NURS FPX 8045 Assessment 7 Literature Review

Name

Capella university

NURS-FPX 8045 Doctoral Writing and Professional Practice

Prof. Name

Date

Conceptualizing a Potential Project-Signature Assessment

Nursing shortage is a critical issue in health settings, affecting patient care and safety. Understanding and resolving practice gaps is crucial for efficient medical services. Lima Memorial Hospital (LMH) is also grappling with clinical disparity due to nurse understaffing. Scarcity leads to nurse pressure, burnout, and substandard patient care. A recent study found that in 2021, shortages of nurses cost healthcare facilities $24 billion, and in 2022, $86 billion in health expenses (Beauvais et al., 2023). Inadequate staff levels lead to compromised care for patients, which leads to adverse events. The assessment provides a summary of the practice gap and PICO(T) question and discusses solutions to interact with stakeholders to address the nurse understaffing issue at LMH.

Practice Gap and PICO(T) Question

Nursing shortage at LMH creates an immense practice gap in patient care regarding care quality. A recently conducted staff poll at LMH indicated an elevated rate of nurse burnout, including 65% claiming higher workloads due to shortages in staff. LMH is experiencing inadequate nurse-to-patient ratios due to a lack of staffing, which can result in extra exertion, burnout, and a lower level of care. The United States of America (USA) is facing a significant nursing shortage, with an estimated 3.2 million nursing staff needed to cover the gap (Tamata & Mohammadnezhad, 2023).

Ohio Nursing Association (ONA) stated that 83.21% of nurses encountered significant turnover, which resulted in inadequate staffing and unsatisfactory care service. The data reveals significant problems in the use of assets, insufficient planning, retention, and hiring approaches, and insufficient training related to nurses’ skills. Limited nurse staffing is connected with missing care, which leads to adverse incidents (Nantsupawat et al., 2022). Understaffing issues are directly impacting health results, nurse contentment, and organizational compliance with quality medical care.

NURS FPX 8045 Assessment 7 Literature Review

Establishing a PICOT query is essential to bridging the nursing shortage practice disparity identified at LMH. The PICOT strategy delivers tailored research that addresses pertinent challenges (Hosseini et al., 2024). The PICOT question is: In licensed nurses at LMH (P), does improved retention and recruitment policy (I), compared to current strategies without adequate policy (C) enhance nurses’ satisfaction and retention (O) over 12 weeks (T)? PICO(T) comprises recruiting and keeping staff policy interventions such as creating a favorable work environment, providing nurses with training and remuneration packages, and developing an effective retention and hiring method (Pressley & Garside, 2023). The PICO(T) questions focus on increasing the continuation and job satisfaction of licensed nurses at LMH, enhancing the level of care and patient safety within 12 weeks.

Bridging this practice disparity through a Doctor of Nursing Practice (DNP) initiative allows for significant advances in healthcare, improves medical results, and strengthens the organization’s commitment to providing high-quality healthcare. Applying policy-based interventions is consistent with the DNP’s goal of improving patient results. The intervention is consistent with the DNP project; it promotes evidence-based procedures to resolve staff shortages (Pressley & Garside, 2023). The DNP project comprises establishing, executing, and measuring the performance of the change by applying feedback and discussions with stakeholders regarding retention and hiring strategies to improve the understaffing at LMH. Retention and hiring policies result in improved outcomes, like enhanced nursing job satisfaction, nursing skills, and care quality by optimizing nurses-to-patient ratios.

 Research Related to Practice Gap

The gap caused by unfilled nursing posts required to fulfill patient care needs, along with the various factors that lead to understaffing, has received substantial attention in recent research. Research by Tamata and Mohammadnezhad (2023) exhibited that the nurse workforce shortage is a major concern, impacting around one billion patients globally who require high-quality medical care. Increased strain and stress conditions among nurses lead to a lower standard of nursing care, jeopardizing patient safety and boosting patient mortality. The credible study highlighted the causes contributing to the practice gap using a systematic review technique and robust methodology, including a decline in student enrollment in nursing degrees and premature retirement due to the absence of adequate financing and planning.

Other reasons that contribute to staff turnover include an ineffective implementation strategy, an absence of leadership management, nursing training, social support, and work overload or poor job satisfaction. Undesirable raises in wages and poor workplaces are contributing reasons to nurse turnover (Tamata & Mohammadnezhad, 2023). The cited causes are related to the issue at LMH, as nursing shortage impacts the patient owing to the lack of prompt identification of patient complications and patient safety.

