NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Name

Capella university

NURS-FPX 8045 Doctoral Writing and Professional Practice

Prof. Name

Date

Synthesis of Evidence Substantiating an Intervention

Achieving success in patient care is critical in health settings by addressing issues like nursing shortages. Lima Memorial Hospital (LMH) is dealing with the practice gap of nurse shortage. Based on the Ohio Nursing Association (ONA) report, around 83.21% of nursing staff faced significant turnover, leading to insufficient staffing and poor care services (Ohio, n.d.). The assessment focuses on empirical research, and leadership can employ targeted initiatives to close the gap and maintain an appropriate patient-to-nurse ratio in the hospital. 

Introduction of Gap in Practice

Adequate nursing numbers in health settings are crucial to offering improved care provision and fulfilling the needs of patients. The shortage of nurses is a significant practice gap noted in the LMH. The internal data of LMH reveals that 12% of its total nursing positions are unoccupied, with 500 recognized certified nurses and 75 left vacant. The staff poll at LMH found nurse burnout, with 65% indicating overwork due to shortages of nurses. Overall number of licensed nurses in American hospitals fell by 100,000 in 2021, posing issues like nurse discontent, poor patient safety, and fatalities (Lucy, 2024). The data reveals shortcomings in allocating assets, poor planning, retention and hiring approaches, and a lack of nurse training (Vries et al., 2023). Disparity in the practice of nursing scarcity underlines the critical necessity of strategic efforts to boost care quality and achieve effective outcomes.

PICO(T) Question

A PICOT question formulation is vital for closing the nursing shortage practice disparity identified at LMH. The PICO(T) is: In licensed nurses at LMH (P), does improved retention and recruitment policy (I), compared to current strategies without adequate policy (C) improve nurses’ satisfaction and retention (O) over 12 weeks (T)? PICO(T) entails hiring and retention policy interventions, including a positive workplace, offering staff training, compensation packages, and adequate retention and hiring strategy (Pressley & Garside, 2023). The PICO(T) questions focus on boosting the retention and job satisfaction of registered nurses at LMH, improving care quality and patient safety over 12 weeks.

The strategic implementation of retention and hiring policies is an effective intervention for closing the recognized practice gap of the nurse shortage at LMH and improving clinical outcomes. A recent study has revealed the significance of retention and hiring policies in managing nursing shortages; Peters et al. (2023) emphasized the importance of retention and recruitment strategies like building a supportive atmosphere and motivation through training in boosting nurse satisfaction and retention, which are consistent with the concepts underlying extensive hiring and retention policies. Implementing a recruitment and retention policy represents a paradigm change toward effective care practices. 

An adequate scope for a Doctor of Nursing Practice (DNP) project includes a targeted and attainable goal that deals with a particular healthcare issue in LMH. The retention and hiring policies intervention to solve the nursing shortage have a direct impact on medical care quality and results. Applying policy interventions aligns with the DNP’s scope of enhancing care and patient outcomes. The intervention complies with the DNP project; it supports evidence-based practice to resolve understaffing, such as increasing recruiting and retention by training and creating a positive workplace (Pressley & Garside, 2023). The DNP project entails establishing, implementing, and assessing the success of the change by introducing retention and hiring policies to improve the nursing shortage issue at LMH. 

Overview of Chosen Scholarly Articles

Current research articles offer persuasive data supporting the introduction of interventions aimed at enhancing nurse satisfaction and retention, resolving the recognized practice disparity at LMH. Vries et al. (2023), performed a systematic review assessing the effect of workplace settings on nurse retention and fulfillment in hospitals. The study found that poor nursing leadership and management and an unattractive work environment cause nurse burnout. Offering a respectful environment, social assistance, and adequate work-life balance play a crucial part in improving nurse retention. These findings underscore the necessity of retention and hiring policy to optimize nurse shortage and satisfaction.

Oates et al. (2020), studied integrating data from several studies exploring the nurses’ experience in mental health settings, impacting nurses’ retention and hiring. The authors suggested that investing in mentoring, nurses’ wellness, and training and education aid in improving nurses’ experiences and retention. Niskala et al. (2020), performed a meta-analysis that revealed the significance of staff training and education toward job satisfaction. They found that a strategy based on education and training significantly enhanced nurses’ work satisfaction or retention, overcoming understaffing issues. Research offers evidence advocating the necessity of intervention to boost nurses’ satisfaction and retention and improve care outcomes in LMH.

