Improving the patient experience.
Article Type: Viewpoint essay
Subject: Nurse and patient (Analysis)
Nursing services (Forecasts and trends)
Nursing services (Human resource management)
Patients (Care and treatment)
Patients (Management)
Author: Clendon, Jill
Pub Date: 08/01/2011
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2011 Source Volume: 17 Source Issue: 7
Topic: Event Code: 280 Personnel administration; 200 Management dynamics; 010 Forecasts, trends, outlooks Computer Subject: Market trend/market analysis; Company personnel management; Company business management
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 266344846
Full Text: While many people have positive experiences during a hospital stay, unfortunately experiences like Pip Murdoch's are becoming all too common. In fact, Kai Tiaki Nursing New Zealand has received at least three articles describing negative, unsafe hospital experiences in the last few months. Nurses rushed off their feet trying to stay on top of an increasingly complex case load; agency staff brought in to fill gaps due to inadequately resourced wards; and experienced nurses moving on because they are sick of the stress and taking their institutional knowledge with them, leaving inexperienced nurses to fill the gaps--it certainly paints a grim picture.

It is evident from international research that if we are to make the patient experience positive and improve health outcomes, then addressing the needs of nurses is paramount. Work by director of the Centre for Health Outcomes and Policy Research at the University of Pennsylvania, Linda Aiken, and others over the past ten years, has demonstrated that the higher the number of patients per nurse, the greater the death rate, the higher the nurse burnout rate, and the greater the job dissatisfaction of nurses. (1)

Introducing mandatory numbers of registered nurses to patients in California has resulted in lower mortality rates and nurse outcomes predictive of better nurse retention. (2) Victoria in Australia has also introduced a mandatory nurse-to-patient ratio and we will await the outcomes of this with interest.

In New Zealand, the Safe Staffing Healthy Workplaces Unit is working on a model that will address many of the issues associated with poor staffing. Care capacity demand management is slowly being rolled out across district health boards and is designed to ensure appropriate numbers of nurses are available on each shift and that wards are staffed by nurses with the appropriate skills.

Agency nurses are an expensive, temporary stop gap--wards must be staffed by nurses experienced in the specialty, who are able to mentor inexperienced nurses to ensure appropriate succession planning. The last time New Zealand restructured experienced nurse leaders out of the system, patient care quality also decreased. (3) While every nurse is responsible for providing safe, effective and compassionate nursing care, the systems and structures must also exist for nurses to be able to achieve this. It is a two-way process--individually we can make a significant difference to the patient experience, but if we have the system and structures to support us, making the difference will be something we achieve for every patient, every time, and Pip's experience will become a thing of the past.


(1) Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. & Silber, J. H. (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA: The Journal of the American Medical Association; 288: 16, pp1987-1993.

(2) Aiken, L., Sloane, D., Cimiotti, J., Clarke, S., Flynn, L., Seago, J A., Spetz, J. & Smith, H. (2010) Implications of the California nurse staffing mandate for other states. Health Services Research; 45: 4, ppg04-921.

(3) McCloskey, B. A. & Diets, D. K. (2005) Effects of New Zealand's hearth reengineering on nursing and patient outcomes. Medical Care; 43: 11, pp11.40-1146.

Reflection by NZNO nursing policy adviser/researcher Jill Clendon
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