Nurses' Perceptions of Dynamic Patient Events and Workflow Changes

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The Ohio State University

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Despite the large role of nurses in a hospital, there remains much debate about how to quantify their role and how to determine the best methodology to staff each nursing care unit. Nurses make up the single largest employee group and cost center in the hospital and are essential in maintaining patient safety and promoting the most efficacious patient outcomes. In spite of the large expense associated with providing nursing care, there is currently no method that accurately captures their contribution and helps administrators to make evidence-based staffing decisions (Beswick, Hill, & Anderson, 2010). The reality of the nurse’s workload is that they are often faced with dynamic patient events, which shift the nurse from being available to all patients to focusing on one patient for an extended period of intense care. The specific aim of this project is to gain a greater understanding of nurses’ perceptions about dynamic patient events, workflow disruption, and its’ impact on missed nursing care. This is a qualitative analysis of focus groups with nurses that were conducted at a large, urban, Midwestern hospital. Examination of the data revealed five major themes: (1) the types of dynamic patient events that frequently occur; (2) missed or delayed care as a result; (3) the emotional and stress response of the nurse; (4) workflow changes; and (5) the impact on patient satisfaction. These findings indicate that dynamic patient events impact nurses’ workload and both nurse and patient satisfaction. Patient status and acuity can fluctuate throughout the day and cause nurse-to-patient ratios to be awkward. This study facilitates our understanding of the demands on the nurse and provides the hospital administration with more information to make informed staffing decisions.



nursing workload, adverse patient events, personnel staffing and scheduling