In Phase 3 of the project, you are to complete your literature review by building on the content in your annotated bibliography. The literature review (8–10 pages) must include at least 15 current sources. The sources cannot be more than five years old unless they are considered seminal literature. Each citation is followed by a descriptive and evaluative paragraph (approximately 150 words).
Each source review should address the following questions, but be sure to provide a cohesive narrative paragraph and not just a collection of answers.
What is known about the subject?
Are there any gaps in the knowledge of the subject?
Have areas of further study been identified by other researchers that you may want to consider? What is the current status of research in this area?
Who are the significant research personalities in this area?
What aspects have generated significant debate on the topic?
What methods or problems were identified by others studying in the field and how might they impact your research?
What is the most productive methodology for your research based on the literature you have reviewed?
What sources of information or data were identified that might be useful?
For an overall idea please refer to my phase 1 paper attached below and phase 2 paper completed by you earlier. thank you
An Issue Relevant to Clinical Setting
Nursing is a vital component of care delivery and a major cost for hospitals which brings our attention to nurse staffing practices and costs. Hospitals have the challenge to accomplish maintaining a committed and stable nursing workforce, quality patient outcomes and bringing strong financial results in the triad that supports competitiveness (Frost & Sullivan, 2015). This paper describes how proper staffing adequately can meet patient workload leading to less adverse patient outcomes.
The Background and Context of the Issue
Patient safety is a crucial and vital element of quality nursing care. Still, the health care system is prone to errors, and can be damaging to safe patient care as a result of primary systems mistakes (Ballard, 2003). When a nursing unit is regularly short-staffed, nurses are forced to keep up a pace to guarantee patients receive appropriate care. Over time, this results in not only in burnt-out nurses but depressed or dissatisfied patients and also cause in increase in medical errors. Time and time again, research has proved that the understaffing of nurses results in higher rates of poor outcomes, including hospital-acquired infections (American Sentinel University, 2014).
Stakeholders
All Americans could be considered stakeholders since nearly all of us will be in the hospital at some point in our lives. The basic goal for safe staffing is to improve patient care and safety and keep nurses at the bedside. If shorter hospital stays, fewer complications, and more satisfied patients would bring hospitals to recruit and retain quality nursing staff, then it is unlikely that so many people would be advocating for nurse staffing legislation. Nurses must not wait for mandated ratios, but make their opinions and wishes acknowledged to the administrators who are making these important decisions (Stokowski, 2009).
Inherent Costs to Patients, Healthcare Organizations, Healthcare Providers, Etc.
According to Agency for Healthcare Research and Quality (AHRQ) and others, hospitals with fewer nurses tend to have higher rates of cardiac arrest, shock, urinary tract infections and pneumonia and an increase in the length of stay (Hickam et al., 2003; Needleman et al., 2001). When nurses have fewer patients to care for, patients are more likely to know how to manage their diabetes, watch for signs of infection or brain injury, walk with crutches, so they can stop further illness or know when to seek help. When nurses have fewer patients to care for, they are more likely to catch and prevent errors and avoid patients from getting hurt. And by providing more time to advocate for patients with physicians, insurance companies or others for the patient\’s care plan, patients are more likely to get well (The Truth About Nursing, 2016).
Nurse staffing represents 35-40% of hospital costs. In acute care facilities, nursing account 50% of total costs and provides 95% of its patient care (Nguven, 2006). Nurse managers are pressured to use lower-competency personnel to reduce costs and address nursing labor shortages. If a hospital is not able to assist with stable nurse workforce, not only are patient safety, outcomes, and satisfaction at risk but nurse satisfaction and retention deteriorate, resulting in overtime, agency staffs, and additional recruitment costs. US hospital normal nurse attrition is 14% with a 13-week impact on training replacement personnel and productivity to recruit (KMPG, 2011).
Nurse turnover is a repeated problem for health care organizations. One commonly cited study did report that organizations with low turnover rates ranging between 4% and 12%, had lower risk-adjusted mortality and less patient lengths of stay than did organizations with moderate 12% to 22% or high 22% to 44% turnover rates (VHA, 2002).
The Ethical and Legal Issues
The persistent nursing shortage is challenging the beliefs of the nursing profession and causing nurses to ask how they can satisfy their ethical responsibilities to patients when there is a maldistribution of nurses on the floor. The ethical issue nurses are facing are job dissatisfaction, emotional distress, harming patients and wind up not giving quality care to their patients. Nurses find this challenging and end up in a dilemma, where they must choose between caring for their wellbeing or the needs of their patients (Lowrie, n.d.).
Nurses can initiate Safe Harbor Rule (SHPR) in good faith on every occasion when asked to take part in assignments that might result in violations of Texas Board of Nursing rules. Safe Harbor is a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction (Texas Board of Nursing, 2013).
According to Lowrie (n.d.) regarding legal issues, the community is alert to the problem of understaffing and view it as a significant matter in health care centers. Family members may use it to trigger lawsuits even in the absence of other systematic problems. Issues relating to these lawsuits touch on poor nursing care leading to injuries, bedsores, and even death. In most cases, the jury grants large settlements to the victims’ families, making it a high concern for the health care providers.
By encouraging hospital administrators to use higher ratios of RNs to non-licensed employees, they can achieve their purpose of quality patient outcomes and cost containment. Why delay this process?
