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Relationship between NDNQI Nurse Satisfaction & Staffing

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on 29 October 2013

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Transcript of Relationship between NDNQI Nurse Satisfaction & Staffing

Purpose: Educate nursing students and healthcare providers on the quality indicators of nurse satisfaction and staffing.
Nurse Satisfaction
"The attributes of nursing work environment, including staffing and resources, ward practice, and management were found to have significantly predicted nurses' job satisfaction and intention to leave," (Choi, Cheung, & Pang, 2013, p. 435).

Staffing is a very important component of patient outcomes and nurse satisfaction.
“Nurses are at the front-line of patient care and are in the best position to detect problems, monitor conditions, and rescue when necessary.” - The Joint Commission (Esparaza, 2012)
American Nurses Association. (2013). About NDNQI: our mission. Retrieved from http://www.nursingquality.org/About- NDNQI2
American Nurses Association. (2013). Nurse staffing. Retrieved from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Nurse Staffing
Chen, Y., & Johantgen, M. (2010). Magnet Hospital attributes in European hospitals: a multilevel model of job satisfaction. International Journal Of Nursing Studies, 47(8), 1001-1012. doi:10.1016/j.ijnurstu.2009.12.016
Choi, S., Cheung, K., & Pang, S. (2013). Attributes of nursing work environment as predictors of registered nurses' job satisfaction and intention to leave. Journal of Nursing Management, 21(3), 429-439.
Chou, H., Hecker, R., & Martin, A. (2012). Predicting nurses' well-being from job demands and resources: a cross-sectional study of emotional labour. Journal Of Nursing Management, 20(4), 502-511. doi:10.1111/j.1365-2834.2011.01305.x
De Gieter, S., De Cooman, R., Pepermans, R., & Jegers, M. (2010). The Psychological Reward Satisfaction Scale: developing and psychometric testing two refined subscales for nurses. Journal of Advanced Nursing, 66(4), 911-922.
Duffield, C., Roche, M., Diers, D., Catling-Paull, C., & Blay, N. (2010). Staffing, skill mix and the model of care. Journal Of Clinical Nursing,19(15-16), 2242-2251. doi:10.1111/j.1365-2702.2010.03225.x
Esparza, S., Zoller, J., White, A., & Highfield, M. (2012). Nurse staffing and skill mix patterns: Are there differences in outcomes?. Journal Of Healthcare Risk Management, 31(3), 14-23. doi:10.1002/jhrm.20092
Flynn, M., & McKeown, M. (2009). Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research. Journal Of Nursing Management, 17(6), 759-766. doi:10.1111/j.1365-2834.2009.01023.x
Hinshaw, P. (2011). The national database of nursing quality indicators (NDNQI): linking nurse staffing with patient outcomes. Arizona Nurse, 64(2), 6.
Jones, C., & Gates, M. (2007). The costs and benefits of nurse turnover: a business case for nurse retention. Online Journal Of Issues In Nursing, 12(3),
Montalvo, I. (2007). The national database of nursing quality indicators (NDNQI). Online Journal of Issues in Nursing, 12(3), 1-8.
Sanford, K. (2010). Nurse staffing. Finding the right number and mix. Hfm (Healthcare Financial Management), 64(9), 38-39.
Trossman, S. (2005). Who you work with matters: RN surveys reveal the importance of working relationships to job satisfaction. American Nurse, 37(4), 1.
Whitehead, D., Weiss, S.,& Tappen, R. (2010). Essentials of nursing leadership and management. (5thed.). Philadelphia, Pennsylvania: F.A. Davis Company.
Workload due to understaffing directly effects nurse satisfaction

Understaffing r/t a nursing shortage caused negative consequences

Deprived of rest days

Prone to musculoskeletal and back injuries because of workload (Choi, Cheung, & Pang, 2013).
Work Environment
Nurses working in an adequately staffed environment had more positive job experiences and a better perception of care quality (Choi, Cheung & Pang, 2013)

higher overall job satisfaction

Under staffing caused more negative outcomes r/t heavy workload (Choi et al., 2013)

deprived of rest

prone to back and musculoskeletal work injuries

Psychological Reward
Key component of the social exchange relationship between employees and employers

employees invest time and effort into careers and expect reward in return

Psychological reward satisfaction is a better predictor of RN job satisfaction than monetary rewards (De Gieter, De Cooman, Pepermans & Jegers, 2010).

