Write a 3- to 4-page literature review that includes the following:
A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
Your literature review summary table with all references formatted in correct APA style
Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library?s databases.
Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Template located in this week?s Learning Resources.
Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
In nursing what is the effect of staffing by number compared to acuity during a shift?
Chutney E. Walley
In nursing what is the effect of staffing by number compared to acuity during a shift?
Staffing adequately improves patient care. When you staff with numbers you staff by patient nurse ratio. If you have a floor of twelve patients and three nurses, your patient nurse ratio will be 4:3. Looking at acuity you staff based on the level of care that has to be given. For example, if you have ten patients and two of them are a level three for care; the nurse that has those patients gets the least number of patients. The current organization that I work for staff by number. I have found that staffing by acuity in smaller hospitals is much easier versus a large hospital. California is one of the few states that has laws that regulate patient nurse ratio. ?However, as the proportion of hospital nurses working shifts of more than thirteen hours increased, patients? dissatisfaction with care increased. Furthermore, nurses working shifts of ten hours or longer were up to two and a half times more likely than nurses working shorter shifts to experience burnout and job dissatisfaction and to intend to leave the job. Extended shifts undermine nurses? well-being, may result in expensive job turnover, and can negatively affect patient care.? (Stimpfel, 2012)
Significance of the problem
Staffing is one of the biggest problems we face in nursing. Inadequate staffing over a period of time causes nurses to become burnt out, medical errors, and poor patient care. ?Despite regulations on shift length and cumulative working hours for resident physicians and people in other industries, there are no national work-hour policies for registered nurses.? (Stimpfel, 2012) When we staff by numbers and the nurse has patient five to six patients with high acuity the level of care declines. Most nurses work twelve hour days so this opens the door for medical errors.
?In 1999, California became the first state in the United States to pass legislation requiring minimum nurse-to-patient staffing ratios in acute care hospitals. The legislation, for which nursing unions were outspoken advocates, was, in part, a response to a reported decline in hospitals’ nurse staffing and skill mix induced by pressures from increasing managed care penetration. California Assembly Bill (AB 394) required the California State Department of Health Services to establish unit-specific minimum staffing levels for licensed nurses (registered nurses [RNs] and licensed vocational nurses [LVNs]) in acute care hospitals. The draft regulations were released in January 2002 and, after a period of highly contentious public comment, implemented in January 2004.? (Mark, 2013).
In my years of practice, I have seen both the risk and benefits of staffing by numbers and acuity. There have been days where we have had seven patients to care for with high acuity levels for twelve hours, and the patient level of care was decreased.
Should all states make it mandatory for a set patient nurse ratio? Should states make it mandatory to staff by acuity? Should nurses have a limit on shift lengths like other professions? States that have regulations in place, should it be an exception when looking at acuity? Looking at evidence based practice what has proven to be the best way to staff nurses? I understand that one way will not work for all hospitals. When you have smaller hospitals it is much easier to stay by acuity. In order to continue to improve patient care we have to work on improve conditions such as staffing for nurses.
PICOT Question. The PICOT question I chose was ?In nursing what is the effect of staffing by number compared to acuity during a shift?? The variables for this question population, factor, comparison, outcome and time. Nurses are considered the population and staffing is the factor of patient care. I am comparing acuity staffing to number staffing during a shift.
Keywords. Using key words has help me find lots of literature about my topic. Key words to research this topic is staffing; nurses; acuity; nurse patient ratio, and numbers. I also used assignment, work environments, healthcare support, outcomes, and burnouts to search for data.
