Nursing Sensitive Quality Indicators (NSQI) refer to indicators or measures that reflect the quality of nursing care based on structures, processes, and outcomes. Over the last two decades, the Department of Health has focused on improving patient care and reducing the related cost (Battaglia et al. 2016). NSQIs aims to determine the value of nurse contributions by evaluating how patient care and outcomes are directly impacted by practicing nurses.
Consequently, patients are increasingly spending less inpatient time and more time in ambulatory or outpatient care. According to the American Nursing Association (ANA) driven NSQIs, nurses play a critical role in improving the efficiency, effectiveness, and quality of outcomes of care. Besides, the need for quality care by patients and communities today requires improved care coordination, health promotion, transition management, and access to resources by nurses.
According to Abugre et al., (2019), the Institute of Medicine (IOM) indicates that nursing and medical errors are among the leading causes of adverse patient outcomes in the United States. As a result, the interests to promote the safety and quality of health care have increased aimed at improving care outcomes. However, the optimal achievement level of patient outcomes has several economic consequences. Several studies, as noted by Fujita et al. (2018), have linked increased investment in nursing to improve patient outcomes. Payment reforms like pay-for-performance initiatives are considered critical in enhancing the level of nurse staffing and the standards of working conditions within hospitals. For this discussion, it is crucial to evaluate the economics related to nursing practice from broad approaches like how federal or state policies or hospital setting influence the nurse and patient outcomes. The two major economic factors with a direct impact on nurse and patient outcomes include nurse staffing levels and hospital cost-containment strategies (Tchouaket et al. 2017) and (Twigg et al. 2015). Cost offsets are critical and are considered from the basis of promoting saving patient care resources that arise from nursing investment. They are evaluated based on interactions among various nursing investment strategies like the level of staffing and nursing outcomes based on education levels and quality of the nursing practice environment.
Over the decades, nursing shortages have consistently limited the level of innovation introduction and sustenance in nursing practice. Nursing shortage should not be the primary justification for increasing nurse staff, instead of improving nurse and patient outcomes should be the driving reason. For instance, nurse staffing ratio legislation enacted in California tried to address the nurse shortage and resulted in improved patient outcomes. The existing shortage in nurses has also prevented the US government from standardizing entry-level education for registered nurses (RN) as a baccalaureate level. The government, as noted by Abugre et al., (2019), lacks a national nurse workforce plan to help ease the shortage problem. Hundreds of thousands of aspiring nurse students are being turned away from colleges due to capacity limitations. It is difficult to establish the actual benefit if the nurse shortage issue was addressed; however, it would definitely improve the level of care outcomes.
Nurses are consistently in support of policies that tend to increase resources that support nursing care provision. On the other hand, hospitals have supported strategies that help in lowering the costs of running the facility. As a result, the impacts of policies like the Hospital Prospective Payment Systems (PPS) between 1981 and 1987 have been identified to adversely impact on nurse workforce and patient safety (Verma, 2017). The PPS policy resulted in increased nurse shortage due to the elimination of some positions in the hospital aimed at reducing the number of paid hours. Hospitals consider nursing services as an expense or cost instead of a revenue source that make nursing a possible target for cost reduction policies. Because healthcare institutions are d not receive direct compensation for offering nursing care, there lacks motivation for institutions to provide the rightly qualified and experienced nurses to address the different needs of patients. Consequently, some practitioners argue that direct reimbursement would greatly impact positively on the quality of care and patient outcomes (Tchouaket et al. 2017).
Abugre, D., Mogre, V., & Bhengu, B. R. (2019). Effect of Patient-centred Care on Quality Nursing Care, Nurse-sensitive Indicators and Satisfaction of Nurses and Patients in Adult Medical Inpatients Setting: A Mixed Methods Systematic Review Protocol. Asian Journal of Research in Nursing and Health, 1-14.
Battaglia, R., Start, R., & Morin, M. (2016). Ambulatory care nurse-sensitive indicators series: Starting with low-hanging fruit: Proposing the adaptation of health care measures to the role of the nurse in ambulatory care. Nursing Economics, 34(4), 199.
Fujita, K., Moles, R. J., & Chen, T. F. (2018). Quality indicators for responsible use of medicines: a systematic review. BMJ open, 8(7), e020437.
Tchouaket, E., Dubois, C. A., & D’Amour, D. (2017). The economic burden of nurse‐sensitive adverse events in 22 medical‐surgical units: retrospective and matching analysis. Journal of advanced nursing, 73(7), 1696-1711.
Twigg, D. E., Myers, H., Duffield, C., Giles, M., & Evans, G. (2015). Is there an economic case for investing in nursing care–what does the literature tell us?. Journal of advanced nursing, 71(5), 975-990.
Verma, D. A. (2017). Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs.
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