Symbolic value- satisfying internal need for recognition of achievement (De Gieter et al., 2010)

shows employees their good work is noticed and appreciated

Provides incentive to continue working in the same manner

Presence of assistive devices to help nurses complete their jobs more easily will help prevent work injuries (Choi et al., 2013).

Patient lifts


makes tasks easier and less time consuming for nurses
Budget: Psychological Reward
Psychological rewards require no money

Influence employees' morale, turnover intention and organizational commitment (De Gieter et al., 2010)

Retain employees and spend less money on nurse turnover
Salary vs. Psychological Reward
Social exchange relationships based on feelings of mutuality result in better work relationships, committed employees and trust in the employing organization

Monetary rewards and bonuses standardized; not based on individual performance (De Gieter et al., 2010).

psychological reward- individual performance

Nurses that believe they are valued and supported by managers and leaders have more job satisfaction and intent to stay in the position

Nurses want managers to discuss issues and consider their views when implementing quality measures and unit decisions (Choi et al., 2013)
Democratic leadership strategies

Effective managers communicate with staff, show sensitivity, understanding and support (Choi et al., 2013)
Co-worker relationship
Mutual respect

spoken word
nonverbal message
emotional state
cultural background affects interpretation of message (Whitehead, Weiss & Tappen, 2010).

Conflict arises everywhere
handled with skill by every involved party--> stimulate learning about peers and how to more effectively work together

Resolving conflict well -> improved work relationships and higher productivity
(Whitehead et al., 2010).
What is NDNQI
National Database of Nursing Quality Indicators

Started in 1998 by the ANA

The NDNQI is the only national, nursing quality measurement program that provides hospitals with unit-level performance comparison reports for state, national, and regional percentile distributions. (ANA, 2013)
Provides quarterly and annual reporting
outcome indicators

Build the nursing's body of knowledge that improves the relationship between nurse staffing and patient outcomes.

NDNQI’s mission: to aid the nurse in patient safety and quality improvement efforts by providing research-based, national, comparative data on nursing care and the relationship of this care to patient outcomes.
(ANA, 2013)

Development of nationally accepted measures to assess the quality of nursing care.

Improvements in training procedures for data submission.

Identification of nursing workforce structures and processes that influence outcomes.

Sharing best practices for improving outcomes.
(Montalvo, 2007)

Operation of NDNQI
University of Kansas Medical Center School of Nursing.

"80% of NDNQI-participating facilities join because they believe in the value of evaluating the quality of nursing care and improving outcomes," (Montalvo, 2007, p. 5).

Quarterly conference calls with the NDNQI

Some indicators include Falls, Nursing Care Hours per Patient Day, Skill Mix, Pressure Ulcer Prevalence, and Nurse Job Satisfaction
(Montalvo, 2007)
Importance of NDNQI
Hospitals evaluations

Reimbursement based off of patient outcomes and results.

NDNQI aids improve quality of care and patient outcomes.

NDNQI measures nursing care by a unit perspective.

Nursing units vary by patient population and type.

Nursing satisfaction has been linked to positive patient outcomes (Hayes, Bonner, & Pryor, 2010)

Magnet Hospitals
Magnet hospitals: institutions that are favorable places for nurses to work.

Attributes are associated with work environments that support professional nursing practice, which is conducive to quality of care and better nurse outcomes

Attributes include: management style, autonomy, interdisciplinary relationships, professional development, quality of nursing leadership, and personnel policies.

Nurses working in hospitals with higher ‘‘magnetism’’ perceive higher job satisfaction and less burnout (Chen & Johantagen, 2010)
Difficult Patients
Higher frequency of interactions with difficult patients: emotional exhaustion and job dissatisfaction (Chou, Hecker, & Martin, 2012).

In their study they defined "difficult patients" as patients that were impatient, complaining, or unreasonable.
Several studies have shown that autonomy increases job satisfaction (Hayes, Bonner, & Pryor, 2010).

Autonomy is defined by Hayes et al. (2009) as "Being able to control one's own work by prioritizing tasks, working without close supervision and having control of decisions within the scope of nursing," (p. 405).

Related because accomplishments can be attributed to oneself (Hayes et al., 2010).

