Nurse Leader Perceptions of Appropriate Nurse Staffing: An Omani Perspective

Sunday, 22 July 2018: 2:45 PM

Center for Strategic Initiatives, Augusta University, Augusta, GA, USA
Christie Emerson, MSN, BSN, RN
WellStar School of Nursing, Kennesaw State University, Kennesaw, GA, USA
Laura Caramanica, PhD, MEd, BSN
Tanner Health System School of Nursing, University of West Georgia, Carrollton, GA, USA

Purpose: An important responsibility of nurse leaders is to ensure that there is an adequate number of competent nursing staff to provide safe, effective, efficient, high quality, patient-centered care. Nurse leaders carry out this responsibility as they develop, provide oversight, and evaluate staffing schedules and care delivery models. The delivery of safe and high quality care and service is dependent on adequate numbers of staff, educational level of staff, mix of staff, level of training and a multitude of other variables.

Nursing leaders have the responsibility for reviewing the impact that the nurse career delivery model has on patient care outcomes. Nursing research has revealed positive associations between measures of nurse staffing and patient outcomes which have been demonstrated in hospital systems across the United States and various other countries. Specifically, United States and Canadian health care organizations have studied nurse staffing productivity metrics and the link to enhanced quality patient outcomes. This association is present despite different hospital organizational structures and different healthcare financing methodologies. Appropriate staffing is impacted by numerous variables and the determination of what is considered appropriate staffing for a specific patient care area is extremely complex.

In addition to understanding the internal variables that impact nurse staffing, today's nursing leaders must also consider external factors that influence staffing considerations. Nurse leaders from different countries face similar yet different healthcare delivery dilemmas, In the United States, nurse leaders must consider the impact of the Patient Protection and Affordable Care Act (PPACA). PPACA will provide individuals who were previously unable to effectively access healthcare services the opportunity to become insured and access needed medical care. Healthcare systems and providers are seeing patients who are presenting with higher levels of acuity and multiple chronic comorbid conditions. PPACA has started to shift the focus to prevention of illness rather than treatment alone. Understanding the effects of PPACA will be important for nurse leaders in order to inform innovative staffing models and the enhancement of patient care outcomes.

Similarly, Omani head nurses also contend with internal and external forces the impact nurse staffing. In Oman, a primary issue for nurse leaders is the diversity of the nursing workforce. Nursing leaders have to consider the multicultural nature of their workforce with more than 60 percent of nurses coming from other countries. Over the last few years, Oman has seen rapid population growth and expansion of healthcare services. The nursing workforce is not able to keep pace with the demand for care. These factors impact nurse staffing and potentially patient care outcomes. Considering all of the internal and external variables, establishing appropriate nurse staffing levels is a dynamic multifactorial activity that is a challenge for nurse leaders.

Nurse leaders in a hospital located in Oman participated in this study with a follow-up comparison study planned in the southeastern part of the United States. This study is important because it will improve the profession's understanding of what Omani nursing leaders believe constitutes safe, effective staffing. Additionally, it will increase knowledge about how and to what extent metrics inform staffing and scheduling decisions and the relationship to patient care outcomes in Oman.

The purpose of this qualitative descriptive study was to understand how nurse leaders in Oman define appropriate nurse staffing in today's healthcare environment. Additionally , this study explored what metrics Omani nursing leaders use, as a practical matter, to plan for staffing needs as well as assess effectiveness of staffing models.

The Data Driven Model for Excellence in Staffing (DDMES) and the Principles of Nurse Staffing (2nd ed.) informed this study. It is anticipated that the DDMES framework will generate innovative care models and strategies that will lead to the effective, efficient, optimal use of knowledgable staff and resources that will achieve optimal outcomes.

The research question was: "What factors influence decisions of Head Nurses in Oman to achieve excellence in nurse staffing?"

Methods: A qualitative descriptive study with inductive content analysis was used in this study. Data were collected through fourteen semi-structured interviews utilizing a fifteen-item interview guide. Additionally, data were collected through the use of a sixteen-item demographic questionnaire. The researchers also posed probing questions as needed during the interviews to further elicit details regarding interview items. Both the demographic questionnaire and the interview guide were created for use in this study by the research team and were based on a review of the literature, professional experiences, and in consultation with nursing researchers/leaders from the participating academic-practice partners involved in this project. Omani head nurses were recruited for this study using a purposive sampling technique. After consent was received and the demographic questionnaire was completed, participants were interviewed face-to-face by one of three researchers. Based on Omani customs, nursing leaders from the tertiary care hospital where the head nurses were employed indicated that individual interviews were preferred over focus groups and that male and female research could serve as interviewers. Head nurse participation in this study was voluntary and could have been discontinued at any time without consequences. Interviews were digitally audio recorded. These digital recordings were saved to a University-issued laptop or computer with password protection. Transcription of interviews occurred and the saved audio file was utilized to verify the accuracy of the transcribed document. The transcribed document did not include participant demographic information and was only identified with a numeric identifier. All study related materials were de-identified, kept under lock and key, and/or digitally stored with password protection.

Results: Thematic analysis revealed four themes and twelve sub-themes that emerged from the data. These themes included: (1) Decision-making for nursing resource management is centralized; (2) Operationalization of scheduling and staffing is decentralized; (3) The concept of "team" was an important consideration for head nurses; and (4) Head nurses know staffing relates to quality however lack data to support. The data suggest that senior nursing leaders have responsibility for allocating resources for nursing workforce team members and play a significant role in international recruitment of nurses to supplement the Omani nurse workforce. Head nurses are responsible for making decisions about staffing and scheduling of nurses on individual units. They consider multiple variables on a near daily basis to accomplish appropriate staffing levels. Facilitators and barriers to effective teamwork emerged as a major consideration for staffing and scheduling of units. Head nurses who were interviewed desired additional data to support staffing decisions.

Conclusion: Multiple practical and research implications are suggested as a result of this study. Additional research is needed with greater numbers of nursing leaders using multiple methods. In addition, comparison studies in countries with varying healthcare systems and cultural norms are needed to expand knowledge about nurse staffing.