Critical Appraisal of Evidence in Nursing Field


Critical appraisal of research is an integral part of evidence-based practice (EBP). Any change proposal should rely on results of valid, reliable, and applicable studies. The evidence should support both the problem and the proposed intervention to address the matter. While evaluating literature, a care provider is to state the strengths, limitations, and validity of every research. The present paper offers a summary of evidence that supports the proposed intervention to address the issue of understaffing of nurses in outpatient care.

Search Method

The search for evidence to support the problem and intervention was conducted between the beginning of April and the end of July 2019. Grand Canyon University library, Cochrane Database, Medline, and Google Scholar were used to acquire the needed information. To be included in the review, articles were supposed to be written in English, published not earlier than 2014, and address the topic of the shortage of nurses or the unequal gender representation of men in the profession. The keywords were “nurse understaffing,” “men in nursing,” “nurse retention,” “male hiring nursing.” The search generated multiple results; however, only 30 of them were included in the initial reference list.


Glette, Aase, and Wiig (2017) conducted a literature review and thematic analysis of thirty-three studies which showed that the insufficient number of nurses might be associated with increased patient harm and mortality (Glette et al., 2017). The strengths of the study include the number of considered articles and the methods used for information extraction and literature review. However, the results are limited since the review concerns only nurses, and the articles are written only in English. The validity of the methods is confirmed by various studies, as mentioned by the authors.

Kiekkas et al. (2019) also explored the problem of nurse understaffing in their observational, single-center, prospective study. After studying 2,207 patients admitted to the post-anesthesia care for five months, Kiekkas et al. (2019) concluded that insufficient nurse staffing is associated with a higher incidence of hypoxemia and arterial hypotension. The strength of the research is the sample size while the study is limited to only one facility and 5-month period. Cross-validation and verification of collected data were ensured to prevent bias.

Metcalf, Wang, and Habermann (2018) conducted a survey among hospital managers and reviewed it results to study correlations between the number of missed treatments and staffing of front-line employees. The validity of the survey was assured by pre-test and revision. The strength of the research is the number of hospitals under study, while the apparent limitation is the use of subjective data. In short, the three studies mentioned provide sufficient evidence to confirm that nurse understaffing is a critical issue in modern reality.


The proposed intervention to address the problem of insufficient staffing is attracting more men to the profession by focusing on career opportunities while hiring and anti-sexism posters and training sessions. Clow, Ricciardelli, and Bartfay (2015) surveyed 165 undergraduate students to confirm that the focus on masculinity while hiring male nurses may be associated with role incongruity. The primary strength of the study is the reliability since the method for analyzing data was appropriately used. However, even though the study had a robust conceptual framework, validity remains a limitation.

Carrigan and Brooks (2016) conducted a literature review of 31 articles to understand the reason for the insufficient number of males in the nursing profession. The strength of the articles is the holistic approach to the matter, while the significant limitation of the research is the absence of clearly articulated methods. The article may be classified as expertise, and the validity cannot be assessed.

Rule, Bjornsdottir, Tskhay, and Ambady (2016) conducted multiple studies of different experimental and non-experimental designs that confirm that male nurses are considered to be gay, which leads to sexism in the workplace. The strongest points of the research are its reliability and validity of external and internal. However, the samples are the US citizens, which limits the study to one country.

Yi and Keogh (2016) reviewed four papers out of 11,458 search results to understand why males fail to choose nursing as a profession. The obvious limitation is the number of sources and their qualitative nature. However, the apparent strength of the study is that the researches were assessed by six reviewers. Therefore, the validity of the research is high, and the results are trustworthy.

Stanley et al. (2016) employed a non-experimental, comparative, descriptive research design focused on a quantitative methodology to understand why men choose nursing as their profession. The 34-item questionnaire was distributed online among 1055 respondents, which is a relatively large sample size. The survey is characterized by strong content validity and high Cronbach’s Alpha of 0.91 (Stanley et al., 2016). However, the research results are limited only to Western Australia.

Twomey and Meadus (2016) recruited 239 male nurses to conduct a qualitative study to understand the reasons for choosing the profession and barriers of becoming a nurse. The instrument used for assessment scored high in the face and content validity, while Cronbach’s Alpha was 0.71 (Twomey & Meadus, 2016). While the significant strength of the research is its validity and the sample size, its results are limited only to Atlantic Canada.

O’Connor (2015) conducted a qualitative study interviewing 18 male nurses about the reasons for becoming a nurse. While the research provided valuable results, the small sample size limits the study’s generalization capabilities. However, since the research method is reported to have been tested by authoritative scholars, the content validity of the method and its reliability is high.


Nurse understaffing is a considerable bother for the healthcare system since it is associated with increased patient morbidity and mortality. One of the ways to address the matter is to attract more men to the profession. The critical appraisal of evidence confirmed that addressing workplace sexism and adoption of men-focused hiring strategies is an efficient way of reducing nurse shortage.


Carrigan, T. M., & Brooks, B. A. (2016). Q: How will we achieve 20% by 2020? A: Men in nursing. Nurse Leader, 14(2), 115-119.

Clow, K. A., Ricciardelli, R., & Bartfay, W. J. (2015). Are you man enough to be a nurse? The impact of ambivalent sexism and role congruity on perceptions of men and women in nursing advertisements. Sex Roles, 72(7-8), 363-376.

Glette, M.K., Aase, K., & Wiig, S. (2017). The relationship between understaffing of nurses and patient safety in hospitals—A literature review with thematic analysis. Open Journal of Nursing, 7, 1387-1429. Web.

Kiekkas, P., Tsekoura, V., Aretha, D., Samios, A., Konstantinou, E., Igoumenidis, M.,… Fligou, F. (2019). Nurse understaffing is associated with adverse events in postanaesthesia care unit patients. Journal of clinical nursing, 28(11-12), 2245-2252.

Metcalf, A., Wang, Y., & Habermann, M. (2018). Hospital unit understaffing and missed treatments: Primary evidence. Management Decision, 56(10), 2273-2286. doi: 10.1108/md-09-2017-0908

O’Connor, T. (2015). Men choosing nursing. The Journal of Men’s Studies, 23(2), 194-211. Web.

Rule, N., Bjornsdottir, R., Tskhay, K., & Ambady, N. (2016). Subtle perceptions of male sexual orientation influence occupational opportunities. Journal of Applied Psychology, 101(12), 1687-1704. Web.

Stanley, D., Beament, T., Falconer, D., Haigh, M., Saunders, R., Stanley, K., … Nielson, S. (2016). The male of the species: A profile of men in nursing. Journal of Advanced Nursing, 72(5), 1155–1168. Web.

Twomey, J. C., & Meadus, R. (2016). Men nurses in Atlantic Canada: Career choice, barriers, and satisfaction. The Journal of Men’s Studies, 24(1), 78-88.

Yi, M., & Keogh, B. (2016). What motivates men to choose nursing as a profession? A systematic review of qualitative studies. Contemporary Nurse, 52(1), 95-105. Web.