Nursing Practice Problem and PICOT Question


The current nursing practice problem is considered to be the nursing shortage. Many countries have faced this problem due to the insufficient number of new graduates, the high turnover of qualified nursing staff, or a lack of employment opportunities for young professionals. Nurses in healthcare facilities are overworked, quitting more often, further adding to the burden on those nurses who continue to work. Despite acknowledging the issue by most medical institutions, many nurses still face low wages and long shifts. The PICOT question is ‘what are the effects of nursing staff shortage on the quality of care of patients?’. It remains essential to analyze the problem as it directly impacts the quality of health delivery.


The nursing shortage problem appears rather complicated for health care in general. It results in the nurse-patient ratio imbalance as available nurses tend to overwork (McKechnie, 2016). It affects the quality of healthcare delivery, leading to inadequate patient care as nurses experience time pressure (Haddad et al., 2020). The adverse outcomes of such an issue are increased patient mortality and infection rates error. Concerning the United States, the turnover of nurses depends on the nursing specialization and the jurisdiction; the turnover ranges from 8.8% to 37% (Shaffer, 2020). The situation with registered nurses (RN) is not favorable as the US turnover average is 17.1 annually (Shaffer, 2020). The medical facilities’ expenditure on managing the attrition rate is $4.4-6.9 million (Shaffer, 2020). Thus, the significance of the problem is explained by poor quality service delivery.

The purpose of the paper is to provide comprehensive research on the nursing shortage issue, analyzing it from different perspectives. The research question (RQ) is, “what are the effects of nursing staff shortage on the quality of care of patients?” The objectives are to combine results from four articles, distinguish different purposes of qualitative and quantitative research methods, and present the results of the studies. They also involve comparing findings with PICOT question’s anticipated outcomes and provide suggestions for evidence-based practice.

How do these four articles support the nurse practice issue you chose?

The articles will be used to answer the PICOT question regarding different aspects of the nursing shortage issue. Zhu et al. (2015) aim to explore the decision-making processes by registered nurses (RN) in China on existing clinical care. The objectives are to explore reasons why nurses leave the practice. The RQ is “How do leavers describe their experiences of being a clinical nurse during their entering, practicing and leaving nursing practice?” (Zhu et al., 2015, p. 7). Liang et al.’s (2012) article evaluate nursing working conditions by assessing their schedules and human medical resources. Its objective is to identify the link between the patient mortality rate and nurse staffing, finding the problem solution (Liang et al., 2012). The RQ is “What are the effects of acute care hospital nurse staffing on patient mortality?” (Liang et al., 2012, p. 46). These articles will be used to answer the PICOT question by addressing the challenges faced by the nurses.

Concerning two other articles that are conducted using qualitative methods, they help determine the tendencies and future areas for improvements. The purpose of the Buerhaus et al. (2005)’ study is to define how RN see the impact of a lack of nurses on the quality of care (Buerhaus et al., 2005). The RQ is “how the current nursing shortage has affected the quality of patient care from the perspective of RNs and CNOs?” (Buerhaus et al., 2005, p. 214). The objectives of the survey by Amiri et al. (2020) aim at investigating the effect nurse staffing has on decreasing newborn mortality rates. The RQ is “what effect does nurse staffing have on decreasing the newborn mortality rates in member countries of Organisation for Economic Co-operation and Development (OECD)” (Amiri et al., 2020, p. 161). As the PICOT question involves different patient ages, the articles include various people, ranging from older adults to newborns. Overall, the results are an essential informant to medical decision-makers, it should be used in hospitals or on healthcare boards.

Method of Study

The general focus of qualitative research is based on the particular, especially in describing the whole picture of social practices. The methodology used in the article Zhu et al. (2015) interviews; in the article Liang et al. (2012), such a method as stratified random sampling was applied. An interview is conducted according to a pre-developed plan, involving direct contact between the interviewer and the respondent. The stratified sampling method involves a limited number of people being selected from the general population.

Regarding quantitative study methods, their goal is to obtain and analyze reliable data that are subject to comprehensive statistical processing. Buerhaus et al. (2005) used random sample surveys, gathering numeric data presented in tables and percentages. Amiri et al. (2020) implemented the statistical technique of panel data analysis. A random sample model allows measurable data to formulate facts and uncover different patterns in research. Panel data analysis allows researchers to collect results from the same groups of people or individuals, and then the regression is performed in these two dimensions.

The benefit of interviews is the ability to firsthand information and attain real-time results. The principal limitation is susceptibility to biased information. Satisfying sampling’s advantage is its ability to analyze the results and determine patterns and conclusions on the particular issue, but the method is time-consuming. Random sampling helps test the validity of opinions identified through qualitative research. The disadvantage is that the results may be distorted due to the mutual, socio-psychological influence of the interviewer and the respondent. Panel data analysis identifies the tendency of development or change of a particular social process. Nevertheless, the variations recorded may be caused by external reasons that do not follow the specifics of the given object.

