NURS 350 EBNP Group Project http://able2know.org/topic/99389-1 Presented by: Christina Bookheimer Michelle Rowe Sandra Saylor Meagan Smoyer Jackie Tiefenthal

PICO Our purpose was to identify and determine patient satisfaction levels related to staffing in a medical-surgical setting P - medical surgical patients I - low nurse to patient ratio C - high nurse to patient ratio O - patient satisfaction In medical surgical patients, what is the effect of high nurse- to-patient ratios on patient satisfaction compared with low nurse-to-patient ratios? http://www.citytowninfo.com/employment/registered-nurses

Why this matters to nursing Nurses are advocates for their patients and as such need to listen and provide for them. High nurse-to-patient ratios can result in less attention given to patients due to tasks that need to be completed. Appropriate nurse-to-patient ratios result in higher patient satisfaction and higher quality patient care http://www.monroetwp.k12.nj.us/Whitehall/NursesCorner/

article one Highlights from Article Patients' perception of hospital care in the United States Highlights from Article A representation of patients’ experiences in U.S. hospitals can be seen in the data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (Jha, Orav, Zheng & Epstein, 2008). Patients’ experiences were used to assess the performance of hospitals and if key characteristics of the hospitals enhanced patient experiences (Jha, Orav, Zheng & Epstein, 2008). This article examines whether key characteristics of hospitals enhance patient experiences through HCAHPS data from July 2006 through June 2007 (Jha, Orav, Zheng & Epstein, 2008). “The ratio of nurses to patient-days was a predictor of performance on the HCAHPS survey” (Jha, Orav, Zheng & Epstein, 2008).

article one Patients' perception of hospital care in the United States Recommendations & Findings The results “found a moderate relationship between the ratio of nurses to patient-days and patients’ experiences in the hospital” (Jha, Orav, Zheng & Epstein, 2008). The authors felt that the need for reporting by hospitals on performance related to quality indicators may improve the care given to patients (Jha, Orav, Zheng & Epstein, 2008). In respect to interpersonal aspects of care, the study reveals that higher ratio of nurses to patient-days may be associated with better performance (Jha, Orav, Zheng & Epstein, 2008) “Hospitals with a high level of patient satisfaction provided clinical care that was somewhat higher in quality for all conditions examined” (Jha, Orav, Zheng & Epstein, 2008). EBNP Recommendations & Impact on Nursing Practice The authors do not directly relate findings to a specific intervention that could be included but more to the level of staffing.

Article two Highlights from Article Nursing: a key to patient satisfaction Highlights from Article 430 hospitals were examined to determine the relationship between nursing and patient satisfaction across (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009). Cross-sectional data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a four-state nurse survey of hospital quality, and the American Hospital Association (AHA) Annual Survey were used to evaluate the relationship between the nurse work environment and patient satisfaction (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009). To improve the patient experience and quality of care, work environments, including staffing should be addressed. Higher job satisfaction is linked with better nurse work environment and lower burnout rate. (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009)

Article two Nursing: a key to patient satisfaction Recommendations & Findings This article states, “findings demonstrate that patients’ reports of satisfaction are higher in hospitals where nurses practice in better work environments or with more favorable patient- to-nurse ratios (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009). A cross-sectional design was used which revealed study limitations because it “did not inform causation” (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009). “Patient-to-nurse workloads were significantly associated with patients’ ratings and recommendation of the hospital to others, and with their satisfaction with the receipt of discharge information” (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009). EBNP Recommendations & Impact on Nursing Practice This article concludes that it is necessary to “reform nurse work environments, and offer a promising strategy for improving hospital performance” (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009). “The effect of nurse staffing could be stronger when all hospitals report HCAHPS results. Thus, additional research on the impact of nursing on patient satisfaction is warranted when more hospitals are reporting HCAHPS results” (Kutney-Lee, McHugh, Sloane, Cimiotti, Flynn, Neff & Aiken, 2009).

Article three Highlights Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue Highlights There are many cross-sectional studies that support the relationship between staffing and patient outcomes, however this study uses a longitudinal design (Seago, Williamson & Atwood, 2006). This longitudinal design “examines the variation in the relationship between the staffing and the outcomes of interest over time within a given unit, and to compare that variance across units” (Seago, Williamson & Atwood, 2006). There were two main objectives in this study #1 “Compare the relationships between nurse staffing and positive patient outcomes for 3 medical-surgical nursing units in one university teaching hospital across 4 years” (Seago, Williamson & Atwood, 2006). #2 “Explore the use of 2 new failure-to-rescue (FTR) rates as outcomes, specifically from medication errors and FTR from decubitus ulcers” (Seago, Williamson & Atwood, 2006).