The patient-to-nurse ratio is critical for enhancing treatment quality and managing nurse burnout to close the practice gap. According to an observational study conducted by Lasater et al. (2021), a lack of acceptable patient-to-nurse ratio policies contributes to shortages of nurses in hospitals. Poor patient-to-nurse ratios are associated with increased nurse workloads, leading to inadequate care, increased mortality, prolonged hospitalization, and greater hospital costs. It is suggested that hospitals can avoid 1595 fatalities and conserve $117 million by staffing at a 4:1 ratio within a one-year (Lasater et al., 2021). Addressing insufficient nursing ratio is crucial to overcome nursing staffing in hospitals.

NURS FPX 8045 Assessment 7 Literature Review

The participation of nurses at work, job satisfaction, and intention to depart are significant indicators of hospital success, such as LMH. Reducing intention to depart and improving satisfaction help to alleviate the nursing shortage. Nurses’ poor working circumstances and potential risks, such as emotional and physical dangers, can drastically reduce job satisfaction and retention, exacerbating staffing shortages. Challenging workplaces also contribute to the overall negative results in nursing, leading to significant stress due to work and shortages of resources, leading to nurses’ desire to leave their jobs (Wei et al., 2023). Using Convergent Care Theory, Wei et al. (2023) asserted that Nurse turnover can be reduced by employing retention methods such as encouraging workplace cultures, cooperation, and training for skill acquisition. Recognizing factors allows LMH to close the practice gap and improve nurse satisfaction and retention.

Retention of nurses in hospitals such as LMH is contingent on providing opportunities for professional advancement, which increases staff happiness and nursing care abilities. Through a quantitative, analytical approach, Suprapto et al. (2023), underscored the need to develop training resources, advocate for advanced certifications, and provide an appealing workplace to nurses with proficiencies for effective nursing care. Nursing shortages are associated with compromised patient safety, resulting in complications, long hospitalization, and mortality.

NURS FPX 8045 Assessment 7 Literature Review

The register-based study of Peutere et al. (2020), revealed that a 20% rise in inadequate staffing in nursing contributed to a 1.05-fold higher probability of patient fatality. Lack of skill development training leads to poor work experience and satisfaction with nurses’ jobs, ultimately leading to nurses’ understaffing. The studies are crucial to offer an in-depth overview of the factors that lead to nurse shortages in health settings like LMH. A research gap and area of uncertainty exist regarding the role of interprofessional collaboration in improving the practice gap. Further research is needed to learn about the nurses’ perspectives on improving their satisfaction and retention.

Solutions to Address the Practice Gap Based on Analysis and Synthesis of Articles

Recommending solutions and actions to solve the nursing shortage at LMH is crucial to improving the standard of care. Recent research studies also provide convincing evidence supporting the adoption of interventions or solutions focused on improving nurse fulfillment and retention, eliminating the observed practice disparities at LMH. First of all, refining hiring and retention processes based on retention and recruitment policy intervention enhances the nurse’s satisfaction. Offering compensation packages and increments can encourage nurses and boost their satisfaction and retention. The research by Alshahrani (2022), underlined the vital significance of changing the adverse impression of nursing, improving wage packages, and the continuing retention of older nurses in solving the shortage of nurses.

Secondly, promoting a positive workplace setting for nurses can aid in reducing nurses’ burnout and turnover rates. Providing a courteous atmosphere, interpersonal support, and a proper balance between work and personal life are critical actions in boosting the retention of nurses. Vries et al. (2023), undertook a systematic evaluation to analyze the impact of workplace conditions on retaining nurses and contentment in hospitals. The study discovered that inadequate nursing leadership and administration and an unappealing job setting contribute to nurse burnout. Research emphasizes the importance of retention and hiring policies, including positive workplaces, to enhance nurses’ satisfaction and resolve understaffing issues.

NURS FPX 8045 Assessment 7 Literature Review

Offering nurses growth opportunities assists nursing staff in improving their skills and enables them to work in stressful environments efficiently. Skill development training and education also enhance nurses’ satisfaction with their jobs and organizations, resulting in increased intention to retain and reducing understaffing issues. Oates et al. (2020), stated the impact of nurses’ experience in psychological settings on retention and hiring by merging data from multiple research. The researchers proposed that investing in mentoring, nurses’ well-being, and educational opportunities can help improve nurses’ experiences and engagement. Niskala et al. (2020) undertook a meta-analysis that indicated the importance of  educational and training opportunities for nursing staff in determining satisfaction with work. Niskala et al. revealed that an education and training-based method significantly boosted nurses’ job satisfaction or job continuation, addressing insufficient staffing difficulties. Research provides evidence supporting the significance of intervention in raising nurses’  retention and recruitment and improving the quality of care at LMH. 

