Running head: INTEGRATIVE REVIEW 1

Kamari Parris

Bon Secours Memorial College of Nursing

NUR4222

April 16, 2017

“I Pledge”
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Abstract

For over a decade there has been a significant nursing shortage in the United States and globally.

While the shortage of nurses is an issue we must try to resolve, there is another issue just as

pressing, and that would be how the quality of patient care is affected by this growing problem.

This integrative review will touch on the most recent research studies on this daunting topic.

Five studies were reviewed to discover the most recent evidence to incorporate into practice on

ways to care for patients without compromising quality. Among the studies the most common

theme to alleviate this issue was by modifying work environments and hiring more Bachelors

prepared nurses.
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Introduction

The purpose of this integrative review is to shed light on the different ways to improve

quality of nursing care by answering the PICOT question of “What qualitative impact does the

nursing shortage have on patient care”? These results will then be formulated to come up with a

solution that can be transferred to the bedside.

Design, Search Methods

To find the appropriate articles for this integrative review the key words that were

searched include nursing shortages, impact on patient care and quality, and job satisfaction. The

database that was used is the OVID online that was provided by the College of nursing. I also

searched the Internet a little to find scholarly articles that fit this criteria. The articles were all

fairly recent and dated between the timeframes ranging from 2013-2015. Although there were

many articles related to this topic, I had to limit the number I used due to them being beyond five

years old. The articles reviewed on this PICOT question included the design method that

included cross sectional surveys of nursing staff and reviews of publications of this topic. This

method was best for this type of research because cross sectional research has the ability to study

several variables at once (study.com n.d.). The studies reviewed were all qualitative in design.

The subjects researched included nurses of different genders, ages, demographic areas, and

levels of nursing education. Of the five articles reviewed on the topic, the one that related most

closely to my PICOT question was the article from the International Journal of Nursing Studies.

This study was most relevant because it covers nursing and patient’s perceptions of quality of

care and safety in the workplace (Coetzee et al, 2013). Nurses were surveyed on the medical and

surgical units of 55 private and 7 public hospitals in South Africa, which gave a large survey

population.
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Findings, Results

Findings from the studies ranged from high rates of burnout, dissatisfaction with work

environments, disengagement with their position and managerial dissatisfaction. Appendix A.

Goes into detail of the findings from the research studies. The commonalities amongst the

studies include that practice environments greatly impacted the outcome of patient care quality.

Some of these environmental factors included inappropriate staffing ratios and the use of

temporary nursing staff. The differences seen across the various studies blamed nursing burnout,

low wages, poor management and resources as the reason for poor patient outcomes. Three of

the five studies were international, which was another trend I noticed. There weren’t many

studies done in Western countries because countries with transitional economies were in need of

research (You, et.al, 2012). Theoretical framework for this research include Donabedian’s

structure-process-outcome model of quality by looking at the complexity of RN’s work

environments to gage its relationship to patient outcomes (Djukic, et. Al, 2012).
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After reading and reviewing all of the articles the changes that would most impact the

quality of nursing care would be by making some environmental changes in the workplace. In

China, the issue that has the greatest impact on the quality of nursing care is job related burnout,

which was 38 percent and job dissatisfaction 45 percent (Yat-Sun et al., 2012). This burnout

they are experiencing could be alleviated with the addition of temporary nursing staff (TNS).

Although it is contradicted and may have caused the poor patient outcomes in the article about

TNS, I think it is wise for them to consider making this change because a nurse’s mindset can

directly impact nursing care. The article that researched the use of TNS elaborated on what they

considered qualifies as TNS, it was interesting that PRN float nurses weren't included in the

equation. So by using this evidence, China could hire float nurses as opposed to travel nurses to

fill their void without compromising nursing care. The articles that discussed working

conditions and quality of care were very detailed in it’s discussion and included a breakdown of

the issues that affect patients. This detail included the characteristics of the nurses, the extent of

their job dissatisfaction, reports of staffing skill levels, reporting of patient safety events, and

nurses assessments of quality of care. In this case I feel it would be beneficial to bring this

information to nursing leaders and brainstorm with shared governance on ways in which these

problems can be solved. Finally the last article on the appendix feels the way to alleviate this

issue is by putting the problem back in the hands of management and let them guide staff to the

appropriate resources for the problem (Djukic et al, 2012). This could also be accomplished by

escalating concerns to members of upper management.

