The impact of a planned change to nurse staffing levels in emergency departments: a pre-test, post-test design

Abstract

Aim: to examine burnout levels, nurse perceptions of the work environment, job satisfaction, intention to stay and quality of care for nurses working in emergency departments before and following a planned change to nurse staffing levels.

Design: a pre-post observational design.

Methods: a systematic approach (Nursing Hours per Patient Presentation) was introduced to determine nurse staffing levels based on patient presentations resulting in adjustments to nurse staffing. Data on burnout, the work environment, intention to stay, job satisfaction and quality of care were collected from three emergency departments prior to and following the adjustments to nurse staffing.

Results: an adjustment to nurse staffing levels was made to all three emergency departments. Mean emotional exhaustion scores were significantly lower, and quality of work environment scores and levels of job satisfaction were significantly higher for nurses following staffing adjustments. There was an increase to the proportion of nurses who perceived an improvement in quality of care delivered. In general, the results indicated improvements in outcomes following adjustments to nurse staffing levels.

Conclusion: a more holistic organisational approach is required to address staffing in emergency departments. Initiatives that involve frontline nurses in resource planning facilitating a bottom-up approach to allow for improved work environments would be beneficial.

Impact: this study addressed a planned change to nurse staffing levels in emergency departments and staff outcomes pre and post changes to staffing levels. This study highlighted that staffing an emergency department, based on nursing hours per patient presentation, was associated with improvements in staff outcomes. The research will impact on nurses working in emergency departments as outcomes from this research were used to develop a Framework for Safe Nurse Staffing and Skill Mix in Emergency Care Settings.

Reporting method: STROBE and SQUIRE checklist.

Patient or public contribution: no Patient or Public Contribution.

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