How nurses rate daily job difficulty plays key role in patient care
A nurse's perception of the difficulty of the workday has a bearing on his or her ability to provide the best care possible, findings showed.
A neonatal intensive care unit nurse's ability to provide optimal patient care is influenced by a variety of factors -- not just how many babies he or she is caring for or how sick they might be, a new study suggests.
The study, which appears in the journal JAMA Pediatrics, highlights the importance of considering multiple pressures that nurses experience, as well as developing a broader toolkit of workload strategies that enable high-quality nursing care at the bedside.
WHY IT MATTERS
A nurse's perception of the difficulty of the workday -- everything from being squeezed for time to the mental pressures of the shift -- had a bearing on his or her ability to provide the best care possible, regardless of how many patients the nurse was tending to, the findings showed.
This has reimbursement implications, as the move to value-based care means care quality is becoming ever more intertwined with clinical quality. It also has brand reputation implications, as consumers now possess tools to rate their providers online, creating extra incentive for hospitals to deliver a satisfying patient experience.
THE TREND
Nurses operate within a highly competitive job market, and as is the case in other high-stress fields, there's a fatigue starting to set in. Burnout is a very real danger, and much like physicians, nurses are prone to leaving when they've finally had enough -- and that turnover can have detrimental effects on everything from a hospital's financial strength to the quality of patient care.
WHAT ELSE YOU NEED TO KNOW
The study included data collected during 332, 12-hour shifts from 136 NICU nurses, and information collected included objective measures of infant-to-nurse staffing ratios and infant acuity; a simple questionnaire that measured perceived workload based on mental demand, physical demand and overall effort needed to accomplish patient care; and reports on tasks considered "essential care" that nurses missed during shifts.
The team compiled all of that information and created multiple statistical models to evaluate the relationships between objective and subjective workload measures and quality of care.
Regardless of the model, the nurses' perceived workloads had a consistently strong influence on missed essential care -- activities that included hourly assessments of the patients' intravenous sites, oral feedings, collection of laboratory results and safety checks of equipment and alarms.
This study did not evaluate patient outcomes, but other research has established that missing the type of essential care tracked in this study is linked to poorer patient outcomes.
Some of the models showed that higher patient ratios contributed to missed care, which has been demonstrated in other studies. But the researchers saw little connection in this study between the severity of patients' health status and missed care.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
