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“Gap in the literature” section needs to be elaborated with more citations – there is none now
JOB SATISFATION AND NURSE PATIENT RATIO
2
4
Table of Contents
Chapter
1
: Introduction
1
Background of the Problem
1
Problem Statement
1
Purpose of the Study
1
Nature of the Study
1
Significance of the Study
1
Research Questions
1
Hypotheses
1
Brief Review of the Literature
2
Conceptual
Framework
2
Assumptions
,
Limitations
, and
Delimitations
2
Definition of Terms
3
Conclusion
3
Chapter 2: Literature Review
4
Historical Development of the Topic
4
Contemporary Perspectives
4
Historical Development of the Theory
4
Importance of the Study and Implication for Practice
4
Directions for Future Research
5
Summary
5
Chapter 3: Research Method
6
Research Design
6
Appropriateness of Design
6
Procedure
6
The Role of the Researcher
6
Research Questions
6
Hypotheses
6
Population and Sample
6
Geographic or Virtual Location
6
Instrumentation
6
Data Collection
6
Data Analysis
7
Human Participants and Ethics Precautions
7
Validity and Reliability
7
Contribution to Social, Practice, or Organizational Change
7
Summary
7
Chapter 4: Results
8
General Description of the Participants
8
Research Questions
8
Sample Size
8
Pilot Tests
8
Data Collection
8
Unit of Analysis and Measurement
8
Data Analysis
8
Coding and Codebook Generation
8
Qualitative Results
8
Results of Hypothesis Tests
9
Between Group Differences
9
Outliers
9
Validity and Reliability
9
Summary
9
Chapter 5: Discussion,
Conclusions
, and
Recommendations
10
Ethical Dimensions
10
Limitations
10
Overview of the Population and Sampling Method
10
Data Collection and Analysis
10
Summary
of Findings
10
Explanation of Findings
10
Recommendations
11
Reflecting Upon the Study
11
Suggestions for Future Research
11
Implications for Social, Practice, or Organizational Change
11
Conclusions
11
References
12
Appendix A: Tables
13
Appendix B: Figures
15
Table of Tables
Table A1
:
This is an Example APA Table in Appendix A and Uses the APA Table
Title Style
14
Table of Figures
Figure B1. This is an example APA figure using the APA Caption Style. Neo meets the Architect while seeking the Source.
16
JOB SATISFATION AND NURSE PATIENT RATIO
i
Chapter 1: Introduction
Fatigue in nurses have been a factor that has always come with very many consequences in the medical world such as poor decision making that has not only led to negligence in the hospital but also inappropriate administration of prescribed medicine leading to, at worst, death of patients. We are to see how nurse’s fatigue relates to job satisfaction and nurse to patient ratio.
Background of the Problem
Nurses who are dissatisfied in their jobs always lack mental strength or the motivation for that matter to endure the ever-demanding requirements that are accompanied by the nursing career. This lack of interest of interest may make them work without much care in their job which results to dissatisfaction among patients (Chang, Chiu, Lin, & Lee,2009). Nurse to patient ratio has been a major topic of focus among stakeholders of healthcare institutions. An appropriate nurse to patient ratio is required to see that healthcare facilities run smoothly as far as taking care of both in-patient and out-patient clients in the medical facilities is concerned.
Workers fatigue has been related to many job related problems such as high stress levels and depression among employees. Among nurses, there has been evidence to show that nurse to patient ratio and dissatisfaction of the nurses in their jobs are the major factors that have led to fatigue among the nurses (Schwab, Meyer, Geffers & Gastmeier, 2012).
Healthcare institutions have always been faced by the burden of operating in a cost effective manner and at the same time are required give their best in terms of the quality of services they offer. In an attempt to meet operating effectively in terms of cost, they end up compromising on nurse to patient ratio that may lead to them unearthing other unforeseen consequences. Fatigue has been seen to compromise patient safety in terms of improper communication between nurses and patients, medication faults and poor and incorrect administration of medicine and prescriptions (Shekelle, 2013).
Problem Statement
A lot of research has indicated that as nurse to patient ratio spike. Also, there is an increase in nurses getting emotionally tired and also getting more dissatisfied in their jobs which eventually leads to fatigue. Pressure exerted on the management of health care institutions to operate cost effectively have seen them allocate many patients to be attended to by one nurse as a means of cost reduction. This has in turn lowered nurse outcomes and motivation in doing their jobs and have also increased mortality rate among patients. Most research on nurse to patient ratio and how it relates to fatigue among employees have majorly focused on hospital setting leaving out other institution such as nursing homes for both the elderly and kids with disabilities. There is need to further studies beyond hospitalized setting to other nursing institutions.
