PICOT Question: Nursing Research

PICOT Question: Nursing Research

Revise the PICOT question you wrote in the Topic 1

PICOT Question: In emergency department patients (P), how does a nurse-to-patient ratio reduction (I) compared with increasing nurse-to-patient ratio (C) impact patient safety (O) during six (6) months (T) in acute care? The population of interest is patients in emergency departments seeking acute care. The treatment outcome for the emergency department patients will be measured within a period of six (6) months.

  • Population (P): Emergency department patients
  • Intervention (I): Reduction of nurse-to-patient ratio
  • Comparison (C): Increasing nurse-to-patient ratio
  • Outcome (O): Patient safety
  • Time (T): Six (6) months

The clinical issue of interest is nurse turnover, i.e., nurse-to-patient ratio, and how it impacts patient safety. The PICOT question concerns the impact of reducing and increasing nurse-to-patient ratio on patient safety. Apparently, there is a positive correlation between decreasing nurse-to-patient ration in the emergency departments seeking acute care. The qualitative studies indicated that skill mix, staffing levels and the quality of time spent by nurses with patients’ impacts patients’ outcomes and hence, enhances the healing process of those in emergency departments. The quantitative studies investigated the relationship between nurse staffing, patient safety, and missed care.  The studies indicated that large cases of missed care are associated with low nurse staffing due to poor quality services they afford to provide to the patients. Generally, the PICOT question was greatly represented in the four articles to unleash how nurse skills, staffing, and their ratio to patients affects the outcomes. Interventions, therefore, emphasize on the need to address these mishaps to enhance patient outcomes in emergency departments.

Research Critiques

  • Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

Quantitative studies included that by Bottcher et al. (2019), and Griffiths et al. (2018). Bottcher et al. (2019)’s article was a cross-sectional study that examined the attitudes of doctors and nurses towards patient safety and potential errors in medical practice. The study argued that a significant number of patient deaths result from an adverse event whereby positive patient safety influence better patient outcomes while negative attitudes lead to poor outcomes.  In this regard, patient safety forms a critical aspect in shaping the patient outcomes while improving healthcare professionals’ job satisfaction (Bottcher et al., 2019). The study provides crucial insights in the healthcare industry by highlighting the impact that the attitudes of healthcare professionals imposes on patients’ outcomes. Professional incompetence, error reporting confidence, and team functions are some of the factors that influence patient safety and hence their positive extremes should be emphasized.

The study unleashed the impact of nurses’ and doctors’ attitudes on patient safety by use of questionnaire from 20 experienced doctors through the Attitudes to Patient Safety Questionnaire III (APSQ-III) as the survey instrument. The results indicated a dire need to implement strategies that motivate doctors and nurses while influencing their positive attitudes to improve patients’ safety.  Medical errors are inevitable, however, an effective collaboration by healthcare team members is crucial to curb the possibility of their occurrence (Bottcher et al., 2019). Besides, patients need to actively be involved in their treatment process to aid in collecting and recording accurate data for results appropriateness.  The article also highlights implementing shorter nurse and doctor work shifts with flexible work schedules as a means to eradicate or minimize medical errors.  The article revealed that nurses’ and doctors’ attitudes are significantly influenced by their working hours and professional incompetence hence a cause of error. In relation to the PICOT question, long working hours reflect the need to attend to more patients by a single nurse or doctor, regarded as increased nurse-to-patient ratio, hence deteriorating the patient outcomes.  As such, the study emphasized that more staffing is necessary to allow sufficient time to attend a patient by nurses.

Griffiths et al. (2019) conducted a systematic review that investigated the relationship between nursing staffing and omissions in nursing care. While the PICOT questions concerns the impact of nurse-to-patient ratio on patient outcomes, the article was relevant to reveal the importance of having sufficient nurse staffing to attend a specific number of patients within a given time period. The quantity and quality of time spent by nurses with patients influences the outcomes since it provides a sufficient opportunity to understand patients’ needs while addressing them appropriately (Griffiths et al., 2018). The study indicates that most of the patient deaths result from insufficient nurse staffing initiating a kind of ‘competition’ by patients for the available nurses. Resultantly, this decreases the quality of the services accorded to the patients hence escalating death rates by patients.

The authors analyzed the studies that examined the link between nurse staffing levels and missed care using terms such as implicit rationing, care left undone, and missed care. Indicatively, low nurse level reciprocated to heightened levels of missed care. However, a thorough research is still called for to ascertain the measures of missed care on patient outcome.  In relation to the PICOT question, the study revealed that low nurse staffing initiate omissions in nursing care – increased nurse-to-patient ratio negatively influences the patient outcomes (Griffiths et al., 2018). In other words, low staffing initiate a scenario whereby the nurses are overworked and hence tend to miss important services to patients in acute adult inpatient wards. Therefore, sufficient nurse staffing should be emphasized to ensure patients get all the necessary services in quality to facilitate their healing process.

