The relationship of hospital organizational characteristics to patient clinical outcome: focus on the impact of nursing unit structure and processes to quality Essay Example

Abstract

Proper Nursing care is imperative to insuring positive patient outcomes. This research will emphasize the pertinent issues involved in order to maintain the utmost top quality care and professionalism, within the structured nursing care environment. It will detail what makes some hospitals have a more positive appeal than others. This research will also theorize on the facts of specific statistical tests used to document the organizational characteristics within nursing in variable hospitals. It will show the multifactor issues that are the insinuating results of positive v. negative nursing structures and the resulting outcome of the patient care. A positive issue that will be included is in regards to medical hospitals that the ANA has designated as magnet medical establishments. Ultimately, the key points will be in regards to: the organization within individual nursing atmosphere’s, communication networks between nurses, head nurses and physicians, proper percentage of patient to nurse ratios, over all job satisfaction and performance, and finally how to maintain a proper equilibrium within the medical field of nursing.

The Relationship of Hospital Organizational Characteristics to Patient Clinical Outcome

Nurses have very hectic schedules and the orientation of their field is very high stress. With that in mind, one of the main concerns within medical establishments is in retaining nurses on staff and insuring that they do not suffer from burn out. According to the research provided by Havens, in the article: “Comparing Nursing: Infrastructure and Outcomes,” the majority of Nurse’s are drawn to hospitals which appear to be ones having a well organized nursing structure (Havens 2001). A hospitals environment has a known directed impact upon nursing operations and the percentage of adverse occurrences in patient care. One specific assessment tool that was utilized in the report done by Boyle (2004) was the Nursing Work Index Revised. This was used to measure how varied the organizational characteristics were between magnet hospitals and non-magnet hospitals, with the resulting outcome of the patient used as the comparison (Boyle 2004: p.2). What was specified within magnet hospitals was the fact that the better the communication between nurses and physicians, and the more control that nurses were given in regards to the care of the patient, the more improved the quality of care would be. This type of structure would equal a higher probability of positive outcomes for patients.

Magnet hospitals stand out from non-magnet ones basically due to the recognition they receive for “excellent patient care, strong nursing practice environments, and the ability to attract and maintain nurses” (Boyle 2004: p.2). An extensive study carried out by Aiken and his associates involved researching a study of links between the organization of hospitals and quality of care for patients. This involved a multivariate control sampling implementation. What this research theorized was that even though magnet hospitals had a higher percentage of registered nurses employed, compared to control hospitals, it is not what determined the outcome of the patients welfare (Boyle 2004: p.2). What it did decipher however, was the fact that the levels of autonomy, and the varied control the nurses had is ultimately what had an effect on patient mortality. This was also found to be a concept that could be included into the structure of nursing units in control hospitals to promote more positive patient outcomes. “The magnet hospital structure may be described as an organizational form that promotes nursing practice and results in better patient outcomes when compared to other hospitals” (Boyle 2004: p.3).

Other factors that the article by Boyle emphasized had to do with how heavy a nurse’s workload is, and how the work was controlled. Also, many of the findings provided validity that adverse events are regulated by how well the nurse/physician relationship is and how effective nurse surveillance is with regard to monitoring the patients’ body signs, on a regular basis. Another assessment that is used in recording the quality of care that is given and how a nurse’s performance is critiqued is utilizing score cards. Score cards have become quite a common practice in every hospital environment. It was stressed, however, the scorecard system needs to focus more on the right metrics and also add in a score for how well communication is between staff at the ground nursing unit level.

Furthermore, communication between nurses and physicians is a detrimental issue in nursing. There must be collaboration between these two medical entities in order to provide appropriate medical care for patients. Basically, this is one of the systematic issues in order to guarantee that there will be a quantifiable number of nurse’s who are satisfied within the areas of which they are going to be working (Havens 2001:p.2)

When a hospital promotes superior organization in the nursing structure and the environment is of satisfactory standing then that is when nurse’s are more probable to share the knowledge and experience necessary to provide the highest level of quality care for patients (Boyle 2004: p.3). Also, it has been insinuated that well organized work, through that of nurse’s has the ability to promote positive influences on patient and staff well being (Boyle 2004: p.3). This is emphasized in the fact that patients’ health has been positively retrieved and maintained from adverse health complications through rescue by nurse’s (Boyle 2004: p.3).