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Title Author and Journal Purpose of Data Recommendations Summary of

Year (full study collection the Article
reference) method
Article A tale of two International To examine Cross Improve the practice Staff are
#1 systems- Journal of the practice sectional environment of dissatisfied
nurses Nursing environment survey of nurses. For example, with work
practice Studies of nurses and nurses the ratios environment
environment, quality of which poses a
well being, care negative affect
perceived… on the patient
Article Patient Nursing To research Review of The use of TNS can Places the
#2 outcomes management if temporary publications negatively affect the blame of poor
and staffing quality of work patient
temporary changed the environments outcomes as a
nurses outcomes of result of using
patients temporary
nursing staff
(TNS)

Article Nurses’ International To look at Cross Work environments Unfavorable

#3 reports of Journal of the nurse’s sectional need to be outcomes were
working Nursing assessment survey improved, but it’s directly
conditions Studies of their expected with the associated
and hospital hospital nursing shortage with job
quality of environments dissatisfaction
care… (inability to
grow)
Article Hospital International Links Nurse Survey Nurses with better Poor work
#4 nursing, care Journal of resources work environments environments
quality, and Nursing and patient had lower odds of and burnout
pt Studies outcomes in high burnout and
satisfaction... China job dissatisfaction

Article Work JONA Studied the Cross- Work environments Focuses on

#5 environment association sectional, affect patient care additional
factors other between correlation quality and factors that
than staffing RN’s ratings also design managers need to compromise
associated and patient find strategies to fix patient safety
with care quality this issue and quality of
nurses… and the care
environments

Appendix A.
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Limitations/Conclusion

Limitations to this PICOT question that were demonstrated from the articles reviewed

included the fact that only nurses were surveyed and not the patients. If patients had been

included it would have strengthened the results and given more insight on just how much

patients are affected by staffing shortages. Mixed reviews were seen on the conclusion of if the

TNS negatively impacted patient outcomes. These results were seen mainly because of the lack

of research articles that discuss the quality of work environments and staffing levels (Mazurenko,

Liu, & Perna, 2015).

In conclusion, I feel like I learned just a few things from reviewing the articles, such as

how this problem is viewed internationally. Much of the information was common knowledge.

Honestly I don’t feel as if there was adequate information available to warrant a practice change

on my end. In summary, the quality of nursing care can be directly associated with staffing

issues and we need to continue to study this growing problem and come up with better evidence

to make changes to our practice.

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References

Aiken, L. H., Sloane, D. M., Bruyneel, L., Heede, K. V., & Sermeus, W. (2013). Nurses’ reports

of working conditions and hospital quality of care in 12 countries in Europe. International

Journal of Nursing Studies, 50(2), 143-153. doi:10.1016/j.ijnurstu.2012.11.009

Coetzee, S. K., Klopper, H. C., Ellis, S. M., & Aiken, L. H. (2013). A tale of two systems—

Nurses practice environment, well being, perceived quality of care and patient safety in

private and public hospitals in South Africa: A questionnaire survey. International

Journal of Nursing Studies, 50(2), 162-173. doi:10.1016/j.ijnurstu.2012.11.002

Djukic, M., Kovner, C. T., Brewer, C. S., Fatehi, F. K., & Cline, D. D. (2013). Work

environment factors other than staffing associated with nurses’ ratings of patient care

quality. Health Care Management Review,38(2), 105-114.

doi:10.1097/hmr.0b013e3182388cc3

Mazurenko, O., Liu, D., & Perna, C. (2015). Patient care outcomes and temporary

nurses. Nursing Management (Springhouse),46(8), 32-38.

doi:10.1097/01.numa.0000469351.33893.

You, L., Aiken, L. H., Sloane, D. M., Liu, K., He, G., Hu, Y., . . . Sermeus, W. (2013). Hospital

nursing care quality, and patient satisfaction: Cross-sectional surveys of nurses and

patients in hospitals in China and Europe. International Journal of Nursing Studies,50(2),

154-161. doi:10.1016/j.ijnurstu.2012.05.003