Practice Issue and Evidence Summary Worksheets – Capstone Project

Practice Issue Worksheet

What is the Practice Issue?

The practice issue is the impact of nurse staffing and its relationship to job satisfaction and job retention.

How would adjusting the nurse to patient ratios and responsibilities on a busy hospital unit increase employee satisfaction and nursing retention rates?

Adjusting the patient ratios and responsibilities on a busy hospital unit has a positive impact on job satisfaction and job retention. The reason for this assertion is that with comfortable patient ratios, nurses do not strain to perform their duties and responsibilities at the hospital. As such, their level of satisfaction increases significantly, which in turn results in the increased rates of nurse retention.

Define the scope of the Practice Issue:

The scope of the practice issue is the nursing staff of the hospital, which means that it covers all the activities and areas that have any influence on the job satisfaction of nurses while at the hospital. In this particular case study, the practice issue centres on the impact of nurse staffing on both job satisfaction as well as job retention in healthcare facilities.

What is the practice area?

• Clinical
• Education
• Administration
• Other (list)

How was the practice issue identified? (check all that apply)

• Safety/risk management concerns
• Unsatisfactory patient outcomes
• Wide variations in practice
• Significant financial concerns
• Difference between hospital and community practice
• Clinical practice issue is a concern
• Procedure or process is a time waster
• Clinical practice issue has no scientific base
• Other:

Describe the rationale for your checked selections:

Safety or risk management concerns lead to job dissatisfaction among the nurses, thereby increasing their rate of turnover, largely because of poor working conditions.

Unsatisfactory patient outcomes lead to job dissatisfaction among the nursing staff, thereby lowering their retention rates.

Financial concerns cause dissatisfaction, especially in case of low payments, forcing nurses to seek possible alternative with better income sources, hence low retention rates.

Clinical practice issue concern affects job satisfaction, especially when the management fails to attend to the issues raised, thereby leading to high rate of workers turnover.

What evidence must be gathered? (check all that apply)

• Literature search
• Guidelines
• Expert Opinion
• Patient Preferences
• Clinical Expertise
• Financial Analysis
• Standards (Regulatory, professional, community)
• Other

Describe the rationale for your checked selections:

The literature review provides a review of previous studies conducted in the same nursing field, thereby pointing out to a particular finding and theoretical perspective of the research topic.

Guidelines provide an ideology of the expected trends and practices in the nursing field, as well as their supposed impact on nurse staffing, job satisfaction, and job retention.

Patient preferences outline the preferred preferences in relation to nursing service, whereby the quality of nursing service delivered largely depends on the nurse staffing at the hospital.

Evidence Summary Worksheet

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The practice problem arises from the ratio of nurses in relation to the patients they are supposed to serve at a given healthcare center. In most community and public hospitals, the ratio of nurses to patients is very low, and as such, a single nurse has to attend to tens of patients. This leads to overworking the nurse, and in turn, causes job dissatisfaction. The less satisfied a nurse is with his or her job, the higher the chances of the nurse leaving the hospital in search of a better job posting. Therefore, it is appropriate to assert that the concept of nurse staffing is directly correlated to job satisfaction, which in turn determines staff retention rates or staff turnover rates.

Find a source of evidence that is a systematic review article on a nursing topic that is relevant to your practice problem. Write the complete APA reference for the systematic review article you selected:

Hairr, D., Salibury, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse Staffing and the Relationship to Job Satisfaction and Retention. Nursing Economic, May-June 2014/Vol. 32/No. 3.

Define the search terms for your systematic review:

The systematic review article reviews the correlation between nurse staffing and job satisfaction as well as job retention. The article uses empirical reviews performed on nurses within the US drawn from the different hospital as well as with different working experiences. The article established that many factors played a crucial role in determining the job satisfaction of nurses, especially the nurse-staffing concept. According to the article, the higher the rate of the patient to nurse ratio, the lower the job satisfaction rates, while to lower the rate of the patient to nurse ratio, the higher the rates of job satisfaction. Similarly, high levels of job satisfaction lead to high rates of staff retention among the nursing staff, while low levels of job satisfaction lead to low rates of staff retention among the nursing staff.

Identify the objectives of the article.

The objective of the article was to determine the correlation between nurse staffing and job satisfaction and job retention rates in acute care hospital environment. The objectives are guided by the need to establish the impact of nurse staffing and job satisfaction, as well as how it affects job retention among nursing staff. The acute care hospital environment requires intensive care for patients, and as such, this means more work for nurses. Therefore, when the nurse staffing is low, one nurse will have to attend to more patients as opposed to one nurse attending only to few patients. The resulting effect would be overworking and overstraining. As a result, the level of job satisfaction for the nurse reduces significantly.

