Perceptions of ICU Stakeholders toward Nursing Staff Levels in Omani Hospitals: A Qualitative

Case Study

Dr. Majid Al Maqbali, RN, DHADirector of Nursing & Midwifery Affairs

MOH(HQ) – Sultanate of Oman

Outline

Background

Problem statement

Purpose

Why qualitative case

study?

Theoretical framework

Research questions

Data collection

Results

Findings

Implications

Limitations

Further studies

Background• Studies examining the relationship between nurse staffing and

health outcomes strongly support the importance of effective

deployment of nursing resources.

• High nurse staffing and an effective skill mix are associated with

improved patient outcomes (RCN, 2010)

• A strong link between quality of care, patient safety, and nurse

staffing (Spetz, 2004).

• Policies and regulations requiring an increase in the number of

nurses would reduce the risk of medical errors (Spetz, 2004).

Background• Skill mix of nurses, not merely the number of nurses, strongly influences

patient outcomes. Despite poor nurse staffing levels, positive patient

outcomes could still be attained (Blegen and Vaughn, 1998) .

• If nurse managers are well-prepared in their human resource planning

and conduct adequate staffing projections, cost savings occur.

• A higher ratio of nurses is associated with reductions in cost and length

of stay (Wiest et al. 2009).

• The adequacy of registered nurses can also prevent unnecessary stays

and reduce the possibility of cross infection of other patients that may

lead to costly adverse effects (AHRQ, 2004).

Background

• There is significant disagreement about the best way to

determine an appropriate number of nurses.

• Nurse job satisfaction, organizational commitment, and intent to

leave/stay were interconnected.

• A significant relationship between ineffective deployment of

nursing resources and negative patient and organizational

outcomes.

• When determining an appropriate level of staffing, the RCN

(2010) recommended healthcare leaders incorporate staff

involvement, triangulation, and regular performance reviews.

Problem Statement

Excessive Nursing workload in ICUs

Leaders Fail to anticipate the significant impact of:

low staffing levels

deployment and utilization

excessive workloads

Purpose Statement

Explore the perceptions of ICU stakeholders

regarding high nurse workloads in critical care

units in Oman

Why Qualitative Case Study?

Explore a problem and gain further understanding

Excessive ICU workloads are poorly understood by

Omani healthcare leaders

Confusion about the severity of the ICU nurse shortage

Empower and sacrifices personal interests to others

Why Qualitative Case Study?

Prior studies have not measured ICU stakeholder

perceptions about the study problem

Allowed exploration and understanding of the

reasons contributing to excessive nursing workload

Data were collected by means of in-depth individual

semi-structured open-ended interviews

Research Questions

RQ 1 – How do stakeholder perceptions differ regarding the severity of the intensive care unit nurse shortage in Oman?

RQ 2 – What factors contribute to excessive nursing workloads in Oman’s intensive care units?

RQ 3 - How can Omani healthcare leaders improve the management of nursing workloads in intensive care units?

Theoretical Framework

Taylor's Scientific Management Theory

o To replace the “rule-of-thumb”

o To select, train, and develop each employee scientifically, rather

than promoting a worker's self-development.

o To provide continuous supervision and performance appraisal

o To separate the work between supervisors and employees

Virtually synonymous with maximization of the use of

available nurses in hospital wards or units

Population and Geographical Location

ICU stakeholders representing Royal, Khoula, and Sohar

hospitals

The population of ICU stakeholders included clinical and

non-clinical workers (nurses, physicians, and hospital

administrators)

21 ICU stakeholders were interviewed.

Stratified sampling

Inclusion and exclusion criteria

Data Collection

Pilot study

o Rustaq Hospital

o A convenience sample of five volunteer healthcare stakeholders

o Fit within the sampling frame and willing to provide timely

feedback on the study’s interview questions.

o Data were not included in the results of the main study

Data Collection

Main study Semi-structured open-ended questions

Face-to face interviews (scheduled for 60 minutes)

Multiple stakeholders from different hospitals strengthened the

validity of the study’s results.

Digitally recorded and transcribed for accuracy

Participants re-read and checked what they said

Participants were able to provide feedback on a draft copy of

the final case study

Data Collection

Three coders

After identifying open-ended themes, coders categorized

responses

Category frequencies were determined.

A Cronbach’s alpha was computed to determine an inter-rater

reliability score.

The study’s coding produced a Cronbach alpha of .91 which was

considered reliable

Data Analysis

Pilot study

Interviews were digitally recorded and transcribed

Five of the seven pilot study questions were retained without

any phrasing changes

Two questions were revised for phrasing

Two new questions were added

Results – RQ1(Severity of the ICU nurse shortage)

RQ1 was supported: 81% indicating ICUs are

inadequately staffed

Institutional Perceptions: Sohar Hospital expressed

highest level of concern (100%)

Role Perceptions: 83% of Hospital Administrators, 78% of

nurses, and 50% of doctors did not believe there was an

adequate number of ICU nurses

Results – RQ2(Factors contributing to nursing workloads in ICUs)

RQ2 was supported: 74 comments, three main themes

emerged:

Shortage of ICU nurses

Shortage of support and resources

Distractions

Nurse Turnover:

Negative working environment

High workloads

Unpopular shifts

Communication, compensation, and hospital policies

Results – RQ3(Suggestions for improving ICU nurse workloads)

RQ3 was supported

More experienced ICU nurses

Increasing the availability of support staff, resources

Revising hospital policies

improve pay

More education and training

Increase recognition

Implications(Health Vision 2050)

Nursing and midwifery human resources: the need for an adequate number of skilled nurses

Positive practice environments : the importance of career pathways (promotions, pay increases, and professional recognition) for nurses.

Access and quality of education: the importance of offering multiple and convenient modalities of professional development programs that includes face-to-face, e-learning, and distance education

Implications(Health Vision 2050)

Scaling up capacity of nursing and midwifery: the need for ICU nurses to be specialized practitioners with a post-basic certificate

Strengthening regulatory capacity : the importance of nurses receiving a minimally acceptable level of education so they are licensed, certified, and/or baccalaureate trained nurses.

Research : the importance of using evidence-based practices when managing Omani ICUs

Limitations

Self-reported perceptions of 21 stakeholders at three major

hospitals in Oman

Study participants were limited to health administrators,

doctors, and nurses

The study’s principal researcher was a senior leader in the

Ministry of Health

Face-to-face interviews may have influenced the candor and

openness of study participants

Further Studies

Identify the types of ICU nurses required to work

Conduct an educational needs assessment

Develop the best career pathways, financial incentives, and

educational programs for nurses in Oman

Align all workforce initiatives within the framework of the Health

Vision 2050 recommendations

Thank you!