute to the theory building on the concept of nursing
staffing but also used as a theoretical reference by both the state and federal governments when
making laws in the healthcare sector. The study is also significant in that it will contribute to the
existing literature and establish gaps for further studies for academicians. The findings in the
study help in decision-making in both the private and public sector on the standards of practice
essential in promoting the quality of healthcare services and promotion of patient-centered care.
Also, healthcare institutions may use the findings from the study to put in place strategies on
how to retain their workforce in order to reduce nursing burnout.
Purpose of the Study
The overall purpose of the study is to determine the staffing and the effect on retention
and patient care. The study aims at determining the relationship between patient safety initiative
and the nursing staffing. Also, the study aims at analyzing the nursing workload and its impact
on the job satisfaction of nurses. Lastly, the study will discuss the strategies for improvement to
ensure retention of nurses and improvement of quality services.
Research Questions, Hypothesis, and Variables with Operational Definitions
The general research question is; what is the effect of staffing on the retention and patient
care? The specific questions of the study include:
1.
What are the challenges of nurse staffing?
2.
What is the effect of nursing burnout on the satisfaction level of nurses?
3.
What are the challenges facing healthcare institutions in achieving the desired staff levels?
The null and alternative hypothesis of the study:
H1: Staffing has an effect on the retention and patient care.
H0: Staffing has no effect on the retention and patient care.
Study Variables
The independent variable of the study is staffing whereas the dependent variables are
retention and patient care. The staffing level in nursing practice has been a point of concern for
many decades in the healthcare sector. Staffing is operationally defined as the number of skilled
registered nurses in a healthcare institution that have the ability to provide quality patient care
services to the patient. It refers to the employees in the healthcare that facilitate the provision of
quality services. Quality services require an optimal nursing level and mix. Staffing is not only
about the numbers of nurses but the mix of the required skills. Adequate nursing is appropriate in
the reduction of the nursing burnout to improve motivation level and quality of services (Stanton
& Stanton, 2004).
Retention refers to the ability of healthcare organizations to be able to motivate the nurses
in order to make them continue working for the organization over a long period of time.
Different factors such as working environme …
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