Purpose of the Study
The purpose of this study is to show the relationship that exists between nurse to patient ratio and job satisfaction with fatigue among nurses. Nurse-patient ratio and job satisfaction evidently play key roles in fatigue among nurses. Most studies have focused on nurses in hospital setting. These studies however extend the scope to include nurses in nursing homes that care for the elderly and children with various disabilities to see if indeed there exist a relationship among these factors.
Significance of the Study
The importance of fatigue as a topic of study has been inspired by the need for every citizen to receive only the best of services from both the private and public sector on healthcare, a field that has the most stakes on the well-being of peoples as far as their health is concerned. Fatigue among nurses has a direct link on how they relate with their patient and studies have shown that with an increase of an additional patient to a nurse, there is a significant increase in fatigue and job dissatisfaction experienced by the nurse (Poghosyan, Clarke, Finlayson, & Aiken,2010). With increase in the number of patients a single nurse attends to, their ability to maintain a healthy relationship with the patient diminishes (Spetz, Donaldson, Aydin, & Brown, 2008). Nurses who see themselves as having adequate number of patients to handle have indicated lower levels of fatigue and are generally satisfied with their jobs. Patient have felt dissatisfied with services offered in health institutions where nurses claimed to having been overwhelmed and that they were experiencing fatigue. These patients felt reluctant to recommend their family and friends to attend these hospitals that nurses were dissatisfied with their work.
Shortage of nursed have plagued the country and fatigue of nurses on the rise, retention of nurses at their work places is also becoming a major problem that need to be dealt with by creating conducive environment for these nurses to work in so the they can feel satisfied in their jobs which will trickle down to patients feel satisfied with these services they get at the healthcare institutions. There is a projection that the shortage of nurses might increase with an excess of one million by the year 2020 (Chang, Ma, Chiu, Lin & Lee, 2009).
Restructuring of hospitals and nursing institutions in the past have on changes being made in the administration of these institutions and allocation of doctors leaving out addition of more nurses a matter they consider trivial but is of major importance and may result into grave problems if not taken seriously.
Intervention should be made to curb fatigue among nurses but before we arrive at that it better we understand the root causes of fatigue that will make it easy in dealing with the problem.
Research Questions
This dissertation will seek to answer a number of questions. These questions form the make foundation of the research paper. These research questions include but not limited to:
· Is there a relationship between job satisfaction and the level of fatigue among nurses in their working area?
· Is there an association between nurse to patient ratio and level of fatigue among nurses in their working area?
· What are the factors to be taken into consideration so as to curb fatigue among nurses and the consequences it brings?
Numerous past research papers have indicated that as nurse to patient ratio increase, nurses start to get emotionally exhausted and also get more dissatisfied in their jobs which ultimately leads to fatigue (Spetz, Donaldson, Aydin, & Brown, 2008). Pressure exerted on the administrators of the health care institutions to operate cost effectively have seen them have nurses handle more than adequate number of patients as a means of cost reduction. This has in turn lowered patient safety outcomes and reduced motivation for nurses in doing their jobs and have also increased mortality rate among patients (Shekelle, 2013).
Most research on nurse to patient ratio and how it relates to fatigue among employees have majorly focused on hospital setting leaving out other institution such as nursing homes for both the elderly and kids with disabilities. There is need to further studies beyond hospitalized setting to other nursing institutions. This study attempts to examine all these factors so as to adequately answer the stated research questions.
The study also tries to examine and answer questions to whether there are other factors that may result to fatigue among nurses and the best way to minimize these factors conclusively.
Nature of the Study
This study will be of descriptive research design. This approach is suitable because of the need to describe the relationship between nurse to patient ratio and job satisfaction with fatigue in nurses. For purposes of this study, the independent variables will be nurse to patient ratio and job satisfaction whereas the dependent variable will be nurse fatigue. The study will analyse these factors using descriptive evidence.