Nurse shortages in hospitals like LMH are at risk of adverse results for patients in terms of safety and care quality. The evidence from Alshahrani (2022), highlighted the critical role of improving the unfavorable perception of nursing, enhancing the workplace setting, salary packages, and retention of aged nurses in overcoming the gap of nursing shortage. Kueakomoldej et al. (2022), offered interventions aimed at boosting nurse retention through financial aid and educational programs,  improving the working atmosphere and training opportunities, effectively addressing the practice gap of staff shortage, and improving the standard of care. By aligning interventions with evidence-based practices, hospitals can ensure appropriate staffing, enhancing patient satisfaction and healthcare standards.

Critical Review of Chosen Studies

The disparity caused by unfilled nursing posts to meet patient demands and the interventions that contribute to overcoming inadequate staffing issues have brought attention to research. Vries et al. (2023), performed a systematic analysis aimed at evaluating crucial determinants impacting nurses’ job retention and strategies to overcome the issue. Through the formation of accessible evidence, the authors highlighted that improving nursing leadership and a positive workplace is crucial to assist in developing adequate work-life balance. Utilizing a systematic analysis approach, the research exhibited the Johns Hopkins framework level three. The approach of data extraction and analysis boosts accuracy, offering evidence for minimizing variables that cause staffing shortages to deliver quality care.

Nurses’ experience is correlated with their retention and satisfaction in health settings, impacting care provision practice. The study by Oates et al. (2020), utilizing an integrative review approach, falls in level three of the John Hopkins framework. The authors intended to investigate a clearly defined research question: How do nurses’ experiences in mental health facilities impact their hiring and retention? Research emphasized that investing in mentoring, nurses’ wellness, and training and education aid in improving nurses’ experiences and retention. The study is credible and applicable as it employs thematic approach data from diverse sources to offer an extensive comprehension of the relationship between nurses’ experience and retention to address understaffing, highlighting intervention recommendations. Addressing nurse retention issues by comparing nursing experience, the authors deliver crucial insights into the intervention to overcome nurses’ inadequacies.

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Evidence-based strategies are vital to resolve the practice gap of nurses understaffing in hospitals, boosting patient outcomes and nurses’ job satisfaction. The research by Niskala et al. (2020), is credible and precise and intended to offer valuable knowledge of significance of educational and training approaches to overcome the practice gap. The study lies in level one of John Hopkin’s model as it is based on meta-analysis and systematic review. Utilizing an efficient study design and profile-likelihood random-effects model as methodology, the study revealed that educational intervention, workshops, mentor-mentee training, and team development education significantly promote work satisfaction among nurses and reduce the rate of turnover. The study emphasizes the importance of developing skilled nurses through training and boosting work satisfaction to mitigate nurse shortages.

Nursing shortage practice gap demands urgent initiatives and interventions to fill this gap efficiently, promoting secure care practices. Alshahrani (2022), conducted a literature review intended to analyze the factors and their implications in nurse retention and devised strategies. Utilizing a descriptive approach and offered strategies to improve understaffing, including enhancing the workplace setting, salary packages, and retention of aged nurses. The article lies in level five of John Hopkin’s framework. The study is credible as it offers concise knowledge and scientific reasoning related to the causes and consequences of the nursing shortage and interventions to overcome these factors. The study exhibits the efficacy of target interventions to address contributors to nurse understaffing in hospitals.

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Developing recruitment and retention approaches is critical to filling the practice gap and aiding in achieving adequate staff for patient care. Kueakomoldej et al. (2022), used Joanna Brigg’s scoping review framework to explore the factors related to registered nurses’ hiring and retention in underprivileged areas. The credible article utilizing a robust search strategy and data extraction method lies at level five of John Hopkin’s model, revealing strategies like offering proficient assistant staff, financial aid, favorable work settings, and career growth initiatives, like training, to promote nurse retention. The article is valuable for comprehending the issues and interventions to mitigate understaffing in hospitals.

Synthesis of Literature Using MEAL Plan

The integration of evidence from the chosen research highlights the varied nature of factors impacting nurses’ shortages and interventions, enhancing care standards. Factors like workplace settings have a significant impact on nurse retention and satisfaction in hospitals. Poor nursing leadership and management, exhaustion due to overwork, lower salary and dissatisfaction, and an unattractive work environment cause nurse burnout and nurse turnover (Alshahrani, 2022; Vries et al., 2023).

Offering a respectful environment, social assistance, and adequate work-life balance play a crucial part in improving nurse retention (Vries et al., 2023). Alshagrani (2022), offered helpful insights into the effectiveness of interventions such as improved salary packages, inclusive work atmosphere, and retention of aged nurses in reducing turnover rate. Implementing efficient approaches promotes nursing care and assists them in improving their perception and job satisfaction.  

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Various research studies offer insight into various aspects of the practice gap of understaffing by demonstrating effective retention and hiring measures. Nurses’ experience is correlated with their retention and satisfaction in health settings, impacting care provision practice. Research elucidated that investing in mentoring, nurses’ wellness, and training and education aids in improving nurses’ experiences and retention (Oates et al., 2020).

