Date of Award

4-22-2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

Abstract

Nurse leaders must consider the influence of nurse-specific and patient-specific factors on nursing workload and nurses’ perception of staffing adequacy when developing nurse staffing plans. All of the factors that influence individual nurses’ perception of staffing adequacy are not known. Using a synthesis of the Roy Adaptation Model (RAM) and economic theory as a guiding model, the purpose of the current study was to determine if selected patient complexity factors that are not consistently captured in the measurement of patient acuity by an automated workforce management system influence nurses’ perception of staffing adequacy. The current study employed a complex predictive correlational research design, which included repeated measures of patient data and nurses’ perception of staffing adequacy at the shift-level. A selection of repeated measures data from 26 Registered Nurses (RNs) and 1,605 patients over 328 shifts was entered into the initial analysis. The number of shifts with complete data used for final analysis was N = 294. Disruptive behavior (r= -.274) and family demands (r=-.186), were negatively correlated with nurses’ perception of staffing adequacy and explained 10% of the variance in a regression model. There was a negative correlation between total shift factor score (r=-.418), derived from the presence of patient complexity factors, and nurses’ perception of staffing adequacy. No correlation was found between perception of staffing adequacy and nurse staffing variables. A theoretical proposition of RAM was tested to describe the interaction between the group subsystems and the RAM modes in relationship to the goals of an organizational system. Study findings supported the RAM proposition and contribute to the middle range theory of adaptation, production decision-making process, and nurses’ perception of staffing adequacy. The findings inform the science of nurse staffing, but indicate further opportunities for research since other factors might exist that contribute to the perception of staffing adequacy.

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