The Relationship Between the Use of Agency Nurses and Patient Outcomes

Abstract

This is a research proposal to investigate the relationship between the use of agency nurses and patient outcomes with reference to failure to rescue, morbidity, and mortality. Some studies show that usages of agency nurses contribute to negative patient outcomes while others attribute such negative outcomes to hospital environments. Thus, further studies are necessary in this area. The research design for the proposal would be a quantitative correlational design. This would allow the investigator to show the relationships between variables. The research participants would be 210 agency nurses. There will be structured questionnaires and tables for data collection. Data analysis techniques would be descriptive statistics and logistic regression. Descriptive statistics will show basic information about study variables while logistic regression would show correlation between variables. Data interpretation will answer the study hypothesis and research questions.

Introduction

The significance of nurse staffing to the delivery of quality health care to patients was “the most important finding in the Institute of Medicine (IOM) committee report” (Wunderlich, Sloan and Davis, 1996, p. 92). The report showed that “nursing was a critical factor in determining the quality of care in hospitals and the nature of patient outcomes” (Wunderlich et al., 1996, p. 92). Therefore, nurse staffing has been a critical health policy matter that policymakers must give a serious consideration. However, there is a general agreement among stakeholders that nurse staffing has effects on the quality of health care outcomes and safety of patients. Hospitals with low nurse staffing levels tend to “have higher rates of poor patient outcomes” (Stanton, 2004, p. 2). As a result, some hospitals have used agency nurses to complement inadequate supply of nurses. There is no clear agreement on impacts of using agency nurses to provide health care services to patients.

Problem statement

Many hospitals depend on agency nurses as ways of addressing the persistent shortage of nurses. However, this practice has raised issues about “the consistency and quality, as well as the cost of care provided by temporary staff” (Joint Commission on Accreditation of Health Care Organizations, 2002, p. 1).

Problem Symptoms

Recent studies have also indicated that work environment and management culture contributed to negative quality of care rather than agency nurses (Aiken et al., 2012). On the other hand, other studies have associated the poor quality of care and patient safety outcomes to agency nurses. There are also issues about the morale of nurses employed by the hospitals and poor relations with the agency nurses (Parsons, 2009). As a result, this literature review seeks to clarify whether usages of agency nurses have negative impacts on the quality patient care within the hospital environment, specifically in failure to rescue, morbidity, and mortality.

Failure to rescue (FTR) refers to cases where caregivers “fail to notice or respond when a patient is dying of preventable complications in a hospital” (Aleccia, 2008, p. 1). Silber and colleagues referred to FTR as “a death after a treatable complication” (Silber et al., 2007, p. 918). The United States’ Agency for Healthcare Research and Quality has recognized data from rates of FTR as crucial indicators of the quality of care and patient safety outcomes. It shows how nurses are sensitive to quality of care during medical care. Aleccia noted that data from HealthGrades reported that more than “188,000 patients lost their lives to FTR between 2004 and 2006” (Aleccia, 2008, p. 1). Mortality reflects deaths that occurred due to nurse staffing characteristics. Morbidity showed the increment in complication among inpatients that delayed recovery and discharge when agency nurses administered care. The earlier research concluded that higher rates of agency nurses were mainly “associated with higher rates of mortality, morbidity, and failure to rescue” (Aiken et al., 2012, p. 931).

Literature review

Interests in agency nurses have been due to staff shortages that started in the 1990s and have persisted to the present time. In addition, projections have shown that nursing shortage shall persist in the US and the world at large. As a result, it shall affect the quality of health care provided and safety of patients and limit the provision of health care services. This implies that staffing and outcomes in the health care quality are critical and relevant for stakeholders in the health care sector.

The review focuses on comprehensive literature in the area of agency nurses and patient care outcomes with to FRT, morbidity, and mortality. In addition, there also other issues that affect patient outcomes like the working environment.

Hypothesis

• H₀: There is no relationship between the usages of agency nurses and failure to rescue, morbidity, and mortality
• H₁: The usages of agency nurses will result in high rates of failure to rescue, morbidity, and mortality among patients
• H₂: The usages of agency nurses will not result in high rates of failure to rescue, morbidity, and mortality among patients

Research design

This is a quantitative correlational study design.

Role and bias of researcher

The researcher shall be in charge of locating and identifying hospitals and nurses who would take part in the study. He will identify appropriate data for the study and what information to exclude from the study. The researcher would develop study instruments. He will classify, count, and develop an appropriate statistical model for describing study results. Further, the researcher shall design every element of the study before the study begins. These elements will include structured questionnaires and checklist document for data from patient outcome records. The researcher will record data in the form of numbers and statistics. He will be able to draw inferences and confirm the study hypothesis. However, in all these roles, the researcher shall remain detached from the study and research participants. The aim is to observe objectivity of the study. In other words, the researcher shall not attempt to influence any aspect of the study by his feelings, beliefs, and experiences.

Sampling techniques

The study will use cluster random sampling method. Random sampling is useful for drawing internal validity. It would assist the researcher to avoid sampling bias in the study.

