Introduction
Quality patient care and a sense of fulfillment at work are both dependent on newly hired individuals being part of our team. Improvements in patient and staff well-being can be made above the minimum requirements of The Joint Commission and the Hospital Consumer Rating of Health Care Providers and Systems with the help of research and methodology. Understanding how we might excel beyond basic care requires an examination of Nursing Sensitive Quality Indicators (NSQIs), as defined by the National Database of Nursing Quality Indicators (NDNQIs), and the ways in which these data are used by our team for service improvements (Thorp, 2020). In particular, the number of nursing hours per patient day (NHPPD) will be examined as an indicator in this article, with evidence showing a link between lower NHPPD and lower quality care and an increase in patient mortality and a fall in job satisfaction.
NDNQI and the Definition of Nursing-Sensitive Quality Indicators
Nursing care outcomes are monitored and reported on a quarter-by-quarter basis through the National Nursing Quality Indicators Database, which was created in 1998 by ANA. Health outcomes are measured and evaluated utilizing categories such as patient falls, nosocomial infections, nurse satisfaction and NHPPD with the help of this instrument. Healthcare quality is evaluated using the structure and processes that lead to positive or bad outcomes (Twigg, 2019). Besides pressure ulcers and urinary catheter infections, other quality indicators studied by NHPPD include patient falls, pressure ulcers, pressure sores, and reduced nurse satisfaction. According to the study, a greater nurse-to-patient ratio (NPR) has been linked to lower rates of falls, shorter hospital stays, fewer readmissions, and better rates of patient rescue. Unplanned ICU stays and greater mortality rates were linked to lower NPRs on the other hand. The conclusion was reached that appropriate staffing is required to deliver high-quality care and improve patient safety on the basis of evidence-based data.
Nursing Hours Per Patient Day
Despite the fact that the NPR refers to the number of nurses available per patient, it is important to evaluate the number of nursing hours per patient day. Specifically, the NHPPD is determined by dividing the number of available nursing hours by the number of patients admitted to a hospital or unit during a twenty-four-hour period, taking into account patient acuity, nurse workflow procedure, and patient demographic (Zhang, 2021). Increased NHPPD has been linked to better results for patients, as demonstrated by a 16-month study conducted in Belgian medical/surgical wards. A negative correlation exists between increased workload and NHPPD and patient supervision, which can lead to patient deterioration that may result in medical complications or sudden mortality. HCAs are a vital part of the nursing team’s support network, but they do not appear to be a replacement for a sufficient number of registered nurses.
A retrospective, longitudinal study from an acute care hospital in England examined staffing ratios and mix, patient diagnosis, health outcomes, and patient morbidity. According to this study, the average patient-day staffing level was 5.23 NHPPD and 2.33 HCA hours. Registered nurses comprised 72% of the workforce (RNs) (Blume, 2021). Patients’ risk of death went up by 7 percent when they spent less time in the care of nurses, and when 98 percent of patients were hospitalized over their census norm, their risk of death went up to 3 percent. More specifically, for every additional three hours of RN time per patient, the mortality risk was lowered by 6%, just to be clear. In addition, the risk of death was not statistically reduced by the number of hours of HCA. One additional RN hour per patient day was predicted to extend the average duration of stay by 2.7 hours and reduce the risk of death by 11%. High patient-to-nurse ratios increase the chance of death, but the lack of care can also contribute to patient harm, illness progression, and patient and staff dissatisfaction.
Collection and Distribution of Quality Indicator Data
The collection and dissemination of NHPPD data is a two-way process. Computer technology in hospitals enables physicians and organizational leaders to capture useful data for the evaluation of policies and protocols. This includes censuses, unit capacities, patient diagnoses, condition charts, and adverse occurrences (Kim, 2018). NDNQI can use this data to develop and implement quality improvement programs and revise work schedules for the benefit of patients, employees, and management alike.
Personal experiences in a 143-bed hospital were shared in an interview on NHPPD and the sharing of data. In her role as a nurse and staff member closely observing the NHPPD, there are worries regarding patient outcomes and recurrent staff shortages. She explained that her firm employs the Cerner system, which can be accessed by nurses, advanced care providers, administration, and healthcare aides. This form of data gathering aids in the tracking of population, patient state, and outcomes, as well as an insight into all quality indicators of nursing sensitivity in general (Kim, 2018). A variety of quality indicators, issues, and possibilities for improvement are reviewed in safety meetings and emails sent to staff on a periodic basis by the company.
Even though the data collection process is normally reliable, there may be interruptions due to system faults, slow internet, or computer malfunctions. NHPPD’s assessment by the NSQI found that prospects for improvement were limited due to a lack of staff and an increase in patient hospitalizations. Several of the seven nurses who recently left her department claimed weariness and burnout as the primary reasons for their departure. For her company, text messaging is a current technological breakthrough that she frequently employs. Sharing data and information is handy but does not always lead to greater staffing and NHPPD.
Conclusion
NSQIs such as NHPPD are useful indicators of quality patient care and increase the risk of mortality or harm for patients when NHPPD is low, as documented in these papers and specifically stated. Additionally, it is necessary to conduct regular reviews of organizational personnel in order to avoid nurse fatigue and future staff reductions, both of which could contribute to a drop in the quality of patient care. Patients and their caregivers can benefit from professional research and review collaborations that use clinical data and technology.
References
Blume, K. S.‐H. (2021). Staffing levels and nursing‐sensitive patient outcomes: Umbrella review and qualitative study. Health services research, 56(5), 885-900.
Kim, C. G. (2018). Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: a retrospective observational study. International Journal of Nursing Studies, 80, 115-164.
Thorp, A. M. (2020). Empowering Nurses to Engage With Transplant Quality Data and Outcomes. Progress in Transplantation, 30(2), 169-171.
Twigg, D. E. (2019). A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting. Journal of advanced nursing, 75(12), 3404-3423.
Zhang, M. C. (2021). Nursing‐sensitive quality indicators for pernicious placenta previa in obstetrics: A Delphi study based across Chinese institutions. Nursing Open, 8(6), 3461-3468.