Qualitative studies were carried out by Bridges et al. (2019) and Wolf et al. (2017) to assess the association between nurse staffing and patient outcomes. this too, related to the PICOT question since the intervention measures pointed at increasing nurse staffing to ensure a decreased nurse-to-patient ration for better outcomes. Bridges et al. (2019) carried out an observational study (238 hours of care for 270 patients) rate the staff-patient interactions using the Quality of Interactions Schedule (Bridges et al., 2019).  The observation was made on the outcomes of patients both when nurse to patient ratio was increased and decreased. The study revealed an increase in the odds of a negative interaction with the increase in the number of patients per registered nurse. Suggestively, the low levels of nurse staffing negatively impacted the quantity and quality of staff-patient interactions.  In this regard, sufficient nurse staffing are crucial to allow sufficient nurse supervising and limit the scope for substitution.

Apparently, as nurses interact maximally with patients, they create a strong bond that develops a mutual relationship which enhances patient outcomes as they understand wholly their needs. In other words, there is a dire need to allow nurses to spend quality time with a specific patient for effective interactions.  Nurse staffing correlates with staff-patient interactions (nurse-to-patient ratio in the PICOT question) which reveals that the number of patients attached to a single nurse in a given time period influences the kind of results by the patients.

Wolf et al.’s (2017) study asserted that nurses perceive staffing as inadequate which degrades the quality of services they provide to patients. The factors influencing safe staffing levels in emergency departments and how nurses perceived this phenomenon was the primary goal of this study. Low nurse staffing increases the work toll that the staff undergoes in their efforts to ensure quality patient outcomes. However, subjection to enormous amount of work results in poor outcomes due to insufficient ability to provide excellent services to a single patient.  The study sampled 26 emergency nurses and the quality of patient outcomes, in regard to the number of patients assigned to a single nurse to a particular patient (Wolf et al., 2017). Such was in correlation with the PICOT question to affirm that a decreased nurse-to-patient ratio reciprocates to improved patient outcomes.

The study was critical in expressing the participants’ feelings, opinions, and experiences while interpreting the implications. Generally, sufficient staffing and appropriate skill mix depict important approaches to enhance patient outcomes. The qualitative studies provide crucial insights in realizing the value of having sufficient nurse staffing with effective skill mix to allow a healthy patient-interaction. Such acts as a therapy in attending patients in emergency rooms and those with acute medical needs, hence ensuring quality patient outcomes. The study emphasizes the need to formulate staffing plans that consider patient acuity and volume, rather than the number of patients (Wolf et al., 2017). As the PICOT question reveals the need to decrease the nurse-to-patient ratio, the study proposes that the components of situational workload should guide the strategies to improve the recruitment and retention emergency nurses.

Proposed Evidence-Based Practice Change

  • The link between the PICOT question, the research articles, and the nursing practice problem

Generally, nurse staffing is a significant indicator of the potential or expected patient outcomes in the emergency departments. Adults in the acute care rooms reveal a critical need for keen attendance by skilled and registered nurses who should understand their problem cause, assess the relevant treatment measures, and spend quality time with them to assess their progress. The PICOT question emphasizes the need to decrease nurse-to-patient ratio and the articles discussed this tenet in different dimensions. Indicatively, significant errors and missed care which negatively impacts patient outcomes are the results of low nurse staffing. Such could be addressed by implementing strategies that promote high nurse-to-patient ratio to ensure that nurses provide elegant services to individual patients. In this regard, healthcare organizations should focus to assess the bed capacity and consider short work schedules to determine the relevant number of nursing staff to deploy.


  • Bottcher, B., Abu-El-Noor, N., Abuowda, Y., Alfaqawi, M., Alaloul, E., El-Hout, S., & Abu-El-Noor, M. (2019). Attitudes of doctors and nurses to patient safety and errors in medical practice in the Gaza-Strip: a cross-sectional study. BMJ Open9(8), e026788. DOI:10.1136/bmjopen-2018-026788
  • Bridges, J., Griffiths, P., Oliver, E., & Pickering, R. M. (2019). Hospital nurse staffing and staff           patient interactions: an observational study. BMJ Quality & Safety2 (9), 706-713.            DOI: 10.1136/bmjqs-2018-008948
  • Griffiths, P., Recio‐Saucedo, A., Dall’Ora, C., Briggs, J., Mariotti, A., Meredith, P., & Missed Care Study Group. (2018). A systematic review is the association between nurse staffing and omissions in nursing care. Journal of advanced nursing74(7), 1474-1487. Doi: 10.1111/jan.13564
  • Wolf, L. A., Perhats, C., Delao, A. M., Clark, P. R., & Moon, M. D. (2017). On the threshold of
  • Safety: A qualitative exploration of nurses’ perceptions of factors involved in safe staffing levels in emergency departments. Journal of Emergency Nursing43(2), 150-157. DOI: 10.1016/j.jen.2016.09.003