Linear regression model is used to demonstrate whether there is a relationship between the response variable (nurse-fatigue) and the deterministic variable (nurse-patient ratio and job satisfaction). The study makes use of data collected by use of a questionnaire. The group that is going to be the point of focus are the nurses. The questionnaires are going to be given out to nurses in hospitalized setup and nursing homes for the elderly and children with various kinds of disability. Closed ended questions of quantitative design will be the major point of focus but a few open-ended questions of qualitative nature will be added to shed more light into this inquiry. The questions will be created in such a way that they simple but offer a depth of information. Leading questions in the questionnaire will be avoided so as to escape bias from the response given by the target nurses.
The data collected from the questionnaire will measure the level of job satisfaction among the nurse and the nurse to patient ratios.
The sample will be obtained using convenience sampling where the nurses that will be present at the identified homes and hospitals will be issued with questionnaires using no order. Convenience sampling is a method non- probabilistic sampling where the respondents are selected due to the ease if their accessibility and nearness to the researcher (Emerson, 2015).
The chi squared test of association is going to be the statistical analysis to be used in this study to see if there is a relationship that exist between. Chi square is a nonparametric statistic in which cases are classified into a set of categories (Franke & Christie2012). This analysis will enable all the variables in the data be compares to see if a relationship exists between them
Hypotheses
This paper is based on the following hypotheses:
· H01: There is no relationship between job satisfaction and fatigue in nurses
· H11: There is a relationship between job satisfaction and fatigue in nurses
· H02: There is no relationship between nurse to patient ratio and fatigue in nurses
· H12: There is a relationship between nurse to patient ratio and fatigue in nurses
Brief Review of the Literature
The reason for this study is to determine the relationship between nurse to patient ratios and job satisfaction with nurse-fatigue. It has been made clear that these two factors play a role in fatigue in hospital setups, although whether they have an effect on other institutions such as nursing homes for the elderly and children with disabilities is a topic yet to be advanced. The review of literature will help appreciate the work already done in this area and also give insights on how go about the study as well as expanding our knowledge on this field generally.
Context of the problem Comment by Author: This subsection had no citations in the literature…and it should be aligned left (the heading that is)
The survey attempts to determine the relationship between the three variables under study: patient to nurse ratio, job satisfaction and nurse-fatigue. A lot of research have indicated that as patient to nurse ratio rise, nurses tend to get emotionally tired and more dissatisfied in their jobs which eventually leads to fatigue. Pressure exerted on the management of health care institutions to operate cost effectively have seen them have many patients assigned to one nurse as a means of cutting on cost and expenditures. This has in turn lowered nurse outcomes and motivation in doing their jobs and have also increased mortality rate among patients.
Most research on nurse to patient ratio and how it relates to fatigue among employees have majorly focused on hospital setting leaving out other institution such as nursing homes for both the elderly and kids with disabilities hence the need to further studies beyond hospitalized setting to other nursing institutions.
Contribution of the study to literature Comment by Author: Please use proper headings…
Not one citation in this subsection
This study addresses fatigue among nurses in their places of work and the factors that lead to this fatigue while not limiting itself solely on hospital setups but broadening the scope outside hospitals to even focus on nursing homes. The issue of nurse fatigue is prevalent in the nursing profession and should not be ignored or taken lightly for that matter by stakeholders in healthcare.
Although there has been a growing body of evidence which suggests that high patient to nurse ratios are related to unpleasant patient and nurse outcomes, rising mortality among patients, increased stress levels among nurses and dissatisfaction in their jobs, health institutions are still reluctant to embrace these truths due to the financial cost that they come with (Patterson, 2011).
Contribution to the context of the problem Comment by Author: Please use the proper caps for this heading…this section is better
Fatigue in nurses as a topic of study has been motivated by the basic need for every person to receive only the best of services from both the private and public sector on healthcare, a field that has the most stakes on the well-being of peoples as far as their health is concerned. Fatigue among nurses has a direct link on how they relate with their patient and studies have shown that with an increase in-patient per nurse ratio, there is a significant increase in fatigue and job dissatisfaction experienced by the nurses. This in turn reduces their ability to maintain a healthy relationship with the patient (Poghosyan, Clarke, Finlayson, & Aiken,2010).
Nurses who see themselves as having the right number of patients to care for have indicated lower levels of fatigue and are generally satisfied with their jobs (Spetz, Donaldson, Aydin, & Brown, 2008). Equally, patient have shown signs of dissatisfaction with services offered in health institutions where nurses registered to having been overwhelmed and that they were fatigued. These patients felt reluctant to recommend their family and friends to attend these hospitals that nurses were dissatisfied with their work.
