Enough Nurses on Staff in Intensive Care Units

Summary of Clinical Issue

The typical number of patients that one nurse is responsible for caring for on the unit is four; however, due to the high acuity level, this number is frequently lowered to two or even only one patient. The charge nurse is responsible for finding a replacement nurse available to work if a registered nurse calls in ill or takes a day off without prior notice. It is difficult for her to find a substitute nurse; as a result, four nurses are forced to care for five patients instead of the usual four. When there are four patients in the unit, the nurses have plenty to do to keep themselves occupied; adding a fifth patient doubles their work. Patients suffer additional harm because of the increased likelihood that medical errors may occur when there is a shortage of personnel. In addition, the nursing staff is affected since they are susceptible to burnout and, consequently, have back injuries caused by poor lifting practices. Urinary tract infections are caused by holding urine in the bladder for an extended period, getting stuck with needles frequently, and being emotionally distressed. Therefore, adequate staffing lowers mortality rates, shortens lengths of stay in hospitals, helps prevent infections, improves nurses’ morale, and is beneficial to patients’ health.

PICOT Question

Does having enough nurses on staff in the ICU (I) in comparison to not having enough nurses on staff (C) (O) decrease medical errors and infections among patients and stress and disorders among nurses (O) within a year (T)?

• Population (P) – patients in ICU.
• Intervention (I) – enough staff nurses.
• Comparison (C) – not having enough nurses on staff.
• Outcome (O) – decrease medical errors and infections among patients and stress and disorders among nurses.
• Time (T) – within a year.

