The Impact of Shortage of Nurses on Quality of Care among CCU patients

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Introduction

The current nursing shortage is an alarming situation in most of the hospitals. Registered nurses are the most affected, as many of them have reached the retirement age and left the profession. Delivery of quality care in the clinical area is greatly affected by the number of nurses, in relation to the population of patients (Stechmiller, 2002). The situation is worse in the critical care settings due to understaffing. According to Stechmiller (2002), the shortage of critical care nurses results from a shortage of skilled nurses who may attend the patients in the critical care setting, as well as, the other areas of clinical practice. The shortage leads to compromised delivery of care in the Critical Care Unit. Also, there are not enough nurses to conduct research, which can be used to improve patient outcomes. According to Petterson (2010), many of the nurses in the clinical setting are under-educated; as they have been requested to provide their services, as a measure of addressing the shortage. Since the critical care set-up requires specialized professionals, it remains the most hit department in the provision of quality nursing care. As a result of the shortage, Petterson (2010) asserts that, nurses in the critical care unit are overworked, fatigued and work for long hours. This leads to undesirable patient outcomes in the critical care settings. Addressin,g this area of clinical practice will lead to an improvement in the quality of critical care, and eventually patient outcomes.

Research Problem and Purpose Statement

Nurse-patient ratios are a critical part of nursing practice. This is extremely important in areas that are very demanding, in regard to nursing care, like the critical care unit. The number of nurses in a hospital unit, in relation to patient population, affects the quality of care provided to the patients. According to Stechmiller (2002), the nurse-patient ratio directly affects the quality of care that is provided in the CCU. In addition, the delivery of care in the CCU has been compromised as a result of the shortage of skilled staff, which is affecting the whole world. Critically ill patients, who make the highest population of the patients in ICU, require total nursing care. If this care is not provided, the results will not be desirable (Stechmiller, 2002). Ewart et al. (2004) agree that the shortage of qualified nurses in the US is posing a great challenge to the availability of quality care for the critically ill patients. According to Ewart et al. (2007) critical care delivered by nurses who are trained in critical care delivery has been effective in realizing patient outcomes than care delivered by unskilled nurses. Addressing this issue is a matter of utmost importance in clinical practice. The stakeholders need appreciate the effects that shortage of skilled nurses has on the delivery of patient care. This can be accomplished through research. In lieu of this, the current study aims at looking at the effects of the shortage of nurses on the delivery of critical care services, at the critical care setting.

Research Questions

What is are the effects of shortage of nurses on the quality of care among CCU patients

What is the impact of improved quality of care?

Does shortage of nurses affect quality of care?

In what ways does the shortage of nurses affect quality of care?

What are the outcomes of improved quality of care?

While analyzing the feasibility of the five questions, the elements of a satisfactory research question were considered. The aim was to identify the question that could be empirically tested. Questions 2, 3, 4 and 5 were found not to be empirically testable, because they lacked some variables that would be necessary for the study. For example, question 2 does not indicate to whom the impact of improved quality of care applies. This also applies to questions 3, 4 and 5. They do not identify the population under study. However, question 1 indicates the problem under study, the variables under study, and the expected outcomes. Looking at the questions through the PICO perspective, question 1 meets the criteria.

Preliminary PICO question

What are the effects of the shortage of nurses on the quality of care among CCU patients?

The PICO variables relevant to this question are explained as follows:

P in the question (the population or patient) is represented by ‘critically ill patients’. The study’s population is the critically ill patients in the Critical Care Unit. The intervention is represented by ‘quality care’, which is realized through having enough number of skilled staff. To accomplish the ‘C’ part of PICO, the study compares the outcomes of care provided by few nurses in relation to high patient population, and the care provided by enough number of nurses in relation to patient population. In regard to ‘O (outcome),’ the study will consider the effects that shortage of nurses has on the delivery of quality care in the CCU.

Keywords

Critical care nursing

Shortage of nursing

Nurses shortage in acute care settings

Under-staffing in Critical Care Unit

Under-staffing in Intensive Care Unit

Quality of care in Critical Care Unit.

Impact of Shortage of nurses on quality of care

Effect of shortage of nurses on critical care delivery

Acute care settings crisis

Quality of care in acute settings

While developing the key-words, the rationale focused on the variables. Some of them are “shortage of nurses”, “quality of care’ and “Critical Care Unit”. In order to develop many keywords for effective literature search, the synonyms of the variables were considered. For example, ‘acute’ was substituted with ‘critical’. Additionally, alternative terminologies were used. For example, ‘Critical Care Unit” was substituted with ‘Intensive Care Unit’. Finally, related words were used. For example, ‘effects’ was used in place of ‘impact’.

References

Petterson, J. (2010). The effect of high patient-nurse ratios. Nursing Times, 107(2), 1-4.

Stechmiller, K. J. (2002). The nursing shortage in acute and critical care settings. AACN Clinical Issues, 13(4), 577-584.

Ewart, W. G., Marcus, L., Gaba, M. M., Bradner, H. R., Medina, L., & Chandler, B. E. (2004). The critical care medicine crisis, a call for federal action: A white paper from the critical care professional society. CHEST, 125(4), 1518-1521.