Results of Study

Nursing availability is often connected with high patient mortality rates. According to Liang et al. (2012), the survey results show that the average direct hours of nursing care were about 4.95% daily, in other words, 21% of an entire patient care day. In the study of Zhu et al. (2015), the four behavior patterns of nurses were determined; these are voluntary leaving, passive staying, adaptive staying and active staying. Patient mortality is caused by nursing negligence or incompetency, false expectations and personal views of majesty (Zhu et al., 2015). Buerhaus et al. (2005) determined that the shortage of personnel impacts negatively; the results are nurse turnover leads to a high workload on the available nurses hence reducing their attention on patients. The research conducted by Amiri et al. (2020) showed that nurse staffing is connected with newborn mortality rates. Thus, there is a link between the nursing shortage and patient mortality rates.

All the conducted studies can be implicated in nursing practice. The study of Zhu et al. (2015) can contribute to the international debate on retention strategies for nursing workforce management. According to Buerhaus et al. (2005), the study implication will help to provide an understanding of the importance of increased funding for training and employment of nursing staff. Liang et al. (2012) encourage monitoring labor mobility of nursing personnel and taking appropriate action responsibly and ethically. Amiri et al. (2020) strengthen the potential of medical institutions to collect, analyze and use data on this category of the health workforce. Therefore, four studies enable broad and cross-sectoral dialogue based on evidence in nursing.

Ethical Considerations

Two fundamental ethical considerations are voluntary participation and confidentiality. Voluntary participation ensures that study participants understand the nature of the research and consciously and voluntarily decide whether to participate. Concerning privacy, information obtained from subjects while participating in research should be protected. In the survey conducted by Zhu et al. (2015), confidentiality was ensured so that participants could voluntarily join the survey. Another qualitative survey Liang et al. (2012) also respected intellectual property, privacy and confidentiality. Other articles by Buerhaus et al. (2005) and Amiri et al. (2020) acknowledged any contributions from other researchers. It is essential to distinguish between acceptable and unacceptable behavior, especially when people are involved in the research.

Outcomes Comparison

The PICOT question is ‘what are the effects of nursing staff shortage on the quality of care of patients?’. The anticipated outcomes are that a considerable inequality in the provision of the population with nursing personnel persists these days. However, the upward trend is expected, meaning that there is an increase in the number of nursing staff and an expansion of the range of its duties and functions. The articles show an opposite tendency; the processes are developing slowly, unable to meet the needs of today’s population. Nurses face challenges, including turnover, equitable distribution and retention of the workforce, quality education, effective regulation, favorable working conditions, and quality and efficiency of health care (Zhu et al., 2015, Buerhaus et al., 2005). Amiri et al. (2020) and Liang et al. (2012) show the rising patient mortality rate resulting from the nursing shortage. As a result, some portions of patients are left without proper nursing care.

Proposed Evidence-Based Practice Change

PICOT question aimed at analyzing the connection between the shortage of nursing personnel and patients’ care quality. Four articles discuss this issue from different perspectives. Zhu et al. (2015) examine nurses’ motivation to leave nursing practice; Liang et al. (2012) reveal nurse staffing problems and patient mortality in Taiwan. Buerhaus et al. (2005) explored hospital nursing shortage and its impact on the quality of care. Amiri et al.’s (2020) research determine the effects of nurse staffing on reducing mortality rates. As a result, nursing-led primary health care should target better patient health outcomes and higher patient satisfaction.

Nursing workers should spend more time in direct counseling with patients. It can be achieved by optimizing the contribution of the nursing profession to a supportive environment through implementing evidence-based practice. For instance, financial aid and establishing appropriate nursing education would be beneficial. Teaching should ensure an influx of nursing workforce to meet the population’s needs in terms of the number, professional qualifications and distribution of nursing workers. Formalized mentoring of graduate hires can facilitate their entry into practice and professional socialization.


Amiri, A., Vehviläinen-Julkunen, K., Solankallio-Vahteri, T., & Tuomi, S. (2020). Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries. International Journal Of Nursing Sciences, 7(2), 161-169.

Buerhaus, P. I., Donelan, K., Ulrich, B. T., & Norman, L. (2005). Hospital RNs’ and CNOs’ perceptions of the impact of the nursing shortage on the quality of care. Nursing Economics, 23(5), 214-221. Web.

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020). Nursing shortage. StatPearls [Internet].

Liang, Y. W., Chen, W. Y., Lee, J. L., & Huang, L. C. (2012). Nurse staffing, direct nursing care hours and patient mortality in Taiwan: The longitudinal analysis of hospital nurse staffing and patient outcome study. BMC Health Services Research, 12(1), 44-52. Web.

McKechnie, T. (2016). Call for nurses: The multi-dimensional manifestation of nursing shortage on patient care. QIHI Journal of Healthcare Improvement and Patient Safety, 2, 1-4.

Shaffer, F. A. (2020). Nurse turnover: Understand it, reduce it. American Nurse Journal. 15(8), 57-59.

Zhu, J., Rodgers, S., & Melia, K. M. (2015). A qualitative exploration of nurses leaving nursing practice in China. Nursing Open, 2(1), 3-13.

Find out your order's cost