PICOT

The United States of America is currently facing a severe shortage of registered nurses, which is anticipated to last until the year 2030. This could be attributed to both an aging population and a high number of nurses who are retiring, which has resulted in many job openings for nurses around the country. The demand for nursing services is at an all-time high, which corresponds with the record number of people seeking medical treatment. According to projections made by the American Nurses Association, there will be a serious shortage of registered nurses in the United States over the next few years unless there is a significant increase in the number of nurses joining the workforce. An unprecedented amount of chances will present themselves at the forefront of the ever-evolving healthcare sector as the scarcity of nurses in the United States continues to worsen.  PICOT Question Essay Paper

The PICOT question for this nursing problem is: In acute care settings, does sufficient nurse staffing compared to a nursing shortage lead to quality care and improved patient safety?

P: acute care settings

I: sufficient nurse staffing

C: nursing shortage

O: quality care and patient safety

This PICO question is relevant to nursing because as nurses actively care for patients, nurses play a crucially vital role in maintaining patient safety. Even with critically ill hospitalized patients, doctors may only spend 30 to 45 minutes per day with them, which hinders their capacity to observe gradual improvements in a patient’s health throughout the course of treatment and diagnosis. To ensure that patients get high-quality care and safety, a nurse’s responsibility involves monitoring patients for clinical deterioration, recognizing and conveying changes in patient condition, comprehending care procedures and the inherent limitations in certain systems, spotting errors and near misses, and executing a plethora of other activities. As such, patient safety is put in jeopardy if there are not enough nurses available to carry out these kinds of activities.

The databases I used for my literature search include CINAHL Plus with Full Text and MEDLINE. These databases are great resources for nursing research because they are assertive, peer-reviewed, and comprehensive. The keywords I used in my search include nursing shortage, retention of nurses, recruitment of nurses, and demand for nursing services. In addition, I refined my search for articles by applying filters to the results of my search. Because of this, I was able to get the most current research publications that were related to the nurse shortage. Filters are a useful tool that may be used in a variety of different ways to restrict the scope of a literature search. For instance, one can use filters to restrict the results to randomized controlled trials (RCTs) or observational studies.

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In my initial search, I came up with a total of 458 titles. After that, I used the limits on the search, and I identified 27 titles that were pertinent to my PICOT question. Only seven of the studies were able to meet the requirements for level I, which is the highest level of evidence. Twelve of the studies were able to meet the requirements for level II research studies. Three articles most relevant to my PICOT question include:  PICOT Question Essay Paper

Ghafoor Y., Yaqoob, M. A., Bilal, M. A., & Ghafoor, M. S. (2021). Impact of nurse shortage on patient care. Saudi Journal of Nursing and Health Care, 4(4), 114-119. https://doi.org/10.36348/sjnhc.2021.v04i04.003

Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., Smith, G. B., & Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487. https://doi.org/10.1111/jan.13564

Rosenberg, K. (2019). RN shortages negatively impact patient safety. AJN, American Journal of Nursing, 119(3), 51. https://doi.org/10.1097/01.naj.0000554040.98991.23

Accepted Article
This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/jan.13564
This article is protected by copyright. All rights reserved.
DR ALEJANDRA RECIO-SAUCEDO (Orcid ID : 0000-0003-2823-4573)
PROFESSOR JIM BRIGGS (Orcid ID : 0000-0003-1559-4879)
Article type : Review
Corresponding Author Email ID: [email protected]
The association between nurse staffing and omissions in nursing care: a
systematic review
Running head:Nurse staffing and missed care
Authors: Job title:
Peter GRIFFITHS*, BA PhD RN 1,2 Chair of Health Services Research
Alejandra RECIO-SAUCEDO*, PhD 1,2 Research Fellow
Chiara DALL’ORA, MSc, RN 1,2 Research Fellow
Jim BRIGGS, BA, DPhil 3 Professor of Informatics
Antonello MARUOTTI, PhD 1 Professor of Statistics
Paul MEREDITH, MSc, PhD 4 Information Analyst
Gary B. SMITH, FRCA, FRCP5 Visiting Professor
1 University of Southampton, Faculty of Health Sciences
2 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care
(CLAHRC) Wessex
3 University of Portsmouth
4 Portsmouth Hospitals NHS Trust
5 University of Bournemouth