However, when the nurse staffing is at appropriate levels, the nurse does not strain too much as he or she is comfortable with the number of patients assigned. Moreover, the nurse does not have to overwork nor overstrain. He or she becomes happy while at the job, meaning the levels of job satisfaction also increase significantly. The article sought to determine the correlation existing between these two variables as well as establish their relationship with the concept of job retention on whether job satisfaction led to higher job retention or if job dissatisfaction led to lower job retention rates.

Provide a statement of the questions being addressed in the work and how they relate to your practice issue:

The statement of questions addressed in the article focuses on the correlation between nurse staffing, job satisfaction, as well as job retention among nurses in the acute care hospitals. This research question relates closely to the practice issue because the practice issue seeks to analyze the impact of adjusting the nurse to patient ratios and responsibilities on a busy hospital unit on employee satisfaction and nurse retention rates. For one, both the scenarios focus on a healthcare study population whereby the nurses are busy, or at least assigned to a wide range duties and responsibilities.

On one hand, the article focuses on the performance of nurses in acute care hospitals. On the contrary, the practice issue focuses on the performance of nurses at a busy hospital unit. Similarly, both scenarios consider the output of the nurses in discharging their duties and responsibilities, especially with regard to the number of patients under their care. In the first case, the article refers to nurse staffing. In the second case, the practice issue refers to the nurse to patient ratios. Both cases affect job satisfaction, as addressed in the article, or employee satisfaction, as addressed in the practice issue, directly, and as a result, affect the rate of nurse retention.

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

The authors in the article suggest the increasing of nurse staffing in acute care hospitals in order to facilitate better service delivery by the nurses to their patients. The reason for this assertion is that low nurse staffing leads to overworking and overstraining among the nurses, while high nurse staffing leads to normalcy in operations for the nursing staff, especially considering the elimination of overworking. Similarly, patients served by understaffed nurses rarely get the best of services, as opposed to patients served with properly staffed nurses, especially in an acute care environment. From this perspective, the best way to improve the outcomes of the patients is by maintaining a good patient to nurse ratio, by ensuring that the hospital has an adequate nursing staff to attend to the number of its patients in the acute care wing. This is because the nurse serving them will not overstrain, neither will they overwork, and as such, they will be focused on delivering the best nursing services to their esteemed clients.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper.

The main findings of the authors in the systematic review established that nurse staffing has a direct correlation to job satisfaction among the nurses, which in turn has an effect on the staff retention rates. From the article, the authors established that nurses who expressed a high level of job satisfaction were those that worked in hospitals that had good staffing levels, and as such, did not overstrain, or overwork, when performing their duties and responsibilities in the acute care hospitals. Similarly, the research also established that nurses who expressed a low level of job satisfaction were those that worked in hospitals with poor staffing levels, and as such, had to overwork and overstrain to meet the demands of their duties and responsibilities at the acute care hospitals.

As a result, the high level of job satisfaction led to an increase in job retention rates among the nurses, while a low level of job satisfaction led to a decrease in job retention rates among the nurses. The findings were established from a quantitative research study, and as such, affirm the feasibility as well as the credibility of the research findings. These findings are therefore relevant to the project proposal for the Milestone 2 project paper in the sense that it defines the possible impact of adjusting patient to nurse ratios within a busy hospital unit on the level of employee satisfaction as well as the nurse retention rates.

Outline evidence-based solutions that you will consider for your project.

In performing the project, some of the evidence-based solutions to consider include the rates of staff turnover in busy hospital units, and the relation of this high rate of staff turnover to the level of job satisfaction. Many theories, as well as research findings, point to a scenario whereby the ratio of patients to nurses greatly affects the job satisfaction levels of nurses. As a result, a high level of job satisfaction leads to a high rate of staff retention while a low level of job satisfaction leads to a low rate of job satisfaction. In the same regard, the patient ratios point to a certain expectation, whereby high rates of patients to nurse ratios lead to low levels of job satisfaction among the nurses, due to overstraining and overworking, while low rates of patients to nurses ratios result in high levels of job satisfaction among the nurses.

Consequently, this results in the high rates of workers turnover and high rates of employees retention respectively.

Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project.
The limitation faced by the researchers while performing the research study in the article was the sample size. The research used seventy nursing staff to participate in the research study, in a study population of over three million registered nurses in the United States. Naturally, the sample size was too small to cater for the demands of the research project, as it was not fully representative of the opinions and ideals of the study population. As such, using the findings from the research study is somewhat inappropriate considering that the results obtained may not be entirely reflective of the opinions and ideas of all the nurses in the job market.