NSG 6101 Research Proposal Week 10 final Paper STUDY GUIDE.

NSG 6101 Research Proposal Week 10 final Paper STUDY GUIDE. Research Project Proposal The emergency department (ED) is the front line to most hospitals, it is important that when patients come to the ED they are receiving the most safe and efficient care. Due to the high volumes of patients in the ED and unknown patient acuity at a given time, the ED needs to be staffed with enough nurses to handle the patient load safely. As an administrator it is important to ensure that units such as ED have sufficient staff to carry out nursing procedures in a safe and effective manner. The purpose of this research study is to determine if adequate staffing of registered nurses in emergency department results in a decrease of the emergency being crowded when compared to when the department is inadequately staffed and decrease in overcrowded population, Background and Significance of the Problem Registered nurses in acute care settings have a variable nursing workload, which is defined as the direct supervision of patients. Nurses working in the ED are subject to a higher nursing workload and staffing shortages, which are factors that can affect patient safety. (Kallberg, Ehrenberg, Florin, Ostegren, & Goransson, 2017) In the ED there are variables that determine a nurse’s workload which include: number of bed per nurse, number of patients per nurse, and patient severity. (Kang, Kim, & Lee 2016). The ED is an ever-changing unique environment with a wide variety of patients and patient acuity levels making it hard to determine the right amount of nursing staff to safely care for patients. Staffing has been proven in previous research to be a direct factor in nurses’ workload. Safe staffing is more than just the number of nurses on a shift but also the skill 2 NSG 6101 Research Proposal WK 10 final paper STUDY GUIDE and experience mix of the nurses working. (Wolf, Perhats, Delao, Clark, & Moon 2017). A high nursing workload can affect patient safety and lead to an increase in medical 3 NSG 6101 Research Proposal WK 10 final paper STUDY GUIDE errors. Medical errors are the third leading cause of death in the United States. As care providers it is our job to provide safe and efficient care to our patients. In order for nurses to provide this care the workload of nurses needs to be manageable and staffing adequate to care for the patient volume. Scott, Considine, & Botti (2014) states that a “high numbers of patients requiring emergency care increases the risk of errors as multiple patients require treatment concurrently.” Statement of the Problem and Purpose of the Study Studies and evidence have linked a shortage in nurse staffing to higher hospital mortality rates. (Griffiths et al, 2016). Research has been conducted on units in the acute care setting regarding nurses’ workload and how it affects patient safety. Studies have shown an increase in RN staffing was associated with lower mortality rates in surgical and medical patients. (Griffiths et al, 2016). While research has been conducted on other units in acute care setting it is limited in regard to how staffing and nurses’ workload affects patient safety in the ED. By increasing ED staff and lowering the nurse to patient ratio, nurses can spend more time with their patients and focus on care provided. If nurses are not overwhelmed by their workload this can lead to a decrease in medical errors made by the nurse. The purpose of this research study is to determine if an increase in ED staff will decrease overcrowded population and improves the safety of patients in the ED. Literature Review 4 NSG 6101 Research Proposal WK 10 final paper STUDY GUIDE The articles presented in this review are both quantitative and qualitative studies. The articles are divided into two groups, one in which the articles are research regarding nurses’ perceptions of staffing and patient safety, and the other are studies that examine the effects of nurse staffing on work environments and patient safety. The amount of workload nurses experience is determined by several factors. Kang, Kim & Lee (2016) report that the number of beds per nurse, nurse to patient ratio, patient acuity are factors in determining nurse workload. However, in the study conducted by Wolf et al. (2017) participants reported that staffing levels are only determined by the number of bed and patients not the acuity of the patients. The acuity of patients in the ED varies at any given time but should be considered in a nurses’ workload. Wolf et al. (2017) also notes that when staffing nurses, the number of nurses on a given shift is important but also need to consider the skill mix and experience of the nurses as well. In the study conducted by Kallberg, Ehrenberg, Florin, Ostergren, & Gotansson (2017) nurses and physicians report that too many inexperienced staff in a shift is a factor in patient safety especially in acute situations of the ED. Insufficient staffing and resources were related to RNs reporting their perceptions of poor patient safety. A cross sectional and observational study was conducted to determine the effects of nurse staffing on patient safety and patient mortality. In the study conducted by Cho et al (2015) nurses were confirmed to have a high nurse to patient ratio and that was associated with higher patient mortality rates. Cho et al (2015) states that “each additional patient per nurse is associated with a 5% increase in the odds of patient death” (p. 535). Another study by Cho et al (2016) showed a common trend that the nurse staffing is associated with nurses’ perception of patient safety. Units that are not sufficiently staffed 5 NSG 6101 Research Proposal WK 10 final paper STUDY GUIDE results in tasks being done in a rushed manner or incomplete. Nursing care that was left incomplete or undone showed that nursing staff level is an important predictor of nursing workload. Research from both studies show that hospitals with lower nurse staffing, which generates higher nurse to patient ratios and therefore higher workload, have a greater tendency to report more medical errors ultimately affecting patient safety. Research Questions, Hypothesis, and Variables.