Article three Recommendations & Findings Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue Recommendations & Findings This study concludes that, “all patient satisfaction measures increased as total hours of care per patient day increased” (Seago, Williamson & Atwood, 2006). The study also concluded that it is necessary to have a “rich RN skill mix and also a need for higher total hours of care, if patient satisfaction is a priority” (Seago, Williamson & Atwood, 2006). The findings of this longitudinal analysis support the cross-sectional studies in that higher patient satisfaction comes as total hours of care per patient day increase (Seago, Williamson & Atwood, 2006). EBNP Recommendations & Impact on Nursing Practice The authors recommend to “vary staffing hours and staff mix” as a direct nursing intervention depending on which patient outcome one wishes to achieve (Seago, Williamson & Atwood, 2006).

Article four Nurse burnout and patient satisfaction Highlights from Article Objective of this study was to examine “the effect of the nurse work environment on nurse burnout, and the effects of the nurse work environment and nurse burnout on patients’ satisfaction with their nursing care” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). Cross-sectional surveys of nurses were conducted from 40 units in 20 urban hospitals in the United States (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). The authors wanted to begin the exploration of the link between patient dissatisfaction in care and nurse burnout while studying nurse burnout and patient satisfaction (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). RN work environment was measured using a revised Nursing Work Index (NWI-R) subscales (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). RN outcomes were “measured by the Maslach Burnout Inventory (MBI) and intentions to leave” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). The La Monica-Oberst Patient Satisfaction Scale (LOPSS) was used to interview patients about satisfaction (Vahey, Aiken, Sloane, Clarke & Vargas, 2004).

Article four Recommendations & Findings Nurse burnout and patient satisfaction Recommendations & Findings This study proved that, “patients cared for on units that nurses characterized as having adequate staff…were more than twice likely as other patients to report high satisfaction with their care” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). “Nurse burnout…is a significant factor influencing how satisfied patients are with their care” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). EBNP Recommendations & Impact on Nursing Practice The authors state the “need for change in the workplace that would both reduce nurses’ high level of job burnout and risk of turnover while maintaining patients’ satisfaction with their care” (Vahey, Aiken, Sloane, Clarke & Vargas, 2004). Nurses would be able to provide quality care and meet the satisfaction of their patients.

Article five Highlights from Article Nurse staffing and patient perceptions of nursing care Highlights from Article Objective of this study was to reveal the relationship between nurse staffing and patient perceptions of nursing care from a sample of 40 California hospitals (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003). Descriptive and inferential statistics were the analytic methods used (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003). Hospitals with Patients’ Evaluation of Performance in California (PEP-C) and California Nursing Outcomes Coalition (CalNOC) data available for the same time period were used to “explore the relationship among nurse staffing structural variables and patient perceptions of nursing care” (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003). “The 40-hospital analyses presented in this report summarize survey data from 6,200 medical/surgical patients” (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003).

Article five Recommendations & Findings Nurse staffing and patient perceptions of nursing care Recommendations & Findings The results in patient perceptions of nursing care were similar in hospitals with wide ranges of staffing levels (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003). This study found that “nurse staffing alone showed a significant but weak relationship to patients perceptions of their care” (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003). The authors felt that nurse staffing is not the only variable in relationship to how patients perceive their care (Bolton, Aydin, Donaldson, Brown, Nelson & Harms, 2003). EBNP Recommendations & Impact on Nursing Practice In terms of management level, the article states, "it is essential that nurse executives integrate results from this and other studies in developing strategic and tactical staffing plans” (Bolton, Aydin, Donaldson, Brown, Nelson & Harris, 2003).

summary Review of the literature did not support any specific changes in nursing practice. Literature did support nursing practice to advocate for improved nurse-to-patient staffing ratios. No true suggestions were made as to how nurses can effectively increase a patients’ satisfaction with overall care. Studies reviewed were qualitative verses quantitative and results were self-reported experiences of patients. Clinical trials that use specific variables and interventions would help to identify changes in nursing practice. Literature did support the intervention of nursing management and the ability to create staffing changes.

References Jha, A., Orav, E., Zheng, J., & Epstein, A. (2008). Patients' perception of hospital care in the United States. New England Journal Of Medicine, 359(18), 1921-1931. Kutney-Lee, A., McHugh, M., Sloane, D., Cimiotti, J., Flynn, L., Neff, D., & Aiken, L. (2009). Nursing: a key to patient satisfaction. Health Affairs, 28(4), w669-77. doi:10.1377/hlthaff.28.4.w669 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.Nurse Staffing and Patient Perceptions of Nursing Care, Journal of Nursing Administration 2003 Nov; 33(11): 607-14 Vahey, D., Aiken, L., Sloane, D., Clarke, S., & Vargas, D. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2), II-57-66. doi: 10.1097/01.mir.0000109126.50398.5a Bolton, L., Aydin, C., Donaldson, N., Brown, D., Nelson, M., & Harms, D. (2003). Nurse staffing and patient perceptions of nursing care. Journal Of Nursing Administration, 33(11), 607-614.