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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

HCM 440 – X1489 Healthcare Research & Evaluation

Southern New Hampshire University

October 4, 2022

References
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

Ahola, K., Toppinen-Tanner, S., & Seppänen, J. (2017). Interventions to alleviate burnout

symptoms and to support return to work among employees with burnout: Systematic

review and meta-analysis. Burnout Research, 4, 1-

11. https://doi.org/10.1016/j.burn.2017.02.001

Ahola, Toppinen-Tanner, and Seppänen conducted a systematic review and meta-

analysis of interventions that assist healthcare workers in preventing or decreasing

burnout symptoms. To analyze the outcomes of primary and secondary interventions to

alleviate burnout symptoms, the authors examined 14 studies. Primary interventions can

prevent burnout. A secondary intervention focuses on healthcare workers at risk of

burnout. In contrast, a tertiary intervention helps to relieve the symptoms of burnout in

individuals who have already been affected by it. This review aims to determine whether

interventions focusing on individuals and organizations are more effective than those

focused solely on individuals. In total, 14 studies were conducted in Sweden, the

Netherlands, Finland, Cuba, Portugal, and Turkey on healthcare workers. As a result of

their burnout scores, these employees either were experiencing workplace burnout, were

participating in surveys and interventions, or were undergoing clinical evaluation. Six

studies involve a controlled before and after design (CBA) and a randomized controlled

trial (RCT). The control group received no intervention or treatment, while the

intervention group received no treatment or intervention. Healthcare workers of both

sexes are included in the sample. Statistical analysis, burnout inventory assessments, and

questionnaires were used to analyze the data. It can be concluded that individual
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

interventions do not alleviate burnout symptoms; however, further research on combined

interventions is required. As the review explores burnout among healthcare workers and

its impact on healthcare workers compared with no interventions, it is aligned with the

PICO question. The study has a high LOE of I since it is a systematic review and meta-

analysis, enhancing its validity and usefulness.

Perski, O., Grossi, G., Perski, A., & Niemi, M. (2017). A systematic review and meta-analysis

of tertiary interventions in clinical burnout. Scandinavian Journal of Psychology, 58(6),

551-561. https://doi.org/10.1111/sjop.12398

This systematic review and meta-analysis were published electronically in 2018 in the

Scandinavian Journal of Psychology by Perski, Grossi, and Perski. This paper aims to

examine the effect of tertiary interventions on the return to work of individuals with

clinically significant burnout. A randomized control trial of tertiary interventions was

conducted, both randomized and nonrandomized. A team of two independent reviewers

extracted and analyzed the data. Participants in this study were individuals suffering

from clinical burnout and 18 years of age or older. The effectiveness of the interventions

was evaluated by analyzing the return to work (RTW), the time until RTW, and the

psychosocial behaviors that affected the outcome. Based on the results of this study, it

was concluded that interventions did not significantly influence employees' total return

to work. Their efforts have, however, resulted in a shorter return to work period. Burnout

is also associated with perfectionists and individuals who are highly dedicated to their
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

careers. To reduce the symptoms of burnout, it is necessary to address these types of

external behaviors. Several studies have explored the effects of stress management

interventions on healthcare workers' burnout, including this review, which supports the

PICO under consideration. Other sources do not examine the use of tertiary interventions

in the same depth as this research. According to the LOE of I in this review, this review

has more validity in determining the optimal intervention for clinicians experiencing

burnout and how to return to their respective careers.

Pijpker, R., Vaandrager, L., Veen, E. J., & Koelen, M. A. (2019). Combined interventions to

reduce burnout complaints and promote return to work: A systematic review of

effectiveness and mediators of change. International Journal of Environmental

Research and Public Health, 17(1), 55. https://doi.org/10.3390/ijerph17010055

The authors of this article analyze the effectiveness of combined interventions in

decreasing burnout, written by Pijpker, Vaandrager, Veen, & Koelen. This review

identifies integrated interventions that are effective at treating burnout and why they are

effective. In this study, a systematic review is conducted. Researchers consider

employees and combined interventions, control groups, Maslach Burnout Inventory

(MBI) assessments, and time to return to work when devising the design. This is

accomplished using three research design approaches: Randomized Controlled Trials

(RCT), quasi-experiments, and pre-test/post-test studies. Male and female healthcare

workers in the United States, Sweden, Netherlands, Norway, Finland, Hong Kong, and
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

