You have to reply to two classmates.
For your replies:
Add to your peer’s discussion by:
a. Locate an additional article for their problem (not their article).
b. Describe how that new article can assist with solving the issues described by your peer.
FIRST POST TO REPLY
A patient care/ safety concern in the department I work at is short staffing of nurses and techs. Having an adequate staff present in the Emergency Department is essential for positive patient outcomes. In the Emergency Department, you never know when there will be a flood of patients or a true emergency such as a trauma cardiac arrest. Being understaffed can result in a patient losing their life. It has been estimated staffing with fewer RNs has led to nearly 11,000 additional patient deaths, over 5,000 avoidable readmissions, an extra $68.5 million in Medicare costs, and hospitals losing over $3 billion in savings annually due to longer lengths of stay (Laskowski-Jones, 2024).
In response to short staffing, the ED Director hired more staff. Some are experienced ED RNs, and many are new grad RNs. As having more staff is a start, having new grads as most of the staff for the night shift is dangerous. Due to staff shortages, inexperienced new grad nurses are placed in positions that may be unsafe for them and the patients as they have not mastered the skills needed to handle critical patients in a fast-paced environment.
A study done on emergency department responses to nursing shortages stated attempts at recruitment of new staff mainly focused on financial-related incentives such as sign-on bonuses, pay increases, referral bonuses, and RN tuition reimbursement. However, some ED leaders increased the ED RN pipeline by hiring new graduates and international RNs, creating or increasing enrollment in an RN ED residency or hospital-affiliated RN school, hiring RN students as externs, cross-training non-ED RNs, and creating internal traveler programs (Hodgson et al., 2024).
According to this study, another route to increasing staff for our ED department would be financial-related incentives such as higher pay. Higher pay would maintain staff retention of experienced nurses and hire experienced ED RNs. Offering higher pay rates or sign-on bonuses is regulated by administration and HR. The ED Director would have to present their case to the administration to approve higher pay rates, which poses another issue.
Resources:
Hodgson, N. R., Kwun, R., Gorbatkin, C., Davies, J., & Fisher, J. (2024). Emergency department responses to nursing shortages. International Journal of Emergency Medicine, 17(1), 1–5. https://doi.org/10.1186/s12245-024-00628-y
Laskowski-Jones, Linda MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN. The real costs of short-sighted nurse staffing schemes. Nursing 54(8): p 6, August 2024. | DOI: 10.1097/NSG.0000000000000049
SECOND POST TO REPLY
Evaluating Research and Evidence-based Literature to Guide Professional Nursing Practices
As a clinical resource nurse, I’ve identified pressure injuries as a significant patient safety concern in our ICU. After consulting with our director and reviewing incident reports, it’s clear that preventing pressure injuries in critically ill patients is an area where we can improve care quality and patient outcomes.
To address this issue, I initiated a search for effective pressure injury prevention interventions for ICU patients. I found a recent systematic review and meta-analysis conducted by Lovegrove et al. (2021) that investigated the efficacy of different interventions aimed at preventing pressure injuries in adults who are admitted to intensive care units. This well-conducted review, published in the respected peer-review journal Australian Critical Care, is highly relevant to our patient population in the ICU and provides timely information about current best practices.
The review analyzed 26 randomized controlled trials covering 10 different intervention types. Notably, prophylactic dressings emerged as the most effective intervention, with sacral dressings reducing pressure injury risk by 78% and heel dressings by 69%. However, as Polit and Beck (2022) emphasize, it’s crucial to critically appraise research evidence before applying it to practice. In this case, the authors caution that most studies had a high or unclear risk of bias, highlighting the need for more rigorous research.
One key finding relevant to our practice is the lack of ICU-specific pressure injury risk assessment tools used in the studies. This suggests we may, therefore, have to revisit our current risk assessment methods and determine whether they are appropriate for our critically ill population. Also, the review identified limited evidence regarding preventing device-related pressure injuries, which further underlines the prevalence of medical devices throughout our ICU.
Based on this research, I propose implementing prophylactic dressings as part of our pressure injury prevention protocol. We should also critically evaluate our current practices in light of the review’s findings. Furthermore, this study emphasizes the need for ongoing research in ICU settings, which could inform future quality improvement initiatives in our unit.
Robert Fowler, RN (Group 1)
References
Lovegrove, J., Fulbrook, P., Miles, S., & Steele, M. (2022). Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomized controlled trials. Australian Critical Care, 35(2), 186-203.
Polit, D. F., & Beck, C. T. (2022). Essentials of nursing research: Appraising evidence for nursing practice (10th ed.). Wolters Kluwer.