A Critical Analysis Of Analyzing Published Research

Nursing shortages have always occurred in cycles. Recently, the shortage has become worse due to the implications of managed care as a way of controlling escalating health care costs. While the shortage did ease some during the recession of 2009, there is still a shortage in some areas of the country (Cherry & Jacob, 2014). Increased student enrollments and government policies have helped with the shortage, but the occupational outlook for nursing jobs is expected to grow faster than any other occupation through 2018. So it is essential that the supply of nurses increases to keep up with the demand. The current shortage is due to several factors. First, new nurses are needed to replace “baby boomers” who will be retiring in the near future. Second, as the population ages, there will be a demand for more healthcare, leading to a demand for more nurses. Third, new advances in patient care will lead to more people in the healthcare system needing more specialized care, and lastly, the affordable care act places a large emphasis on preventive care, leading to more people desiring wellness visits (Cherry & Jacob, 2014). Finally, according to Dall’Ora, Chiara, Griffiths, Peter, Ball, Jane, Simon, Michael Aiken, Linda H. (2015), “shifts lasting 12 hours or longer were associated with a 40 percent greater level of job dissatisfaction and a 31 percent higher risk of planning to quit. Job satisfaction and burnout in the nursing workforce are global

Staff nurses have great responsibilities in caring for patients. Often, these nurses experience heavy workload. Heavy patient load and stress contributes to burnout. Why is burnout important to discuss in relation to nurses? Burnout affects the performance of the nurse and the quality of care he or she provides to the patient. Therefore, it is imperative that staff nurses decrease the possibility of burnout and increase or maintain excitement and enjoyment in the field of nursing. If nurses do so, they will find joy in their work and quality of patient care will be increased. Contributors to burnout and

West, Ahern, Byrnes and Kwanten (2007) indicate that the new graduate nurses may have not worked full-time in the past; given that graduate nurses begin their career with a full-time job can lead to exhaustion. It was discovered that shift work leads to desynchronisation of physiologically determined circadian rhythms which has a major psychobiology effect and it is commonly perceived the effects of shift work contribute to graduate nurses attrition rate. The NGNs often have a high level of stress due to disturbed sleeping patterns, as they find to adaption to shift work or rotating work hours difficult. Eventually, it leads to feelings of lack of job satisfaction, exhaustion and spending of less time with their friends and family, which can eventually could lead to burnout (West et al., 2007).

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)

From a social perspective, H.B. 476 may help narrow the widening gap in supply verse demand of professional nurses needed in acute care settings. Nurses experience high levels of burnout, emotional exhaustion, depersonalization, and lack of personal accomplishment when compared to other health care professionals (Khamisa, Peltzer, & Oldenburg, 2013). The authors relate such high levels of burnout in nurses to the emotional strain they encounter from providing direct personal care to sick and dying patients. Consequently, this has a direct impact on job satisfaction and nurse retention. A survey by the American Nurses Association (ANA) found 74% of nurses proclaim acute or chronic effects of stress and overwork

Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning

These two authors analyse data in their own parts which avoid the different measurements. This is also one of the strengths of data analysis because these two authors can analyse the data according to what they are familiar with. This paper develops a thematic analysis process and clearly defines the stages such as coding, review and thematic developed. The final themes are presented in the paper using a mind map. The authors also give an example of the process of analysis to provide evidence that they analyse deeply. In the results and discussion part, some data are used as examples to support the authors’ ideas. This reinforces the convinces of the paper. Although the authors do not discuss that they take contradictory data into account, it can be assumed that they check and refine the final model after testing in Urbchester. As a result, the ideas that the authors come up with are credibility enough to trust. In conclusion, the data analysis is sufficiently rigorous in the whole

Additionally, the study found that a high patient to nurse ratio resulted in greater emotional exhaustion and greater job dissatisfaction amongst nurses. Each additional patient per nurse was associated with a 23% increase in the likelihood of nurse burnout, and a 15% increase in the likelihood of job dissatisfaction. Moreover, 40% of hospital nurses have burnout levels exceeding the normal level for healthcare workers, and job dissatisfaction among hospital nurses is four times greater than the average for all US workers. 43% of nurses involved in this study that reported job dissatisfaction intended to leave their job within the upcoming year. (Aiken et al.)

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Research Critique, Part 1: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

By recognizing that burnout is a serious problem that impacts an organization’s viability, an assembly of staff nurses, nursing supervisors, human resource staff, social services, nurse administrators, and a physician champion will be arranged to construct mission, objectives and strategies to help ameliorate the issues at hand. Researching literature on nursing burnout is essential so that the members of the task force has a solid grasp on potential underlying hardships contributing to nursing burnout within the facility as well as the financial effects on the organization. Furthermore, in order to determine a solution, the nurse’s work environment should be assessed (Nedd, 2006) and measured using the 26-item Brisbane Practice Environment Measure (B-PEM) (Flint, Farrugia, Courtney, & Webster, 2010). The B-PEM instrument was developed to measure nursing satisfaction within the work environment and the perceived facilities inadequacies (Flint et al. 2010; Hayes et al., 2014; Nedd, 2006). Next, the Conditions of Work Effectiveness - Questionnaire-II (CWEQ-II) will also be utilized to measure the nurses’ perceived access to the four job related empowerment structures: opportunity, information, support, and resources will be administered (Laschinger et al., 2003). Then nursing burnout will be assessed and analyzed by using the Maslach Burnout Inventory (MBI) which is a widely used instrument to assess burnout and is considered the gold standard due to its established