Conclusion. Staffing can be very frustration, but we have to remember it?s for the safety of the patient. Improving staffing improves both patient and employee satisfaction. Staffing by acuity or numbers should always be considered if it benefits the patient and causes less stress on nurses. Staffing will always be one of our greatest down fall in nursing
Mark, B. A., Harless, D. W., Spetz, J., Reiter, K. L., & Pink, G. H. (2013). California?s Minimum Nurse Staffing Legislation: Results from a Natural Experiment. Health Services Research, 48(2 Pt 1), 435?454. http://doi.org/10.1111/j.1475-6773.2012.01465.x
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The Longer The Shifts For Hospital Nurses, The Higher The Levels Of Burnout And Patient Dissatisfaction. Health Affairs (Project Hope), 31(11), 2501?2509. http://doi.org/10.1377/hlthaff.2011.1377
Evaluation Criteria for Applications and Formal Papers
Levels of Achievement
Criteria Outstanding Performance Excellent Performance Competent Performance Proficient Performance Room for Improvement
QUALITY OF WORK SUBMITTED –
1. The extent to which work meets the assigned criteria and work reflects graduate level critical and analytic thinking (0-30 Points) 30 to 30 points
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics 25 to 29 points
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics 20 to 24 points
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics. 16 to 19 points
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed. 0 to 15 points
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
QUALITY OF WORK SUBMITTED: Purpose of the paper is clear (0-5 Points) 5 to 5 points
A clear and comprehensive purpose statement is provided which delineates all required criteria. 5 to 5 points
A clear and comprehensive purpose statement is provided which delineates all required criteria. 4 to 4 points
Purpose of the assignment is stated, yet is brief and not descriptive. 1 to 3 points
Purpose of the assignment is vague. 0 to 0 points
No purpose statement was provided.
ASSIMILATION AND SYNTHESIS OF IDEAS
The extent to which the work reflects the student?s ability to-
1. Understand and interpret the assignment?s key concepts (0-10 Points) 10 to 10 points
Demonstrates the ability to critically appraise and intellectually explore key concepts. 9 to 9 points
Demonstrates the ability to critically appraise and intellectually explore key concepts. 8 to 8 points
Demonstrates a clear understanding of key concepts. 5 to 7 points
Shows some degree of understanding of key concepts. 0 to 4 points
Shows a lack of understanding of key concepts, deviates from topics.
ASSIMILATION AND SYNTHESIS OF IDEAS 2. Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources (0-20 Points) 20 to 20 points
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 3-4 course resources to support point of view. 15 to 19 points
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 3-4 course resources to support point of view. 10 to 14 points
Integrates specific information from 1 credible outside resource and 3 to 4 course resources to support major points and point of view. 3 to 9 points
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view. 0 to 2 points
Includes and integrates specific information from 0 to 1 resource to support major points and point of view.
ASSIMILATION AND SYNTHESIS OF IDEAS 3. Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, and textbook) by comparing different points of view and highlighting similarities, differences, and connections. (0-20 Points) 20 to 20 points
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice. 18 to 19 points
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice. 16 to 17 points
Summarizes information gleaned from sources to support major points, but does not synthesize. 14 to 15 points
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped. 0 to 13 points
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
WRITTEN EXPRESSION AND FORMATTING 1. Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance. (0-5 Points) 5 to 5 points
Paragraphs and sentences follow writing standards. 5 to 5 points
Paragraphs and sentences follow writing standards. 4 to 4 points
Paragraphs and sentences follow writing standards 80% of the time. 3 to 3 points
Paragraphs and sentences follow writing standards 70% of the time. 0 to 2 points
Paragraphs and sentences follow writing standards < 70% of the time. WRITTEN EXPRESSION AND FORMATTING 2. English writing standards: Correct grammar, mechanics, and proper punctuation (0-5 Points) 5 to 5 points
Uses correct grammar, spelling, and punctuation with no errors. 5 to 5 points
Uses correct grammar, spelling, and punctuation with no errors. 4 to 4 points
Contains a few (1-2) grammar, spelling, and punctuation errors. 3 to 3 points
Contains several (3-4) grammar, spelling, and punctuation errors. 3 0 to 2 points
Contains many (= 5) grammar, spelling, and punctuation errors that interfere with the reader?s understanding.
WRITTEN EXPRESSION AND FORMATTING 3. The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list (0-5 Points) 5 to 5 points
Uses correct APA format with no errors. 5 to 5 points
Uses correct APA format with no errors. 4 to 4 points
Contains a few (1-2) APA format errors. 3 to 3 points
Contains several (3-4) APA format errors. 0 to 2 points
Contains many (= 5) APA format errors.