1. SAFE STAFFING AS IT RELATES TO PATIENT SATISFACTION AND SAFETY Are We There Yet? Vicki Tarnow American Sentinel University

2. Poses significant problems at the clinical level  Increases nurse dissatisfaction and burnout  Impacts mortality and morbidity  Impacts patient satisfaction  Increases workload on the nurse  Impacts healthcare costs and the budget  Safety Waters, A. (2012). It is time we took a firm stand in the battle for safe staff levels [serial online]. Nursing Standard, 26(50), 16-19. Retrieved fromhttp://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdfT=P&P=AN&K=2011666759&S=R&D =c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWXS&ContentCustomer=dGJyMPGnsUi 2rrBIuePfgeyx44Dt6fIAhttp://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdfT=P&P=AN&K=2011666759&S=R&D =c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWXS&ContentCustomer=dGJyMPGnsUi 2rrBIuePfgeyx44Dt6fIA UNSAFE STAFFING

3. PURPOSE To gain insight into unsafe staffing as it relates to:  Inadequate staffing  Nurse burnout  Employment dissatisfaction  Higher turnover rates  Patient safety  Decrease over-all patient satisfaction scores American Nurse Association. (2014). Nurse staffing. Retrieved June 27,2014, from http://www.nursingworld.org http://www.nursingworld.org

4. IMPACTS ON NURSING CARE AND PATIENT OUTCOMES How understaffing impacts nursing and patient outcomes  Higher incidence of falls  Increased infection rates  Medication Errors  Nurse burnout due to being overworked  Deaths Waters, A. (2012). It is time we took a firm stand in the battle for safe staff levels [serial online]. Nursing Standard, 26(50), 16-19. Retrieved from http://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdfT=P&P=AN&K=2011666 759&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWXS&C ontentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdfT=P&P=AN&K=2011666 759&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWXS&C ontentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA

5. SOLUTIONS Safe nurse-patient ratios save money  Nurses to drive staffing decisions  Mandating a separate budget for nursing  Legislators to pass minimal staffing guidelines law  Effective communication through accountability  Reducing errors through the synergy model  Taking a firm stand against unsafe staffing Goetz, K., Janney, M., & Ramsey, K. (2011). When nursing takes ownership of financial outcomes: Achieving exceptional financial performance through leadership, strategy, and execution [Journal]. Nursing Economic$, 29(4), 173-182. Retrieved from http://content.ebscohost.com/pdf25_26/pdf/2011/22R/01Jul11/64468966.pdf?T=P&P=AN&K=20112456 86&S=R&D=c8h&EbscoContent=dGJyMNHX8kSep7A4yOvqOLCmr0yep69Srq64S7WWxWXS&Cont entCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf25_26/pdf/2011/22R/01Jul11/64468966.pdf?T=P&P=AN&K=20112456 86&S=R&D=c8h&EbscoContent=dGJyMNHX8kSep7A4yOvqOLCmr0yep69Srq64S7WWxWXS&Cont entCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA

6. ACCOUNTABILITY MODEL The accountability model is  Powerful framework that holds others accountable  Helps to establish key expectations  Manages unmet expectations  Provides support and reinforcement  Promotes learning  Communication is vital part to upholding accountability Goetz, K., Janney, M., & Ramsey, K. (2011). When nursing takes ownership of financial outcomes: Achieving exceptional financial performance through leadership, strategy, and execution [Journal]. Nursing Economic$, 29(4), 173-182. Retrieved from http://content.ebscohost.com/pdf25_26/pdf/2011/22R/01Jul11/64468966.pdf?T=P&P=AN&K=201124568 6&S=R&D=c8h&EbscoContent=dGJyMNHX8kSep7A4yOvqOLCmr0yep69Srq64S7WWxWXS&Conten tCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf25_26/pdf/2011/22R/01Jul11/64468966.pdf?T=P&P=AN&K=201124568 6&S=R&D=c8h&EbscoContent=dGJyMNHX8kSep7A4yOvqOLCmr0yep69Srq64S7WWxWXS&Conten tCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA

7. SYNERGY MODEL Synergy model for patient care  Can apply to nursing practice by training  Nursing needs the knowledge and skills  Essential element of healing practice  System provides quality patient care  A form of income improvement  Provides optimal level of wellness Kohr, L. M., Hickey, P. A., & Q.Curley, M. A. (2012). Building a nursing productivity measure based on the synergy model: First step [Journal]. American Journal of Critical Care, 21(6), 420- 431. http://dx.doi.org/10.4037/ajcc2012859http://dx.doi.org/10.4037/ajcc2012859

8. BATTLE FOR SAFE STAFFING Professionals must take a stance  Improve the care offered  Reduce cost  Decrease length of stays  Improve staff retention  Decrease poor performance  Decrease nurse turnover Waters, A. (2012). It is time we took a firm stand in the battle for safe staff levels [serial online]. Nursing Standard, 26(50), 16-19. Retrieved from http://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdfT=P&P=AN&K=20116 66759&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWX S&ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdfT=P&P=AN&K=20116 66759&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWX S&ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA

9. HIERARCHY OF EVIDENCE The hierarchy of studies for obtaining evidence:  Systematic review of randomized controlled trials(RCT’s)  Ranking system used in evidence –based practice  Describes the strength of the results measured  Hierarchy is dependent on the problem researched  Methodological procedure  Base of the pyramid Polit, D. F., & Beck, C. T. (2012). Introduction to Nursing Research in an Evidence-Based Practice Environment. In Nursing Research generating and assessing evidence and nursing practice (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