Shortage of nurses has been a major issue of concern. To add to that, fatigue as also seen to it that retention of nurses at their work places to be a major problem that needs to be dealt with. There should be conducive environment for these nurses to work in so the they can feel satisfied in their jobs which will trickle down to patients feel satisfied with these services they get at the healthcare institutions. There is a projection that the shortage of nurses might increase with an excess of one million by the year 2020 (AACN,2011). This calls for more studies in this area so as to avert the problem before it gets worse.
Similar and related studies Comment by Author: Again, please use proper headings
Nurse to patient ratios, job satisfaction and fatigue among nurses at work has been a subject for discussion for many scholars and researchers. This section reviews some of these studies and indicating their contribution to the knowledge of the subject.
According to (Teeter, 2014), by use of convenience sampling and correlation studies, he established that the increase in patients per nurse ratios and job satisfaction are the principal causes of nurse burnout. He portrayed that some measure of job satisfaction subscales were better predictors of job satisfaction in general and that there is a positive correlation between patient to nurse ratio and job satisfaction.
In an attempt to establish relationship between patient to nurse ratios and safety outcomes for patients (RinaldiFuller, 2008), he determined that nursing care have critical impact on patient safety and suggested that hospital to staff their hospitals with a lower patient to nurse ratio as an attempt to improve safety outcomes in patients. In his study, RinaldiFuller equates a richer staffing mix and lower patient to nurse ratio with quality of care in hospitals and that understaffing does indeed affect negatively the quality of health care patients get.
According to (Patterson, 2011), high patient to nurse ratio cause negative outcomes for both patients and staff and that there is a strong correlation between patient morality and low staffing levels. His findings suggested that patients in the wards with worst staffing ratios had a 31% bigger mortality risk. He also demonstrated that nurses who were in institution with bad staffing ratios experienced the most job dissatisfaction. Those with the highest number of patients were likely to suffer from job related burnout and more likely to be dissatisfied with their jobs.
Maben J et al (2007) in his study showed that nurses joined their careers with strong ideals but just after about two years they felt disillusioned and that what they believed in and the standards they held so dearly they felt difficult to preserve. Due to burnout, many nurses felt the need to exchange jobs or worst still, even decide to leave the nursing profession entirely. With better staffing ratios, he said would lower job dissatisfaction and burnout among nurses.
Gap
in the literature Comment by Author: Not one citation in the literature
In the review of most literature it has been established that most studies have focused on nurses in hospital settings leaving a whole lot of gap in institutions in setups outside hospitals. This study however extends the scope to include nurses in nursing homes that care for the elderly and children with various disabilities to see if indeed there exist a relationship among these factors which will in turn increase and create a wealth of knowledge in this subject matter.
It is evident from the literature review that several studies have been undertaken to investigate the relationship that exist in job satisfaction, patient to nurse ratio and fatigue among nursed. Most of the studies have shown a strong association between these variables whereas some studies failed to find significant evidence to show the relationships. The difference in finding can be attributed to the differences in the methodologies used by different researchers.
Conceptual Framework
Text goes here
.
Framework
Text goes here.
Illustration appears in the correct appendix.
Assumptions
, Limitations, and Delimitations
Text goes here.
Assumptions
Text goes here.
Limitations
Text goes here.
Delimitations
Text goes here.
Definition of Terms
Jargon. The meaning goes here.
Conclusion
This chapter included an outline of this study, background of the problem, and research questions. An in-depth review of the literature follows in Chapter 2, which will expound upon the development and significance of the study and its literature. Chapter 3 includes a discussion on the methodology of the data collection. In Chapter 4, the results and analysis of the study will be presented. Finally, Chapter 5 consists of commenting on the study combined with suggestions for future studies stemming from this research effort.
Chapter 2: Literature Review
Introduce the literature review.
Historical Development of the Topic
Introduce the historical development of the topic. Be sure to use level 2 headings as needed.
Summary
Text goes here.
Contemporary Perspectives
Introduce the contemporary perspectives relevant to the study. Be sure to use level 2 headings as needed.
Summary
Text goes here.
Historical Development of the Theory
Introduce the historical development of the theory. Be sure to use level 2 headings as needed.
Summary
Text goes here.
Importance of the Study and Implication for Practice
Text goes here.
Contribution to the Literature
Text goes here.
Contribution to the Practice
Text goes here.
Directions for Future Research
Text goes here.
Summary
Text goes here.