Accepted Article
This article is protected by copyright. All rights reserved.
Jane BALL PhD RN 1,2 Principal Research Fellow
On behalf of the Missed Care Study Group
Corresponding Author
Alejandra Recio-Saucedo
Acknowledgements
The work reported here encompasses a search strategy used in a review conducted under a
contract for the National Institute for Health and Care Excellence. We are grateful to Karen
Welch, Information Scientist, who conducted the original literature searches. This paper and
independent analysis funded by the NIHR Health Services & Delivery Research programme
(Grant number 13/114/17) and the National Institute for Health Research (NIHR)
Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex. We
would like to thank the contribution of colleagues in the research team: Karen Bloor,
Dankmar Böhning, Anya de Iongh, Nicky Sinden, and Paul Schmidt. The views expressed are
those of the author(s) and not necessarily those of NICE, the NHS, the NIHR or the
Department of Health.
Conflict of interest
No conflict of interest has been declared by the authors.
Funding statement
This is independent research funded by the National Institute for Health Research (NIHR) Health
Services & Delivery Research programme (Grant number 13/114/17). The views expressed are those
of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
* Peter Griffiths and Alejandra Recio-Saucedo have co-first authorship

Accepted Article
This article is protected by copyright. All rights reserved.
ABSTRACT
Aims
To identify nursing care most frequently missed in acute adult inpatient wards and determine
evidence for the association of missed care with nurse staffing.
Background
Research has established associations between nurse staffing levels and adverse patient
outcomes including in-hospital mortality. However, the causal nature of this relationship is
uncertain and omissions of nursing care (referred as missed care, care left undone or rationed
care) have been proposed as a factor which may provide a more direct indicator of nurse
staffing adequacy.
Design
Systematic review
Data Sources
We searched the Cochrane Library, CINAHL, Embase and Medline (2006-2016) for
quantitative studies of associations between staffing and missed care. We searched key
journals, personal libraries and reference lists of articles.

Accepted Article
This article is protected by copyright. All rights reserved.
Review Methods
Two reviewers independently selected studies. Quality appraisal was based on the National
Institute for Health and Care Excellence quality appraisal checklist for studies reporting
correlations and associations. Data were abstracted on study design, missed care prevalence
and measures of association. Synthesis was narrative.
Results
Eighteen studies gave subjective reports of missed care. 75% or more nurses reported
omitting some care. Fourteen studies found low nurse staffing levels were significantly
associated with higher reports of missed care. There was little evidence that adding support
workers to the team reduced missed care.
Conclusions
Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals.
Missed care is a promising indicator of nurse staffing adequacy. The extent to which the
relationships observed represent actual failures is yet to be investigated.
Keywords
systematic review, nursing staff, skill mix, missed care, care left undone, implicit rationing,
quality, workforce, hospital

Accepted Article
This article is protected by copyright. All rights reserved.
SUMMARY STATEMENT
Why is this research or review needed?
 The role of nurse staffing to maintain patient safety was recognised in the safe staffing
guidelines for adult hospital wards produced by the National Institute for Health and
Care Excellence.
 The National Institute for Health and Care Excellence has highlighted the need for
more evidence on indicators that more directly reflect the impact of nurse staffing on
patient outcomes.
What are the key findings?
 Low Registered Nurse staffing is associated with omission of essential care.
 Missed care is a promising indicator of nurse staffing adequacy.
How should the findings be used to influence policy/practice/research/education?
 Given the potential consequences of missed care, its incidence/prevalence may serve
as an indicator of care quality.
 Maintaining adequate staffing levels is a mechanism to avoid missed care.  PICOT Question Essay Paper