Changing A Failed System : Nurse Patient Ratios

The nurses of today are just as important as doctors. Hospitals thrive on their training and skills to care for sick patients. Nurses are the heart and backbone of all hospital facilities. Nurse’s duties consist of injecting pharmaceutical drugs into a patients IV, measuring dosage, monitoring vital signs, keeping detailed logs of intake of medicine and other important procedures that go with the nursing profession. Hospitals all across the world depend on their valuable skills and determination to help people on their recovery (Olvera). There are different types of nurses, all which work in different paced environments. There are those who work in a calm setting were a patient is scheduled for a long stay, and then there are those who work in the emergency room, intensive care unit (ICU), nursing homes, schools and many more diverse areas (Olvera). The emergency room is a fast paced and hardcore working facility. Nurses within that department depend on their high energy and focus to make fast and accurate decisions (Ibid). It is hard to imagine a hospital with a shortage of nurses, but every day it becomes more perceptible that the U.S is going to be faced with a nursing crisis for the years to come (Tieman).

Transitioning from nursing school to working in a hospital setting can be a challenging time for a new graduate. Due to the nursing shortage, new graduate nurses are being hired with little to no experience. This is overwhelming for new nurses, especially when they are not getting adequate support or training from the hospital. The amount of stress, pressure, and lack of training is leading to a high turnover rate for new graduate nurses. With patient acuity on the rise, new graduate nurses that are filling these vacancies in the hospitals, need to be competent nurses to provide proper and safe care to the patients.

Several studies have shown that patients get well faster and safer when they receive more nursing care. Even more importantly according to Linda Aiken study (2003), mortality rates and staffing ratios are closely tied. Each additional patient per RN after four patients, chances of dying in the hospital is increased by 7%.Patient on a surgical unit with patient –RN ratio of 8:1 were 31% more likely to die within 30days than those on surgical units with ratios of 4:1.Studies have shown that more infections like UTI, pneumonia, shock or cardiac arrest increases when patients receive fewer hours of nursing care. Medication errors and unsafe hand washing techniques were found more in increased patient workloads. Unsafe staffing gave more job dissatisfaction, job burnout and more nurses quit or drove nurses away from nursing. This increased mandatory overtime and increased nurse shortage. According to survey of California state

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

When someone is hospitalized, they are often in their most vulnerable state. Whether you are the fearful individual being hospitalized, a concerned loved one, or the compassionate care provider, ensuring the patient receives the best possible care throughout their stay is a substantial concern. When receiving care and trusting a facility with the health of the individual involved, wouldn’t it be assumed that the amount of attention and level of care received would be unwavering throughout the nation? Would it be surprising to you to find out that the patient’s outcome may be different depending on in which state they are being cared for? Depending on the state in which the care is being received, there may not be a limit to how many other patients your nurse is assigned to, thus, limiting time and energy that nurse has to spend with each individual. While this fact is a scary one, there is evidence that thousands of lives could be saved if hospitals across the nation would implement change and mandate nurse to patient staffing ratios.

The purpose of this paper is to illustrate and demonstrate the significance of lowering the nurse to patient ratio, while implementing quality health improvements. Today’s complex healthcare system faces a number of difficulties that affect the quality of patient care and safety. Current nurse to patient ratios are of increasing focus in today’s healthcare system. Nursing staffing ratios have an effect on numerous areas within nursing; however, one of the most profound is the effect on the quality of care delivered to the patients. For example, medication errors and prevention are important in all aspects of care. Appropriate time is needed to administer medications; however, with overworked nurses and overextended patients loads, nurses are pressed for time. Nurses have the opportunity and responsibility to make sure that their patients obtain quality of care through interventions that keep patient safety a priority. Strategies should include keeping nursing staffed at adequate levels and appropriate to the type of patient care. Furthermore, the patient’s acuity and the nurse’s assignment should be taken into consideration.

Additionally, the study found that a high patient to nurse ratio resulted in greater emotional exhaustion and greater job dissatisfaction amongst nurses. Each additional patient per nurse was associated with a 23% increase in the likelihood of nurse burnout, and a 15% increase in the likelihood of job dissatisfaction. Moreover, 40% of hospital nurses have burnout levels exceeding the normal level for healthcare workers, and job dissatisfaction among hospital nurses is four times greater than the average for all US workers. 43% of nurses involved in this study that reported job dissatisfaction intended to leave their job within the upcoming year. (Aiken et al.)

The study by Aiken et al in 2002 revealed that there was a higher chance of nurses experiencing job related burnout in hospitals with high Patient nurse ratios. Further, nurses in institutions which had the highest rates of patient to nurse ratios were twice likely to suffer from dissatisfaction from their jobs. These influenced the decisions of nurses to leave their current jobs and thus creating more staffing problems that would lead to more negative patient outcomes.

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Why are the outcomes of patients so low when patient to nurse ratio is so high? Nurses are taking on more responsibility than ever before. Hospital administration worldwide believe that they can continue to add responsibility to the nurse’s shoulders and the outcome of patients will thrive. There are several reasons why the patient outcomes depend on nurses. Nurses have fewer resources which is leading to infections and potential falls. The risk of increased medication errors when staffing is inadequate must also be considered. Most importantly, exhausted overworked nurses will lead to poor patient

For every additional patient added to a nurse's workload, a hospital's death rate has been shown to increase by 7 percent, meaning that if a nurse is responsible for four patients and then has her care load doubled, there is a 31 percent increase in the patient death rate for the hospital. The percent increase is even higher for critical need patients. As many as 98,000 patients die each year from medical errors and ensuring high nurse-to-patient ratios is an essential component of reducing that rate.

Effect of new policy on Nursing practice, Health care delivery and Health care consumers (now and in the future).

Nurse to patient ratios is an important topic in health care today. The quality of care and safety of patients is a priority that demands constant improvement. The effect that nurse to patient ratios has on these matters has been the focus of many studies. One study found that the risk of patient mortality increases 7% per patient that a nurse is responsible for (Ratios, 2015). This percentage can become dangerously elevated when the nurse to patient ratio is high.

One of the major issues in the profession of nursing today is whether or not an adequate nurse to patient ratio is of importance to the quality of patient care and patient safety; the overall outcome. Over past decades, there have been many disputes about the shortage of nurses to patients and how nurses would get overworked and do overtime. This would then reflect on the effect that this shortage has on quality of care and safety of patients, whether in a hospital setting or not. There have been many studies done that support the importance of nurse to patient ratio; however, there have been studies that do not support the nurse to patient ratio because of future financial budget issue as well as enough proof to show that implementation of the mandated nurse-to-patient ratio is effective towards positive patient outcome and work satisfaction from nurses. The following peered review research studies include approaches that have been taken to support the positive and negative outcome of nurse to patient ratio.