Changing a Failed System: Nurse-Patient Ratios Amanda Vass Casper College As a new graduate registered nurse, I know that when I begin my first job the reality shock will occur. I will be overwhelmed at times by anxiety, fear, failure, and disappointment. Burnout is higher for new nurses, and it is my responsibility to help combat it for my fellow graduates and for myself. For years nurses have felt the increased impact of compassion fatigue, with patient safety and satisfaction rates plummeting. Nurses are faced with sicker patients with shorter hospital stays everyday. The pressure to treat the patients, but get them out of the hospital as soon as possible; without making any mistakes is a huge burden most nurses will feel at some point in their career. There have been countless studies, thousands of hours, and billions of dollars for research spent on finding a solution to the problem. In order to find a solution one must first understand the problem. These are three separate issues with one common problem, high nurse-patient ratios. A study performed in 2012 found that in hospitals across Pennsylvania that just over 4,500 patients that died within 30 days of hospitalization, and of those 4,500 deaths. It is believed that a nurse-patient ratio of 4:1 could have saved approximately 1,000 lives (Shekelle, 2013, p.3-4). In a 2013 survey, collected by the Daisy Foundation and the Journal of Nursing Scholarship, an overwhelming number of registered
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.
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.
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
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.)
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.
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.
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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.
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
Effect of new policy on Nursing practice, Health care delivery and Health care consumers (now and in the future).
I can bear witness to all the different circumstances that qualify one to one nurse patient ratio. At times, due to staffing and patient acuity the nurse patient ratio cannot be helped. Nurse to patient ratio is a problem in the workplace especially in the critical care setting that requires managers and leaders to intervene. To eliminate this problem as stated by McKenna et al. (2011) nurse managers are working together with other staff members in forming a committee called the Nursing Productivity Committee (NPC), which helps to implement safe staffing strategies to ensure best possible patient outcome and improve nurse satisfaction. The NPC, as stated by McKenna et al., found that nurse patient ratio in the intensive care unit (ICU) was
Jayda, state like Minnesota has a union that fights for the right of their nurses. Either one joins the union or not, the union still fights for the nurses as whole. When one work in a state or country where nurses have union, trust me, you will love it. No body, I say no body can underrate or look down on any one of their member. They are the voice for all the nurses, even to the legislative level. They always fight a good fight for their members and the patients. Any member of their union can never be terminated any how without proper and due process. For example, the nurse/patient ratio is very important for safety purpose and they don’t play with it at all.
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.
Excellent VoiceThread presentation, I found it very informative. I support your legislation platform for making the New York State nursing patient ratio bill into a law. As nurses we have all had days where we felt burn out, stressed and over worked. At the facility I work at the nurse to patient ratio is a constant topic that our union advocate for and is built into a union contract. Martin (2015) states that nurse staffing influences a variety of areas within nursing. One of the most profound is the effects on patient quality of care. Also, poor staffing affects the employee as well, insufficient staffing increase nurse work load and job dissatisfaction. This overall determines patients overall care (Martin, 2015). When staffing is poor,
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).