Offering opportunities for career development and advancing nursing skills through education is crucial to boost nurses’ fulfillment. Professional growth training workshops, based on mentorship and other team-building workshops, assist nurses in developing interpersonal relationships, expertise, and dedication to offering adequate services (Niskala et al., 2020; Oates et al., 2020). Evidence-based strategies aid in promoting nurses’ engagement and developing expertise to offer effective services, improving patient safety.

Evaluating the Quality of Evidence

The examination of the quality of research illustrates the strengths of the method and the implications of comprehending the practice gap and related interventions to improve medical care. Weaknesses and opportunities for further exploration exist, which can hinder the efficacy of efforts aimed at alleviating the nursing shortage at LMH. The selected papers indicate strengths, like vigilant data analysis, literature reviews, and expert agreement formulation. For example, Vries et al. (2023) and Oates et al. (2020), employed systematic reviews and meta-analyses, and integrative reviews, respectively, to evaluate the impact of nursing experience and other determinants of nurse shortage and interventions to overcome the issue.

The methodologies offer robust evidence and contribute to our understanding of factors influencing nurses’ satisfaction and retention; however, the quality and methodology of the included research can vary, impacting the robustness and validity of the results. The research strategy adopted by Alshahrani (2022), which is a literature review, exhibited strength by offering concise knowledge and scientific reasoning related to the causes and consequences of the nursing shortage and interventions. The study exhibits the efficacy of target interventions to address contributors to nurse understaffing in hospitals. Lack of extensive study design and data extraction and evaluation approach can result in introducing biases and hinder reproducibility. Acknowledging the weaknesses of the study supports additional research to improve outcomes. 

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Critical analysis of research articles necessitates the consideration of strengths and limitations based on data collection, study design, and setting. Kueakomoldej et al. (2020) employed a scoping review approach, standard research methods, and study design to outline the appropriate interventions, improving nurses’ experience and intention to retain. However, the practicality of intervention in particular health settings can vary based on the organizational structure and finances. Additional research is required in various aspects. Further studies can focus on prospective research or randomized controlled trials that verify the findings of integrated and systematic reviews like Vries et al. (2023) and Oates et al. (2020). Analysis of organizational challenges, allocation of resources, and stakeholder participation are critical for the effective execution of interventions. Addressing these subjects for additional inquiry will promote the applicability of interventions to fill the practice gap at LMH.

Conclusion

In conclusion, the thorough investigation of the practice gap in the nurse shortage at LMH has shown new avenues for improving patient care. The integration of current studies and critical assessment of data show that resolving this gap requires an integrated strategy. Effective interventions like retention and hiring strategies and inclusive workplaces improve nurses’ satisfaction and retention. Leadership can create significant improvements in the nursing shortage by adopting evidence-based practices.

References

Alshahrani, S. H. (2022). Reasons, consequences, and suggested solutions for nursing workforce shortage: A review of literature. International Journal of Health Science, 6(S5), 1557–1568. https://doi.org/10.53730/ijhs.v6nS5.9004

Kueakomoldej, S., Turi, E., McMenamin, A., Xue, Y., & Poghosyan, L. (2022). Recruitment and retention of primary care nurse practitioners in underserved areas: A scoping review. Nursing Outlook, 70(3), 401-416. https://doi.org/10.1016/j.outlook.2021.12.008

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Lucy, I. (2024). Data deep dive: A national nursing crisis. uschamber.com https://www.uschamber.com/workforce/nursing-workforce-data-center-a-national-nursing-crisis

Niskala, J., Kanste, O., Tomietto, M., Miettunen, J., Tuomikoski, A. M., Kyngäs, H., & Mikkonen, K. (2020). Interventions to improve nurses’ job satisfaction: A systematic review and meta‐analysis. Journal of Advanced Nursing, 76(7), 1498-1508. https://doi.org/10.1111/jan.14342

Oates, J., Topping, A., Ezhova, I., Wadey, E., & Marie Rafferty, A. (2020). An integrative review of nursing staff experiences in high secure forensic mental health settings: Implications for recruitment and retention strategies. Journal of Advanced Nursing, 76(11), 2897-2908. https://doi.org/10.1111/jan.14521

ONA. (n.d.). Official report: The state of nursing in Ohio. ohnurses.org. https://ohnurses.org/wp-content/uploads/2023/09/ONA-White-Paper_092523.pdf

Pressley, C., & Garside, J. (2023). Safeguarding the retention of nurses: A systematic review on determinants of nurse’s intentions to stay. Nursing Open, 10(5), 2842–2858. https://doi.org/10.1002/nop2.1588