Implementing effective preparation and planning for the hospital’s financial resources can help solve the nurses’ concerns and challenges in the care setting. Appropriate allocation of resources and financing allows for possibilities to enhance nurses’ abilities and improve care standards. The research conducted by Kueakomoldej et al. (2022), proposed solutions aimed at increasing nurse retention through monetary assistance and educational initiatives, enhancing the working environment and training opportunities, successfully addressing the practice gap of staffing shortages, and enhancing the level of care. By aligning solutions with evidence-based procedures, hospitals like LMH can guarantee optimal staffing, increasing patient safety and satisfaction and health outcomes. 

The suggested solutions are crucial and appropriate for LMH to resolve the nursing shortage issue and assist in filling 75 vacant nursing positions. Providing opportunities for professional growth and upgrading nursing abilities through education can increase nurses’ satisfaction. More nurses would prefer to apply and join the nursing team at LMH. Career development training workshops that incorporate mentorship and other collaboration workshops help nurses establish interpersonal connections, skills, and a commitment to provide sufficient healthcare (Niskala et al., 2020; Oates et al., 2020). Providing a courteous atmosphere, financial aid, proper work-life balance, and enhanced remuneration packages can increase nurse retention. (Alshahrani, 2020; Vries et al., 2023).  The metrics to measure the outcomes include the rate of adverse events, length of hospital stays, and mortality rate.

Improved organizational actions will result in boosting job satisfaction and intention to continue the job and encourage nurses to join the hospital to offer nursing services.

Communication with Stakeholders

Communication with stakeholders is critical to conveying concerns related to the practice gap and nursing shortage at LMH. Effectively communicating with stakeholders efficiently conveys information regarding intervention strategies and solution actions among implementation teams. First of all, identifying the stakeholders which are crucial for the implementation of the intervention. The stakeholders include clinicians, nursing staff, hospital executives, human resources staff, and the finance team. Conducting formal and informal meetings to comprehend specific concerns and roles of stakeholders (Paguio et al., 2020).

For example, the nursing staff is concerned about the high nurse-to-patient ratio and heavy workload, while the administration has concerns about hiring and retention strategies. Secondly, tailoring the message or information regarding intervention, considering the concerns and desires of each group on the implementation team. Using open and simple language and avoiding jargon aid in conveying information effectively (Alotaibi et al., 2022). Open communication helps in improving the strategy and stakeholders’ buy-in.

NURS FPX 8045 Assessment 7 Literature Review

Digital tools are effective in fostering efficient communication. Thirdly, utilizing digital tools, video conferencing, online surveys, and update emails is crucial to getting input from stakeholders and offering opportunities for refinement. Update emails also keep every member informed about the progress of the change (Taylor et al., 2020). Lastly, promoting a collaborative environment can aid and encourage all stakeholders to work together to achieve shared goals. Respect and empathy foster a sense of shared accountability in overcoming the practice split. The interactive talks promoted idea-sharing and focused interventions.

Approaches like brainstorming and scenario evaluation can facilitate the debate (Paguio et al., 2020). Adapting communication to the individual demands and concerns of different groups within the implementation team assists in developing an inclusive and successful approach to managing the nursing shortage. Effective communication improves the efficiency of the solutions and also builds an effective and collaborative workplace.

Feedback to Enhance Writing

Reflecting on how feedback has enhanced writing is a crucial step in personal and professional development. Feedback is vital in making potentially difficult subjects easier to understand by limiting the use of jargon. The comments helped me improve the content in every paragraph, making it easier and more concise to develop a uniform structure and clear interconnections across the entire assessment. The feedback helped with the content organization by guaranteeing that the material was presented logically and cohesively. Using a MEAL plan for each paragraph increased the logical order of assessment and coherence.

The writing standards were fulfilled, and writing competence improved by using feedback to correct grammar and use suitable syntax for sentences. The comments also pointed out the need to investigate credible databases such as CINAHL, Google Scholar, and PubMed for pertinent research, reinforcing the assessment’s evidence base. Using the Capella Library’s online tools boosted my research and writing skills. Quality standards were closely adhered to, following the inclusion of writing comments, showing improved proficiency in writing. Integrating comments can promote continual progress and help me develop stronger communication and writing skills, which are essential in any work environment. Incorporating feedback properly will keep my writing concise, pertinent, and engaging, increasing my professional skills and performance.