10. HIERARCHY OF EVIDENCE Literature review:  Expert Opinion Level VII  Nonrandomized control trial Level III  Systematic review and correlation study Level III  Utilized both qualitative and quantitative methodology  Research question must be clearly defined  Hierarchy provides framework for ranking evidence  Researchers needs to consider the research question Polit, D. F., & Beck, C. T. (2012). Introduction to Nursing Research in an Evidence-Based Practice Environment. In Nursing Research generating and assessing evidence and nursing practice (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

11. WAYS TO IMPLEMENT IN AN ACUTE CARE SETTING Form a nurse staffing steering committee :  Survey  Develop tools based upon results  Obtain input from the front line staff  Committee members to help with the design  Mandate training for all staff  Formulate a minimal staffing guideline and policy Longenecker, C.O., & Longenecker,P.D. (2014). Why hospital improvement efforts fail: A view from the front line. [Journal] Journal of Healthcare Management, 59(2), 147-157 Retrieved from: http://content.ebscohost.com/pdf29_30/pdf/2014/37I/01Mar14/95274939.pdf?T=P&P=AN&K=2012526350&S=R &D=c8h&EbscoContent=dGJyMNHX8kSeprc4v%2BvlOLCmr0yep69Sr624TbOWxWXS&ContentCustomer=dG JyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf29_30/pdf/2014/37I/01Mar14/95274939.pdf?T=P&P=AN&K=2012526350&S=R &D=c8h&EbscoContent=dGJyMNHX8kSeprc4v%2BvlOLCmr0yep69Sr624TbOWxWXS&ContentCustomer=dG JyMPGnsUi2rrBIuePfgeyx44Dt6fIA

12. CONCLUSION  More research required  Convey the leading standards of care  Cost effective  Produces a positive conclusion  Way to confirm the assimilation of evidence  Scientific knowledge  Promotes quality of care and security Polit, D. F., & Beck, C. T. (2012). Introduction to Nursing Research in an Evidence-Based Practice Environment. In Nursing Research generating and assessing evidence and nursing practice (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

13. REFERENCES  American Nurse Association. (2014). Nurse staffing. Retrieved June 27,2014, from http://www.nursingworld.org http://www.nursingworld.org  Goetz, K., Janney, M., & Ramsey, K. (2011). When nursing takes ownership of financial outcomes: Achieving exceptional financial performance through leadership, strategy, and execution [Journal]. Nursing Economic$, 29(4), 173-182. Retrieved from http://content.ebscohost.com/pdf25_26/pdf/2011/22R/01Jul11/64468966.pdf?T=P&P=AN&K=2 011245686&S=R&D=c8h&EbscoContent=dGJyMNHX8kSep7A4yOvqOLCmr0yep69Srq64S7 WWxWXS&ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf25_26/pdf/2011/22R/01Jul11/64468966.pdf?T=P&P=AN&K=2 011245686&S=R&D=c8h&EbscoContent=dGJyMNHX8kSep7A4yOvqOLCmr0yep69Srq64S7 WWxWXS&ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA  Kohr, L. M., Hickey, P. A., & Q.Curley, M. A. (2012). Building a nursing productivity measure based on the synergy model: First step [Journal]. American Journal of Critical Care, 21(6), 420- 431. http://dx.doi.org/10.4037/ajcc2012859http://dx.doi.org/10.4037/ajcc2012859  Longenecker, C.O., & Longenecker,P.D. (2014). Why hospital improvement efforts fail: A view from the front line. [Journal] Journal of Healthcare Management, 59(2), 147-157 Retrieved from: http://content.ebscohost.com/pdf29_30/pdf/2014/37I/01Mar14/95274939.pdf?T=P&P=AN&K=2 012526350&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeprc4v%2BvlOLCmr0yep69Sr624T bOWxWXS&ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf29_30/pdf/2014/37I/01Mar14/95274939.pdf?T=P&P=AN&K=2 012526350&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeprc4v%2BvlOLCmr0yep69Sr624T bOWxWXS&ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA

14. REFERENCES  Polit, D. F., & Beck, C. T. (2012). Introduction to Nursing Research in an Evidence-Based Practice Environment. In Nursing Research generating and assessing evidence and nursing practice (9th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.  Waters, A. (2012). It is time we took a firm stand in the battle for safe staff levels [serial online]. Nursing Standard, 26(50), 16-19. Retrieved from http://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdf?T=P&P=AN&K=20116 66759&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWXS &ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/pdf27_28/pdf/2012/4ER/15Aug12/78945798.pdf?T=P&P=AN&K=20116 66759&S=R&D=c8h&EbscoContent=dGJyMNHX8kSeqLY4yOvsOLCmr0yep65SsK64SLKWxWXS &ContentCustomer=dGJyMPGnsUi2rrBIuePfgeyx44Dt6fIA  Wattenbarger, C. (2013). Improving patient satisfaction scores [Journal]. Healthcare Traveler, 20(7), 6. Retrieved from http://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=2011936177&S=R&D=c8h&EbscoC ontent=dGJyMMTo50SeprY4v%2BvlOLCmr0yeqK5SsK24TLaWxWXS&ContentCustomer=dGJyMP GnsUi2rrBIuePfgeyx44Dt6fIA http://content.ebscohost.com/ContentServer.asp?T=P&P=AN&K=2011936177&S=R&D=c8h&EbscoC ontent=dGJyMMTo50SeprY4v%2BvlOLCmr0yeqK5SsK24TLaWxWXS&ContentCustomer=dGJyMP GnsUi2rrBIuePfgeyx44Dt6fIA