Participants

The study participants are agency nurses. The researcher targeted 210 research participants in order to get 168 responses.

Data collection methods

The researcher would use structured questionnaires to gather information for the study from research participants. There would also be a table (checklist) to collect data and comments from patient outcome records about failure to rescue, mortality, and morbidity in cases where both agency nurses and regular nurses were in charge of patients.

Instruments

The researcher would use structured questionnaires for data collection from research participants and a table (checklist) to collect data and comments about failure to rescue, mortality, and morbidity from the hospital records.

Research procedure

• The researcher identified the study problem as usages of agency nurses and patient outcomes
• The researcher noted that some studies have associated the usages of agency nurses with high rates of failure to rescue, morbidity, and mortality
• The researcher conducted a literature review of past studies in order to identify what other scholars have done in usages of agency nurses and failure to rescue, morbidity, and mortality as indicators of patient outcomes
• The researcher designed quantitative study approach for the research
• Data collection instruments for the study would be structured questionnaires and a checklist document to capture data from the patient outcome records
• The researcher targeted agency nurses in this study
• The investigator shall send structured questionnaires to agency nurses
• He will also review patient outcome records for cases of failure to rescue, mortality, and morbidity
• Data analysis will involve descriptive analysis and logistic regression

The researcher shall identify all data suitable for tabulation and those for charts, graphs, frequency tables, percentage distribution, and inferences:

• There would be analysis of data and drawing of inferences by answering the research question through inferential techniques and correlation coefficient
• The process shall show how agency nurses (independent variables) correlate with failure to rescue, morbidity, and mortality (dependent variables)
• Quantification of results shall show differences in frequencies
• Results shall be precise and set stage for experimental studies
• The researcher shall write the final report based on study outcomes and inferences

Data analysis

The researcher will use two techniques to analyze collected data, which would include descriptive statistics and logistic regression. The software for data analysis shall be IBM SPSS (Statistical Package for the Social Sciences) version 17.

The initial stage would involve screening data for any errors. This is necessary because of mistakes, which occur when entering data. Thus, the researcher would be cautious to avoid mistakes. He will focus on outliers in the data. Data screening would involve checking, identifying, and correcting errors (Pallant, 2005).

The researcher shall interpret results of data analysis from both descriptive statistics and logistic regression in order to answer research hypothesis and questions.

Conclusion

This has been a process of writing a research proposal about the relationship between usages of agency nurses and patient care outcomes. The proposal covers all areas required for approval.

Building this research proposal presented challenging opportunities for me. It showed me that research proposal must meet all the necessary procedures and guidelines set by the faculty. I wrote this proposal in sections without developing the entire guideline. The experience I have gained in writing this proposal would be useful in my next project. For instance, in my next I will design a rough outline of all areas before embarking on writing. The outline would assist in tackling difficult sections in writing a proposal.

The most complex and challenging sections of the proposal were choosing suitable research design and data analysis techniques. One must formulate a research design, which must answer the research hypothesis and questions. Moreover, it must align with data analysis techniques. The researcher must get this section right for the whole methodology to be right.

The most intriguing part of the proposal was the data analysis section. It is interesting to understand how researchers can use various techniques of data analysis to draw inferences and generalize the findings to a given population. This marks the important aspect and useful part of the study.

This proposal would be useful for reference purposes because of the well-developed literature review and research design sections. In addition, the researcher can proceed to the field and collect data for the research hypothesis and questions.

References

Aiken, H, Shang, J, Xue Y, and Sloane, M. (2012). Hospital Use of Agency-Employed Supplemental Nurses and Patient Mortality and Failure to Rescue. Health Services Research.

Aleccia, J. (2008). Before Code Blue: Who’s minding the patient? Web.

Joint Commission on Accreditation of Health Care Organizations. (2002). Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis. Web.

Pallant, J. (2005). SPSS Survival Manual. Sydney: Ligare.

Parsons, J. (2009). Agency nurses – whats the problem? Web.

Silber, H., Romano, P., Rosen, K., Wang, Y., Even-Shoshan, O., Volpp, G. (n.d.).

Stanton, M. (2004). Hospital Nurse Staffing and Quality of Care. Research in Action, 14, 1-12.

Wunderlich GS, Sloan F, and Davis CK. (1996). Nursing staff in hospitals and nursing homes: is it adequate. Washington, DC: National Academy Press.

Appendix

Research Instruments

1. How many cases of failure to rescue, morbidity, and mortality were reported when agency nurses were in charge of patients?
2. Do agency nurses neglect their roles and engage in actions that affect the quality of health care negatively?
3. Does the relationship between agency nurses and nurses directly employed by the hospitals affect the quality of health care outcome?
4. Do agency nurses observe the quality of care during their work?
5. Do agency nurses affect the quality of health care outcome?
6. Are there notable differences between the use of agency nurses and regular nurses with regard to patient outcomes?

Checklist for Patient outcomes from hospitals