Conclusion

In conclusion, the nursing shortage is a crucial concern for patient safety and care in health settings, including LMH. The shortage of nurses offers significant challenges, including workload and nurse burnout among existing nursing staff, compromising patient safety and quality of care. An inadequate nurse-to-patient ratio leads to improper or delayed patient care, resulting in adverse events, longer hospitalization, mortality, and increased medical expenses, impacting the hospital’s reputation. Evidence revealed several contributing factors, such as improper planning or financial resources, lack of nurse training, inadequate hiring and retaining procedures, and unfavorable job settings. Contributing factors adversely impact job satisfaction, and nurses tend to leave the job, resulting in understaffing. 

Recommended solutions and interventions like adequate hiring and retaining strategies, through offering compensation packages, increments, and financial assistance, improve nurses’ satisfaction. Offering skill enhancement training and education improves their expertise and boosts their dedication to offering nursing services, ultimately improving the practice gap. Fostering inclusive job setting, collaboration, and interpersonal assistance aid in overcoming nurses’ concerns, mitigating their intentions to leave the job. Evidence-based practices are crucial to addressing the understaffing practice gap in LMH and boosting care services and the reputation of the hospital.

References

Beauvais, B., Kruse, S. C., Ramamonjiarivelo, Z., Pradhan, R., Sen, K., & Fulton, L. (2023). An exploratory analysis of the association between hospital labor costs and the quality of care. Risk Management and Healthcare Policy, 16, 1075–1091. https://doi.org/10.2147/rmhp.s410296

Nantsupawat, A., Poghosyan, L., Wichaikhum, O. A., Kunaviktikul, W., Fang, Y., Kueakomoldej, S., & Turale, S. (2022). Nurse staffing, missed care, quality of care and adverse events: A cross‐sectional study. Journal of Nursing Management, 30(2), 447-454. https://doi.org/10.1111/jonm.13501

Tamata, A. T., & Mohammadnezhad, M. (2023). A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing Open, 10(3), 1247-1257. https://doi.org/10.1002%2Fnop2.1434

Hosseini, M. S., Jahanshahlou, F., Akbarzadeh, M. A., Zarei, M., & Vaez-Gharamaleki, Y. (2024). Formulating research questions for evidence-based studies. Journal of Medicine, Surgery, and Public Health, 2, 100046. https://doi.org/10.1016/j.glmedi.2023.100046

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

Wei, H., Horsley, L., Cao, Y., Haddad, L. M., Hall, K. C., Robinson, R., Powers, M., & Anderson, G. D. (2023). The associations among nurse work engagement, job satisfaction, quality of care, and intent to leave: A national survey in the United States. International Journal of Nursing Sciences, 10(4), 476–484. https://doi.org/10.1016/j.ijnss.2023.09.010

NURS FPX 8045 Assessment 7 Literature Review

Peutere, L., Pentti, J., Ropponen, A., Kivimäki, M., Härmä, M., Krutova, O., Ervasti, J., Koskinen, A., & Virtanen, M. (2024). Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study. International Journal of Nursing Studies, 150, 104628–104628. https://doi.org/10.1016/j.ijnurstu.2023.104628

Suprapto, S., Lalla, N. N., Mulat, T. C., & Arda, D. (2023). Human resource development and job satisfaction among nurses. International Journal of Public Health, 12(3), 1056-1063. https://doi.org/10.11591/ijphs.v12i3.22982

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 7 Literature Review

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

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, 1-21. https://doi.org/10.1177/00469580231159318

Paguio, J. T., & Yu, D. S. F. (2020). A mixed methods study to evaluate the effects of a teamwork enhancement and quality improvement initiative on nurses’ work environment. Journal of Advanced Nursing, 76(2), 664-675. https://doi.org/10.1111/jan.14270

Alotaibi, M. S., Alotaibi, M. S., Aldossri, S. M. M., Alsahli, M. A. A., Alzahrani, N. H., Alsubai, N. A., & Alanezi, A. A. (2022). The effect of effective nurse-patient communication on healthcare quality. Journal of Namibian Studies: History Politics Culture, 32, 1233-1246. https://doi.org/10.59670/nmpbar81

NURS FPX 8045 Assessment 7 Literature Review

Taylor, M. J., Chiya Shikaislami, McNicholas, C., Taylor, D., Reed, J., & Ivo Vlaev. (2020). Using virtual worlds as a platform for collaborative meetings in healthcare: A feasibility study. BioMed Central Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-05290-7 

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