Literature Evaluation Table

Criteria	Article 1	Article 2	Article 3	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Nogueira, T. D. A., Menegueti, M. G., Perdoná, G. D. S. C., Auxiliadora-Martins, M., Fugulin, F. M. T., & Laus, A. M. (2017). Effect of nursing care hours on the outcomes of Intensive Care assistance. PloS one, 12(11), e0188241. Web.	Tawfik, D. S., Profit, J., Lake, E. T., Liu, J. B., Sanders, L. M., & Phibbs, C. S. (2020). Development and use of an adjusted nurse staffing metric in the neonatal intensive care unit. Health services research, 55(2), 190-200. Web.	González-Gil, M. T., González-Blázquez, C., Parro-Moreno, A. I., Pedraz-Marcos, A., Palmar-Santos, A., Otero-García, L., & Oter-Quintana, C. (2021). Nurses’ perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services. Intensive and Critical Care Nursing, 62, 102966. Web.	Fagerström, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents, and mortality: an observational study from Finland. BMJ open, 8(4), e016367. Web.	Van Schothorst–van Roekel, J., Weggelaar-Jansen, A. M. J., Hilders, C. C., De Bont, A. A., & Wallenburg, I. (2021). Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice. BMC nursing, 20(1), 1-11. Web.	Pazokian, M., & Borhani, F. (2017). Nurses’ perspectives on factors affecting patient safety: A qualitative study. Evidence-Based Care, 7(3), 76-81. Web.
How Does the Article Relate to the PICOT Question?	It calculates the ratio of available nursing care hours to actual patient needs.	It constructs a model for estimating future nurse staffing needs and assessing the impact of unexpected staffing gaps on patient outcomes.	The article identifies what CCU and HES nurses in the Madrid area thought they needed in terms of safety, organization, decision-making, communication, and psycho-social and emotional support during the peak of the COVID-19 crisis in Spain.	It established a connection between a nurse’s daily workload and patient well-being. There was a positive correlation between workload and the occurrence of patient safety incidents and an inverse correlation between patient safety incidents and workload.	The article revealed how the new BN nursing roles progressively got ingrained in new nursing routines, organizational routines, and structural arrangements through an experimental process of action and appraisal by nurses.	It highlights patient safety issues, such as insufficient nursing staffing, are among.
Quantitative, Qualitative (How do you know?)	The study was quantitative because it relied on numerical data.	Quantitative study because it quantifies the impact of staffing reforms on health outcomes	It is a quantitative and qualitative study because it involves both numerical and non-numerical data	Quantitative because it was an observational study that gathered numerical data.	Qualitative because it seeks an in-depth understanding of Nurses in the lead.	This study was qualitative because it aimed to understand nurses’ perspectives and relied on semi-structured interviews.
Purpose Statement	To compare the amount of nursing care provided to patients with the amount of care needed	The study aims to construct a model for estimating future nurse staffing needs and assess the impact of unexpected staffing gaps on patient outcomes.	This study aims to identify the perceived needs of critical care and emergency nurses in the Madrid, Spain, area during the peak of the current pandemic in terms of safety, organization, decision-making, communication, and psycho-socio-emotional support.	The purpose was to determine if the amount of work each nurse had to do each day had any connection to adverse patient outcomes or deaths.	This research aims to compare the regular contributions of registered nurses with a Bachelor of Science degree (RN-BS) and licensed vocational nurses (RN-VNs).	To learn nurses’ perspectives on issues related to patient safety.
Research Question	How many patient hours do nurses provide for every patient?	How does an adjusted nurse staffing metric help better understand nurses’ role in determining essential patient outcomes and the relationships between other risk variables and those outcomes?	What do Nurses think about how care is delivered for patients with COVID-19 in Intensive Care Units and Emergency Rooms, and what do they expect from those services?	Does the number of patients a nurse has to care for each day affect the number of adverse events or deaths in their care?	Which nursing duties are shaped by the differences between licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs)?	In the nurses’ opinion, what elements affect patient safety?
Outcome	Health outcomes are affected by the time a patient spends receiving nursing care.	Reduced rates of HAI in the NICU were observed in patients whose nurse staffing levels were higher than expected or whose nurse staffing levels deviated positively from predictions.	There was an increase in nurses’ autonomy and decision-making responsibilities, as well as in the amount of work they had to do under stressful and uncertain conditions.	As hospital occupancy increased, so did the likelihood of patient safety events (1.24) and mortality. Reducing the number of tasks nurses had to complete decreased the likelihood of a patient safety incident (to 0.79) and death.	There was no difference between VNs and BNs regarding the complexity of care they provide; both have the knowledge and experience to care for patients with extensive medical requirements.	Staffing levels impact patient care.
Setting (Where did the study take place?)	Intensive Care Unit at a private Sao Paulo, Brazil hospital.	NICU at The California Office of Statewide Health Planning and Development (OSHPD)	26 public hospitals in the region of Madrid	Finland’s hospitals have supplied 36 units in total.	A purposefully selected Dutch teaching hospital.	In Tehran where there are five medical and educational institutions.
Sample	Critical care unit patients from January 1, 2011, through December 31, 2013.	100 NICUs and 12000 infants	557 questionnaires were administered to the respondents	36 units.	481 beds, 2,600 employees, including 800 nurses.	There were 32 nurses from the ICU, CCU, PCCU, ED, GU, and NE.
Method	Quantitative and qualitative information, such as the daily and monthly staffing levels of the intensive care unit’s nurses, were extracted from the database.	Measurement repetition observational study. Nursing staffing levels were predicted using machine learning and hierarchical linear regression, and the correlation between understaffing and healthcare-associated infections, length of stay, and mortality was quantified using hierarchical logistic and linear regression.	The research followed quantitative-qualitative mixed methods sequential design, with two phases: (1) a cross-sectional online questionnaire with closed questions and (2) a qualitative phenomenology investigation with in-depth interviews. This post will examine Step 1 of the process.	To gather data from event reporting systems in healthcare facilities and undertake relevant fieldwork.	An ethnographic case study was conducted.	After obtaining the nurses’ informed consent, data were collected through semi-structured interviews. The length of each interview varied from 30 to 45 minutes.
Key Findings of the Study	Patients’ ventilator-related pneumonia and phlebitis rates decreased as their hours of care increased.	A model explained thirty-five percent of nurse staffing differences between NICUs with 11 factors. The risk-adjusted odds of acquiring a healthcare-associated infection were lower in hospitals with higher-than-expected nurse staffing (OR: 0.79, 95% (CI: 0.63-0.98), but this was not the case for hospital length of stay or mortality.	Advanced-degree nurses reported feeling less incompetent and less fearful of making mistakes.	When hospital nurses have more patients to care for, more adverse events related to patient safety can occur, and more patients can die.	BNs play a crucial role in coordinating the flow of patients between different floors, while VNs typically contribute more to organizing care at the level of the individual patient.	Nurses’ job satisfaction, motivation, and, ultimately, patient safety is all impacted by staffing levels.
Recommendations of the Researcher	When deciding how many nurses to hire, know how many patient care hours are provided.	This has important implications for the design of prospective studies to establish a causal relationship between nurse staffing levels and health outcomes and quantify these changes’ impact on patient care and safety.	The complexity of caring for patients with COVID-19 in intensive care units necessitates a nurse-to-patient ratio that accounts for this, and there should also be recognition of more advanced nursing roles that require nurses to acquire new clinical competencies.	The research is essential for resolving the PICOT problem.	There is a need for a study that defines nursing specialties at the associate’s and bachelor’s degree levels.	Hiring more nurses can improve patient outcomes and decrease nurse burnout.