The emphasis that Irvine’s article, “Linking Outcomes to Nurse’s Roles in Health Care” gives is in holding individual nurse’s accountable for the percentage of adverse or positive patient outcomes they might have (Irvine 1998: p.1). This type of framework has been argued against by many researchers, simply due to the fact that there is not a certainty in knowing what actually caused the favorable or unfavorable outcomes. Therefore, in order to try and substantiate these outcomes, in all hospital environments, a model is utilized in Irvine’s article, depicting the essential characteristics a nurse has in relation to the care of the patient. For example, the duty of having to transport the patient to various areas of a hospital normally falls within the role the nurse has. This deciphers that whatever takes place during the time the patient is in the actual care of the attending nurse, can be categorized as the direct result of that nurse’s actions (Irvine 1998: p.2). So the components that make up the nurses role in various hospital settings are in correlation to the outcome of the patient. These variables include: “experience level, knowledge, and skill level” in regards to the type of quality nursing care that will be received (Irvine 1998: p.2). Also, it is only fair to the nurse that the patients’ health be assessed upon entry into the hospital. This plays a major role in the final outcome that will be established after the patient is discharged.

The nursing independent role has been determined to be a deciphering factor in outcomes of patients as well. This refers to procedures that are carried out by the nurse without first having to have physician approval. These activities include: “assessment, decision making, interventions, and follow ups” (Irvine 1998: p.4). According to the NIC, these also include nurse intervention treatments in order to rescue the patient from adverse health conditions. Some examples of intervention following the Iowa intervention guidelines would be: “physiologic comfort promotion, coping assistance, self care facilitation, activity and exercise enhancement, immobility management, skin wound management, and nutritional support” (Irvine 1998: p.4). These are all extenuating circumstances that take place in any medical hospital so therefore are all directly relative to the patient outcomes in magnet hospitals, non-magnet hospitals, and control hospitals. In order to be able to provide sufficient quality care, in all of these areas, it all falls back to correct organization in a hospital nursing unit. Specific studies have found that the amount of registered nurses and the percentage of staff are directly related to the outcomes of many complications and the quota of mortality rates as well. Due to the research performed in Irvine’s report, it is found that if there is inadequate staffing within the first three days of a patients stay, then the results equaled a 30% increase in the probability of some form of a complication for the patient. This concurrently leads to the length of stays for patients which can pose more adverse complications. “Adverse event rates for nosocomial pressure ulcer prevalence, falls, cardiac arrest, nosocomial pneumonia, and UTI’s are reported per thousand patient days while death and failure to rescue rates are percentages” (Boyle 2004: p.5). This provides verification that longer stays can lead to more severe problems for the patient and end up in an unfavorable outcome.

Other areas that affect the quality of care in various hospital environments includes the extent of the nurses educational background and the time with a specific nursing unit. Theoretically studies emphasized the fact that 74% of some nurses had a level of education that was marked at a bachelor’s degree or higher (Boyle 2004: p.4). Furthermore, only 46% of nurses were shown to have worked within a specific nursing unit less than 2 years and another 16% had been with a specific unit for less than 5 years. This equals up to 60% of nurses having very little extensive knowledge in caring for acutely ill or diverse patients. This does not bode will for patient outcomes due to the fact that 51% of hospital admissions involve emergency patient care.

In conclusion of these three articles it is found that the contrast and comparison between magnet hospitals and non-magnet hospitals shows that organizational characteristics prove to be a guiding factor in implementing positive patient outcomes. It is imperative to insure the nursing structure within medical facilities is organized and that the nursing units are a balanced equation of knowledge and skill level in varying degrees. Thereby, effective care can be given in all medical situations and in any type of medical environment.

References

Boyle, M. Suzanne (2004). Nursing Unit Characteristics and Patient Outcomes. Nursing

Economics, Vol.22, No.3

Haven, Donna (2001). Comparing Nursing: Infrastructure and Outcomes: ANCC Magnet and Non-Magnet. Nursing Economics, Vol.22, No.3

Irvine, Diane (1998). Linking Outcomes to Nurse’s roles in Health Care. Nursing Economics. Vol.16, No.2