Chapter 3: Research Method
Text goes here.
Research Design
Text goes here.
Appropriateness of Design
Text goes here.
Procedure
Text goes here.
The Role of the Researcher
Text goes here.
Research Questions
Text goes here.
Hypotheses
Text goes here.
Population and Sample
Text goes here.
Geographic or Virtual Location
Text goes here.
Instrumentation
Text goes here.
Data Collection
Text goes here.
Data Analysis
Text goes here.
Human Participants and Ethics Precautions
Text goes here.
Validity and Reliability
Text goes here.
Contribution to Social, Practice, or Organizational Change
Text goes here.
Summary
Text goes here.
Chapter 4: Results
Text goes here.
General Description of the Participants
Text goes here.
Research Questions
Text goes here.
Sample Size
Text goes here.
Pilot Tests
Text goes here.
Data Collection
Text goes here.
Unit of Analysis and Measurement
Text goes here.
Data Analysis
Text goes here.
Coding and Codebook Generation
Text goes here.
Qualitative Results
Text goes here.
Themes Confirming the Literature
Text goes here.
Novel Themes Emerging from the Study
Text goes here.
Results of Hypothesis Tests
Text goes here.
First Hypothesis Test
Text goes here.
Second Hypothesis Test
Text goes here.
Between Group Differences
Text goes here.
Outliers
Text goes here.
Validity and Reliability
Text goes here.
Summary
Text goes here.
Chapter 5: Discussion, Conclusions, and Recommendations
Text goes here.
Ethical Dimensions
Text goes here.
Limitations
Text goes here.
Overview of the Population and Sampling Method
Text goes here.
Data Collection and Analysis
Text goes here.
Summary of Findings
Text goes here.
Explanation of Findings
Text goes here.
Research Question 1
Text goes here.
Research Question 2
Text goes here.
Findings of the Hypothesis Tests
Findings of the first hypothesis. Text goes here.
Findings of the second hypothesis. Text goes here.
Open-Ended Questions
Text goes here
Open-ended Question 1. Text goes here.
Open-ended Question 2. Text goes here.
Potential Errors
Text goes here.
Summary
Text goes here.
Recommendations
Text goes here.
Reflecting Upon the Study
Text goes here.
Suggestions for Future Research
Text goes here.
Implications for Social, Practice, or Organizational Change
Text goes here.
Conclusions
Text goes here.
References
Chang, W. Y., Ma, J. C., Chiu, H. T., Lin, K. C., & Lee, P. H. (2009). Job satisfaction and perceptions of quality of patient care, collaboration and teamwork in acute care hospitals. Journal of advanced nursing, 65(9), 1946-1955.
Emerson, R. W. (2015). Convenience sampling, random sampling, and snowball sampling: How does sampling affect the validity of research?. Journal of Visual Impairment & Blindness (Online), 109(2), 164.
Franke, T. M., Ho, T., & Christie, C. A. (2012). The chi-square test: Often used and more often misinterpreted. American Journal of Evaluation, 33(3), 448-458.
Poghosyan, L., Clarke, S. P., Finlayson, M., & Aiken, L. H. (2010). Nurse burnout and quality of care: Cross‐national investigation in six countries. Research in nursing & health, 33(4), 288-298.
Schwab, F., Meyer, E., Geffers, C., & Gastmeier, P. (2012). Understaffing, overcrowding, inappropriate nurse: ventilated patient ratio and nosocomial infections: which parameter is the best reflection of deficits?. Journal of Hospital Infection, 80(2), 133-139.
Shekelle, P. G. (2013). Nurse–Patient Ratios as a Patient Safety StrategyA Systematic Review. Annals of Internal Medicine, 158(5_Part_2), 404-409.
Spetz, J., Donaldson, N., Aydin, C., & Brown, D. S. (2008). How many nurses per patient? Measurements of nurse staffing in health services research. Health Services
Review. Annals of Internal Research, 43(5p1), 1674-1692.
Appendix A: Tables
Table A1
This is an Example APA Table in Appendix A and Uses the APA Table Title Style
Category
Very Important
Heading 1
Heading 2
First category
4.0
16
Second category
3
43.6
Third category
88
67.9*
Notes. The values denoted by an asterisk (*) are important because they have a particular quality.
Appendix B: Figures
Figure B1. This is an example APA figure using the APA Caption Style. Neo meets the Architect while seeking the Source. Notice the caption is not emphasized!
