Park Claire Su-Yeon
Doctoral Student, University of Alberta Faculty of Nursing, Edmonton, Canada.
CEO, Center for Econometric Optimization in the Nursing Workforce, Seoul, Republic of Korea.
Int Nurs Rev. 2023 Jun;70(2):149-159. doi: 10.1111/inr.12785. Epub 2022 Jul 11.
This paper aims to propose Park's sweet spot theory-driven implementation strategy, which makes optimal safe staffing policy really work in nursing practice.
For the last 40 years, mainstream nursing workforce research has emphasized that having more registered nurses leads to better patient outcomes, and yet staffing policies have failed to implement this crucial concept. Meanwhile, global nursing shortages have become rampant, a problem that only dilutes the skill-mix ratios in the nursing workforce. Low fertility and an aging population worldwide are then accelerating these shortages. These dire circumstances may be persisting because of unclear, unsubstantiated cost-efficiency in the nursing workforce. For this reason, there remains a dearth of well-researched evidence for a clear threshold on optimal safe staffing levels that could maximize quality of care relative to cost given limited healthcare financial budgets and which could also be fitted into each care setting. Along with that, an implementation strategy for optimal safe staffing levels is nonexistent.
An implementation strategy has been developed through interdisciplinary consilience-based theory synthesis of both prospective theory and regulatory focus theory combined with Park's optimized nursing staffing (sweet spot) estimation theory.
DISCUSSION/CONCLUSIONS: A theory-driven novel implementation strategy is proposed, which functions as a nudge strategy that uses the synchronous balance of quality of care, nurse staffing, and cost. It illustrates (1) how to create shared value among patients, nurses, and stakeholders through robust evidence-based, informed shared decision-making rationales on the optimal safe nurse staffing levels and (2) how to induce stakeholders to overcome resistance to innovation and improve their nursing workforce through value chain in management science.
This novel implementation strategy may be a viable solution to mitigate the nursing shortage by leading stakeholders (1) to compete with each other (on the basis of nursing sufficiency) and (2) to competitively demonstrate the patient-centered value (patient-perceived care quality relative to cost) of their institutions.
本文旨在提出基于帕克最佳点理论的实施策略，以使最佳安全人员配置政策在护理实践中真正发挥作用。
在过去40年里，主流护理劳动力研究一直强调，增加注册护士数量会带来更好的患者护理结果，然而人员配置政策却未能落实这一关键理念。与此同时，全球护理人才短缺现象猖獗，这一问题只会稀释护理劳动力中的技能组合比例。全球范围内的低生育率和人口老龄化正在加剧这些短缺。由于护理劳动力成本效益不明确、缺乏依据，这些严峻情况可能会持续存在。因此，对于在有限的医疗保健财政预算下，能够使护理质量相对于成本最大化，并能适用于每种护理环境的最佳安全人员配置水平的明确阈值，仍然缺乏充分研究的证据。除此之外，也不存在最佳安全人员配置水平的实施策略。
通过将前瞻性理论和监管焦点理论与帕克优化护理人员配置（最佳点）估计理论相结合，进行跨学科的基于一致性的理论综合，制定了一种实施策略。
讨论/结论：提出了一种理论驱动的新型实施策略，它作为一种助推策略，利用护理质量、护士人员配置和成本的同步平衡。它阐述了（1）如何通过基于有力证据的、明智的关于最佳安全护士人员配置水平的共同决策理由，在患者、护士和利益相关者之间创造共享价值，以及（2）如何通过管理科学中的价值链促使利益相关者克服对创新的抵触情绪，并改善其护理劳动力。
这种新型实施策略可能是缓解护理人才短缺的一个可行解决方案，它可引导利益相关者（1）相互竞争（基于护理充足性），以及（2）竞争性地展示其机构以患者为中心的价值（相对于成本的患者感知护理质量）。