Salary vs. Psychological Reward contd
Trossman (2005) found:
RN satisfaction simply is not about money. A major factor is how well nurses feel supported in their work. Do people listen to us- our managers, upper management, human resources? Being able to communicate with each other-to be able to speak directly with your peers, physicians, or managers in a way that is non confrontational- is really important to having good working relationships and to providing good care. You need to have mutual respect, (p. 1).

Budget: Nurse Turnover
Nurse turnovers are expensive

The cost of a single nurse turnover ranges from $22,000 - $64,000.

Direct costs: advertising cost, hiring process, training process

Strong relationship between nurse satisfaction and retention (Jones & Gates, 2007).
satisfaction->retention->decreased turnover cost
Patient Outcomes

Patient outcome "indicators": infections, pressure ulcers, falls, length of stay at hospital, medication errors and severe incidences such as cardiac arrest (Flynn & McKeown, 2009).

According to Esparza, Zoller, White and Highfield, when there is an increase in the “nursing hours per patient day” and RN skill mix, there is a decrease in hospital acquired UTIs and length of hospital stay, resulting in better patient outcomes (Esparza et al., 2012, p. 3).

IOM reported the Crossing the Quality Chasm: The IOM Quality Health Care Initiative and To Err is Human: Building a Safer Health System to improve staffing outcomes (Esparza et al., 2012).

Better patient care, outcomes, and communication between health care providers are seen with adequate staffing (Duffield et al., 2010).
American Nurses Association
Sufficient Staffing:
Increases "nurse job satisfaction"
Increases patient outcomes & satisfaction
Decreases nurse "fatigue" & "burnout"
Decreases hospital-acquired illnesses
Decreases "medication errors"
(American Nurses Association, 2013)
Nurse-Patient Ratio/ Staffing
No standard for nurse to patient ratio due to differences in types of patients, units and technology (Whitehead, et al., 2010).
A higher ratio increases likelihood of nurse “burnout”, “failure to rescue”, and overall dissatisfaction with jobs (Esparza et al., 2012, p. 3).
NDNQI staffing mix quality indicator includes the appropriate combination of nursing staff and experience for optimum quality and safe patient care (Whitehead, et al., 2010).
Nurse to patient ratio example:
Clinical experience with preceptor
Critical Care Unit 1:3 w/ no UAP
Telemetry Unit 1:7 w/ 2 UAPs
Med Surg Unit 1:6 w/ 2 UAPs
Neuro Unit 1:8 w/ 2 UAPs

Nursing Theory
Behavioral Theory

Democratic leadership in conjunction with team nursing shows how responsibility of patients and workload can be divided among the team

Demonstrates “motivation and creativity” from nurses (Whitehead, et al., 2010, p. 6).
Risks/Patient Safety
A lower skill mix of nurses and other assistive personnel, accounts for a higher prevalence of infections and accidents in the hospital (Duffield, et al., 2010).

Correlation between nurse to patient ratio and overall patient and nurse safety (ANA, 2013).

Higher number of RNs in staffing mix account for shorter length of stay for patients and a decrease in hospital -acquired illness (Sanford, 2010).
Inadequate staffing is the number one reason for high nurse turnover rates (Sanford, 2010).

It was found that 45% of new nurses quit their first job due to insufficient staffing (Sanford, 2010).

Four models of patient care:
Functional nursing
Team nursing
Total patient care
Primary nursing (Whitehead, Weiss & Tappen, 2010)

Team nursing and some Total patient care found to be favorable among nurses (Duffield, Roche, Diers, Catling-Paull & Blay, 2010).

Includes a wider mixture of healthcare provider experience such as RNs, LPN, and other assistive personnel to allow for more effective and safe care of patients (Whitehead Weiss & Tappen, 2010).

Decreases workload and stress for nurses by distributing the workload according to experience and education level (Duffield et al., 2010).

Relationship between NDNQI, Nurse Satisfaction & Staffing
Amber Lawthorne
Sarah Webb
Andrew Schlatter

Target Audience: Nursing students and healthcare providers.
October 28, 2013
Nurse Satisfaction
• Sufficient nurse to patient ratios give nurses decreased stress and the ability to provide better patient care, which in turn shows an increase in nurse and patient satisfaction (Duffield, et al., 2010).

• Job satisfaction was seen when team nursing was allocated due to co-worker and manager encouragement and collaboration (Duffield et al., 2010).
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