Vries, N. D., Boone, A., Godderis, L., Bouman, J., Szemik, S., Matranga, D., & Winter, D. P. (2023). The race to retain healthcare workers: A systematic review on factors that impact retention of nurses and physicians in hospitals. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 60. https://doi.org/10.1177/00469580231159318

Appendix

Citation	Conceptual Framework	Design/ Method	Sample/Setting	Major Variables Studied and their Definition	Measurement	Data Analysis	Findings	Appraisal: Worth to Practice
(Vries et al., 2023)	Not specified	Systematic approach using Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA)	Physicians and nurses working in hospital in European countries	Prevalence of intention of leaving job among nurses and determinants impacting nurses retention and intervention. Determinant include personal features like age and self efficacy, Job factors like workload employees services and working conditions like conflicting settings and organizational culture	Not specified	Not specified	12% to 64% of nurses have intention to left job due to determinants. Leadership intervention and positive work setting improve retention and reduce the intention to quit job	Strength: An systematic study highlighted determinant and strategies to overcome. Robust search strategy used Limitations: Risk of biases. No statistical analysis. The study’s methodology does not offered measurement strategy Ranking: Category III Validity: yes Reliability: yes Applicability: No Overall rank: Moderate
(Oates et al., 2020)	Thematic analysis	Integrative review, systematic research method used including Data extraction, evaluation of quality, and converging qualitative summation	Not specified	Impact of nurses’ experience on nurses’ engagement with patients, impact on nursing practices, and nurses satisfaction	Data-based convergent qualitative synthesis	Not specified	four themes were discovered: patient engagement, ward interpersonal atmosphere, nurse effect, and effects on practice.	Strength:  Integrative reviews. Robust search strategy to evaluate the impact of nursing experience and other determinants of nurse shortage and intervention to overcome the issue. The methodologies offer robust evidence and contribute to our understanding of factors influencing nurses’ satisfaction and retention Limitation: Risk of biases, the quality and methodology of the included research can vary, impacting the robustness and validity of the results. There is no statistics evaluation  Ranking: Level III Validity: yes Reliability: yes Applicability: Yes Overall rank: High
(Niskala et al., 2020)	Profile-likelihood random-effects model	quantitative systematic review and meta-analysis. The PICOS format (P = population; I = interventions; C = comparator; O = outcome; S = study design) was applied	Nurses population	Pre and post single group  and control group Effect of organizational intervention and educational intervention	Not specified	Data analysis using Cohen’s d,  Q-statistic, and tau-squared statistic was calculated to evaluate the influence of intervention approaches on nurses’ work satisfaction.	The interventions focused on education, including workshops and training. In a meta-analysis, two interventions significantly increased nurses’ job satisfaction compared to control groups. The Spirituality Training Program and Professional Personality Growth Program significantly increased nurses’ job satisfaction.	Strength: Quantitative research. Robust method, using profile-likelihood random-effects model. The methodologies offer robust evidence and contribute to our understanding of factors influencing nurses’ satisfaction and retention. Credible study due to risk biases analysis Limitation: The quality and methodology of the included research can vary, impacting the robustness and validity of the results. Can be impacted by significant heterogeneity Ranking: Level One Validity: yes Reliability: yes Applicability: Yes Overall rank: High
(Kueakomoldej et al., 2022)	Not specified	Joanna Briggs’ Scoping Review Methodology and PRISMA-SCR reporting standards	Not applicable	Organizational and community-related variables, nurses’ educational initiatives, and finance aid-related factors	Qualitative analysis,	Thematic analysis, identification of key themes	Nurse shortage-related factors include the individual nurses, nurses’ education programs and funding aid, organizational factors, and community-related factors working with nurses	Strengths: Robust methodology and study design. Offer an extensive outline of appropriate interventions, improving nurses’ experience and intention to retain. Limitation: The practicality of intervention in particular health settings can vary based on the organizational structure and finances Publication Biases Ranking: Level V. Validity: Yes. Reliability: Moderately. Applicability: Yes Overall rank: Moderate
(Alshahrani, 2022)	Not specified	Literature review-based study, no method given	No sample and setting specified	Reasons related to nursing understaffing, its implications, and interventions	Not applicable	Not applicable	Reasons: nurses over work, demographic and personal aspects, work setting, nurses dissatisfaction Implications: compromised safety, nurses burnout, poor care services Intervention: enhancing nursing perception, positive workplace, compensation	Strength: offering concise knowledge and scientific reasoning related to the causes and consequences of the nursing shortage and interventions. The study exhibits the efficacy of target interventions to address contributors to nurse understaffing in hospitals. Limitation: The lack of extensive study design and data extraction and evaluation approach can result in introducing biases and hinder reproducibility Ranking: Level V Validity: yes Reliability: No Applicability: No Overall rank: Low