Senior Nurses’ Perceptions of Factors Involved in Safe Staffing in the Operating Rooms in Aotearoa New Zealand: A Qualitative Descriptive Study

Abstract

Nurse staffing is paramount to patients’ safety. Currently, there is no agreement in the literature on what constitutes safe nurse staffing levels in the perioperative setting. Models guiding staffing decisions vary. Understanding decision-making processes for perioperative nurse staffing may help managers identify staffing and skill-mix requirements. A qualitative descriptive approach using thematic analysis was used to identify key factors that perioperative nurses considered when making decisions about nurse staffing and skill-mix. Semi-structured interviews were conducted with seven senior operating room nurses responsible for staffing decisions in elective and acute care operating rooms in two large publicly funded hospitals in Aotearoa New Zealand. Four themes describing operating room nurse staffing decision-making processes were generated from interview data: 1) safety: team-based, person-centred care; 2) the importance of skill-mix; 3) safe staffing: ‘Not just about the numbers’; and 4) the complexity of staffing decisions. Themes were interdependent, multidimensional and intertwined. Collectively, these themes provided insight into, and evidence of, the complexity of safely staffing operating rooms in Aotearoa New Zealand. Our findings support nurses in expressing the unique variables associated with appropriate nurse staffing allocation in this unique context. The traditional ‘numbers’ approach to operating room nurse staffing is questioned. A nursing knowledge framework for person-centred, safe nurse staffing in the operating room is proposed for guiding future work in this area. Te reo Māori translation Ngā Whakaaro o Ngā Tapuhi Mātāmua mō ngā Take e Pā ana ki ngā Taumata Kaimahi Haumaru i roto i ngā Taiwhanga Poka Tinana i Aotearoa: He Rangahau Whakaahua Inekounga Ngā Ariā Matua He mea taketake ngā taumata kaimahi tapuhi mō te haumaru o te tūroro. I tēnei wā, kāore he whakaaetanga i roto i ngā pukapuka he aha rawa tētahi taumata kaimahi tapuhi haumaru i roto i te horopaki i te wā o te poka tinana, i mua, i muri hoki. Ka rerekē ngā tauira tūtohu i ngā whakatau taumata kaimahi. Mā te noho mārama ki ngā hātepe whakatau take mō ngā taumata kaimahi tapuhi i te wā o te poka tinana, i mua, i muri hoki, e taea ai e ngā kaiwhakahaere te tautuhi i ngā hiahia kāhui kaimahi, momo pūkenga hoki. I whāia ētahi tikanga whakamārama inenkounga i whakamahi i te tātari tāhuhu hei tautohu i ngā āhuatanga taketake i whakaarotia e ngā tapuhi poka tinana ina whakatau take mō ngā taumata tapuhi me ngā momo pūkenga. I kawea ētahi uiuinga āhua māhorahora ki ētahi tapuhi rūma poka tinana mātāmua tokowhitu e kawe haepapa nei mō ngā whakatau taumata kaimahi i ngā rūma poka tinana kōwhiri, tiaki tārū hoki i ētahi hōhipera nunui e rua nā ngā pūtea tūmatanui i whāngai, i Aotearoa. E whā ngā tāhuhu whakamārama i ngā hātepe whakatau take taumata kaimahi tapuhi i ngā rūma poka tinana, mai i ngā raraunga uiuinga: 1) te haumaru: te taurimatanga ā-tira, anga ki te tangata; 2) te hira o ngā momo pūkenga; 3) ngā taumata kaimahi tapuhi haumaru : ‘Not just about the numbers’; ā 4) ko te matatini o ngā whakatau mō ngā taumata kaimahi. He tauawhiawhi, he tapatini, he whīwhiwhi hoki ngā tāhuhu. Ina huia mai, nā ēnei tāhuhu ka puta he māramatanga mō te matatini o te whakanoho kāhui kaimahi ki ngā rūma poka tinana i Aotearoa. Ka tautoko ā mātou kitenga i ngā kōrero a ngā tapuhi e whakaputa nei i ngā āhuatanga ahurei e pā ana ki ngā whakaritenga taumata kaimahi tapuhi tika i tēnei horopaki ahurei. Kei te werohia te ara ‘te tokomaha’ tuku iho mō te whakarite ngā taumata kaimahi tapuhi ruma poka tinana. E marohitia ana tētahi anga mātauranga tapuhi mō te whakarite taumata kaimahi tapuhi anga ki te tangata, haumaru hoki hei ārahi i ngā mahi i tēnei wāhanga, ā ngā rā e tū mai nei. Ngā kupu matua te whakatau take; ngā rūma poka tinana; te haumaru tūroro; te tapuhi i te wā o te poka tinana; ngā taumata kaimahi haumaru