England were selected for the study. Combined interventions are characterized by two

types: person-directed and organizational-directed. This study was conducted to identify

types of combined interventions and their success rates and determine what factors lead

to success or failure. Nine combined interventions are effective in treating burnout

symptoms in 10 studies. The study identified that the most successful interventions were

those which increased employee involvement in decision-making, decreased employee

workload, provided social support, and focused on employee wellness. Efforts are being

made to reduce burnout symptoms through research on this topic. It is clear from the

results of this study that combining individual and organizational interventions is more

effective than just using them separately. Healthcare worker burnout and stress

management interventions align directly with this. PRISMA guidelines were used to

conduct this review, and it has an excellent LOE of I, making it a valuable resource for

supporting the PICO research question.

Pollock, A., Campbell, P., Cheyne, J., Cowie, J., Davis, B., McCallum, J., McGill, K.,

Elders, A., Hagen, S., McClurg, D., Torrens, C., & Maxwell, M. (2020). Interventions to

support the resilience and mental health of front-line health and social care professionals

during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic

review. Cochrane Database of Systematic

Reviews, 2020(11). https://doi.org/10.1002/14651858.cd013779
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

This review has eight authors: Pollock, Campbell, Cheyne, Cowie, Davis, McCallum,

McGill, Elders, Hagen, McClurg, Torrens, and Maxwell. This research aims to support

the resilience and mental health of front-line healthcare workers—analysis of front-line

interventions and outcomes that support healthcare workers' mental health and stability.

The second objective is to determine whether these interventions have strengths or

weaknesses that negatively impact their effectiveness in assisting these front-line

workers. Quantitative and qualitative methods are used in the design process. Studies

using controlled before and after studies, interrupted time series studies, and randomized

control trials are among the methods used. A variety of healthcare workers participated

in the studies. In total, 16 studies were analyzed; 9 were descriptive studies with higher

levels of evidence and validity. A mix of qualitative and quantitative methods was used

in the research, leading to low confidence in their conclusions. Despite the lack of

evidence supporting front-line workers' mental health and resilience, the research

outlines supporting interventions and factors that can boost or hinder those interventions,

supporting the research question and PICO. Mix method reviews have an LOE of V,

which is low.

Wiederhold, B. K., Cipresso, P., Pizzioli, D., Wiederhold, M., & Riva, G. (2018). Intervention

for physician burnout: A systematic review. Open Medicine, 13(1), 253-

263. https://doi.org/10.1515/med-2018-0039
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

In Open Med in 2018, Wiederhold B., Cipresso, Pizzioli, Wiederhold M., and Riva

authored this article. The study aims to raise awareness of burnout among physicians.

Burnout interventions are explored based on PRISMA guidelines. PubMed, Medline,

Web of Science (Web of Knowledge) were used, and PsycINFO. Only four out of 13

studies that met the inclusion criteria used RCTs. For data analysis, only articles using

the MBI were included. Various therapeutic tools should be used to prevent burnout

because many factors can cause it. The personal and organizational levels should also be

holistically approached. Researchers also recommend the early intervention to avoid

burnout and employee training. Based on its LOE of I, it supports the PICO. Moreover,

the research identifies successful interventions for addressing burnout in healthcare

workers. In addition, the research topic also corresponds to identifying personality traits

and behaviors that can influence the effectiveness of such interventions.

Zhang, X., Song, Y., Jiang, T., Ding, N., & Shi, T. (2020). Interventions to reduce burnout of

physicians and nurses. Medicine, 99(26),

e20992. https://doi.org/10.1097/md.0000000000020992

This is a systematic review aimed at summarizing the reviews and meta-analyses on

burnout among healthcare workers that have been published to date. PRISMA guidelines

are followed in the design process. Several databases were used to collect data, including

the Cochrane Library, PubMed, Ovid, Scopus, EBSCO, and CINAHL. There were 22

studies published between 2014 and 2019. Researchers used MBI to assess burnout
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Staff retention on the impact of nurse-to-patient ratios on patient safety and outcomes

among healthcare workers in various interventions. Healthcare organizations can use

these interventions to prevent and decrease employee burnout by simplifying evidence of

their effectiveness. Despite the high risk of bias, a systematic review has a low level of

evidence, making it a valuable source when determining the success or failure of an

intervention. Stress management interventions to prevent burnout in healthcare workers

are directly relevant to this research.