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Problem Statement: Diabetic keto-acidosis (DKA) is a serious disease that has become more prevalent among patients with diabetes mellitus type I and II. In these situations it becomes imperative to educate patients on the importance of recognizing the symptoms of DKA and when it is appropriate to seek medical attention. In an article written by Aneesh Ghosh, (2019), it was documented that a patient with blood glucose of 237, was in DKA based on other variant lab values and physical presentation. In these situations, it is imperative for nurses to be able to begin insulin drips based on protocols that have been researched as best evidence based practice. Minimizing the time that patients wait to be treated, will allow for better patient outcomes.
Patient, Population and Problem:
1. Patients who do not have access to proper medical treatment for diabetes and suffer from episodes of DKA
2. population -rural areas where primary care providers may be limited.
3. Problem- not enough properly trained nurses and primary care providers to treat DKA
Observe patient outcomes when nurses are able to administer nurse driven protocols to quickly and efficiently intervene on patients with clinical presentation of DKA versus patients who are treated traditionally.
Comparison of patients who are able to benefit from nurse driven protocols in emergency rooms or critical care settings versus delay of treatment while waiting for traditionally longer waits for primary care providers.
Patients who are treated with nurse driven protocols tend to have better outcomes, and fewer episodes of hypoglycemia when nurses are able to calculate insulin protocols rather than report to primary care providers to await new orders.
Aneesh Ghosh, M. (2019). A case of euglycemic diabetic keto acidosis. Indian Journal of Endocrinology and Metabolism, 23(4), 500. https://doi.org/10.4103/ijem.ijem_302_19
Lee, C., Szwak, J., Bastow, S., & McCarthy, S. (2020). Impact of a nurse-driven diabetic ketoacidosis insulin infusion calculator on the rate of hypoglycemia. Journal of Patient Safety, 16(4), e255–e259. https://doi.org/10.1097/pts.0000000000000647
Staffing by Acuity and Improved Job Satisfaction in Nurses
Perceived workload including patient acuity and dependency as well as staffing has been seen to impact job satisfaction in nurses. Research suggests that nurses experiencing a heavy workload are 3.5 times more likely to report emotional exhaustion and lower job satisfaction (MacPhee et al., 2017). Nurses regularly report high levels of job dissatisfaction due to workload related to inequalities in the patient assignment distribution. The nurse-to-patient ratio design, which is used by many organizations, is unable to fully how many patients a single nurse can provide care for due to unexpected patient needs. An acuity tool helps identify the needs of each patient based upon assessments by the nurse and when utilized may help regulate the number of nurses per shift based on patient needs. This has been seen to improve nursing satisfaction with the standard of care provided and enhance their performance level (Al-Dweik & Ahmad, 2018). The implementation of an acuity tool has been shown to create a more equitable nursing assignment resulting in increased nursing satisfaction (Ageiz & Al-Mageed, 2020).
Nursing workload is leading to decreased job satisfaction and burnout among nurses.
The purpose of this research is to determine if staffing by patient acuity rather than nurse-to-patient ratio improves job satisfaction in nurses providing direct patient care.
Does staffing by acuity (I) rather than nurse-to-patient ratio (C) increase job satisfaction (O) in nurses providing direct patient care (P)?
The population in this study is a nurse providing direct patient care that are at risk for decreased job satisfaction due to staffing and workload issues.
Acuity-based staffing will be implemented. Staff nurses will complete a job satisfaction assessment tool before and after the implementation of acuity-based staffing.
Job satisfaction rates prior to the implementation of acuity-based staffing.
Relevant outcomes will include job satisfaction among staff nurses that is improved, worsened, or unchanged after the new staffing model has been implemented.
Research will be conducted over a period of 4 months.
Ageiz, M. H., & El-mageed, H. (2020). Nurses’ Satisfaction Related to Implementing Patient
Acuity Tool-Based Assignment. American Journal of Nursing Research , 8(4), 452–462. https://doi.org/10.12691/ajnr-8-4-5
Ahmad, M., & Al-Dweik, G. (2018, January). Matching Nursing Assignment to Patients’ Acuity Level: The Road to Nurses’ Satisfaction. ResearchGate. https://www.researchgate.net/publication/322662051_Matching_Nursing_Assignment_to_Patients%27_Acuity_Level_The_Road_to_Nurses%27_Satisfaction.
MacPhee, M., Dahinten, V., & Havaei, F. (2017). The Impact of Heavy Perceived Nurse
Workloads on Patient and Nurse Outcomes. Administrative Sciences, 7(1), 1–17. https://doi.org/10.3390/admsci7010007