Systematic Review of Turnover/Retention and Staff Perception of Staffing and Resource Adequacy Related to Staffing

By Shimp, Kevin M. | Nursing Economics, September/October 2017 | Go to article overview

Systematic Review of Turnover/Retention and Staff Perception of Staffing and Resource Adequacy Related to Staffing


Shimp, Kevin M., Nursing Economics


An optimal nurse-to-patient ratio is a national challenge. Finding the correct ratio without addressing acuity should not be overlooked even though there is a lack of literature existing to address this aspect of the overall concern of inadequate resources to meet patient needs. According to the American Nurses Association (ANA, 2015), adequate staffing levels have shown reduced medical and medication errors, decreased patient complications, decreased mortality, improved patient satisfaction, reduced nurse fatigue, decreased nurse burnout, and improved nurse retention and job satisfaction.

In July 2002, The Joint Commission stated that staffing effectiveness is the appropriate level of nurse staffing that will provide for the best possible outcome of individual patients throughout a particular facility (Health Leaders Media, 2010). This requires hospital administration to track two patient outcome indicators such as falls and hospital-acquired pressure ulcers and determine the variation in performance caused by the number, skill mix, or competency of the staff. In June 2009, this standard was suspended due to the debate that nurse staffing impacted patient outcomes. As a result, interim staffing effectiveness standards came into effect July 1, 2010 and will remain in effect while further research is conducted on staffing's impact on patient outcomes (Health Leaders Media, 2010). Healthcare leaders have been creative in developing strategies to build a safer environment for patients and registered nurses (RNs). Any optimal staffing model must include patient acuity, unlicensed assistive personnel, and the skills, education, and training of the workforce within specific unit settings to be effective. Appropriate staffing is imperative to provide safe and quality patient care (ANA, 2015).

There is a lack of evidence that addresses the influence of staffing and scheduling committees on RN turnover, retention, and their perception of staffing and resource adequacy. A systematic review of the current literature was conducted to add to the overall literature, developing a baseline for RN turnover, retention, and RN perception of staffing and resources adequacy. The purpose of this systematic review was to identify common themes that can be used to evaluate the author's future descriptive study on staffing and scheduling committees' influence on turnover, retention, and staff perception of staffing and resource adequacy at the institutional level when the committee utilizes staff RNs in their decision process.

Background

Since California mandated the ratio between nurses and patients, seven states (Oregon, Washington, Ohio, Illinois, Connecticut, Rhode Island, and Texas) enacted laws or adopted regulations regarding nurse staffing. These states did not follow California's lead in mandating specific nurse-to-patient ratios. Most of these states modeled legislation from the ANA Safe Staffing Principles which address the problem by requiring hospitals to create nurse staffing committees comprising at least 50% clinical nurses. These committees are responsible for developing staffing plans tailored to the institution (Shullanberger, 2000).

Identifying and maintaining the number and mix of nursing staff to patients while considering patient acuity is critical to the delivery of safe and quality care. Frequent studies have revealed an association between higher levels of experienced RN staffing and lower rates of adverse patient outcomes including mortality. The literature shows the number of RNs at the bedside impacts the safety of both patient and nurse (ANA, 2015).

Some authors suggest legislation and regulation is the only way to achieve adequate staffing, but in reality regulation is already in place. At the federal level, legislation was created in 2008 to amend or introduce new staffing guidelines for the healthcare industry. In the 114th Congress, House Bill 2083 and Senate Bill 1132 sought to amend Title XVIII (Medicare) of the Social Security Act which requires Medicare-participating hospitals to implement a hospital-wide staffing plan for nursing services within their organization. …

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