Develop Nurse-To-Patient Ratios

The economic impact on healthcare has taken its toll on the number of registered nurses providing bedside care to patients, compromising patient safety and dramatically increasing the potential for negative outcomes. Several factors have immensely contributed to the nursing shortages over the years, including healthcare organizations downsizing, increased workloads, inadequate staffing plans and job dissatisfaction. Mandated nurse-to-patient staffing ratios have been implemented in several states to date with many more trying to pass some type of legislation. Have these ratios affected the quality of care or is it more realistic to create staffing committees that are based on each unit’s unique situation and varying requirements?

Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses (Jooste, 2013). The nurse manager has to explain to the management of the benefits of change in providing adequate staffing all the time. Adequate staffing helps staff retention. Staff retention saves a lot of money in terms of orienting new people to the unit. Safe staffing always helps in the reduction of falls, infection rates, pressure ulcers, decrease hospital stays and death. Flexible and creative scheduling is essential for retaining staff and promoting a positive work climate (Grohar-Murray & Langan, 2011). Adequate staffing with good staffing ratio will help nurses to concentrate on their patient care which may help in a reduction in medical errors and lawsuits to the hospital.

Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).

Mandatory nurse-patient ratios have been a controversial topic facing nurses for decades. Nurses, patients, physicians, nursing organizations, researchers, hospitals, federal government, and state governments have opposing views in regard to mandatory nurse-patient ratios. Those that support the idea of mandatory nurse-patient ratios believe that there would be an improvement in quality of patient care, decreased nursing shortages, increased job satisfaction, decreased client hospitalization, and increased nurse recruitment (Pamela Tevington, 2012). Groups that oppose mandatory nurse-patient ratios believe that mandatory staffing laws ignore factors such as the level of care a patient requires from a nurse, treatments, length of hospitalization, improvements and differences in technology, the expense of an increased nursing staff, and nurse experience and education (Tevington, 2012).

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

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.

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.

As a certified nursing assistant (CNA) on the medical-surgical unit at Meritus Medical Center, the shortage of staff from CNA to registered nurses have increased. It has become noticeable the amount of stress the staff endures and how it affects patient care. It has also affected their overall satisfaction with their careers. At least five nurses have left the job since last year and that is only from night shift. It makes a big difference when there is adequate staffing because everyone is able to work efficiently. Sometimes there are four nurses with seven patients each and only two aides. Therefore, it makes it harder to offer help because of the workload. According to Martin (2015), patient outcomes are less likely to be adequate when there

When it comes to nurse-to-patient ratio, safety is the number one priority. An article published in the National Nurse journal in 2010 discusses the impact of decreasing the maximum number of patients a specific nurse can safely take care of. At the core of the article’s argument is analysis of Boxer’s effort to introduce the National Nursing shortage reform and patient advocacy act 1031 and the impact it has on the nursing fraternity. According to Smith (2010) “mandatory nurse-patient ratios is that minimum, specific, guaranteed nurse staffing will produce better patient outcomes and alleviate nurse workloads and increase job satisfaction” (Smith, 2010, para. 14). While Senator Boxer is reported not to have enough sponsors for the new bill, the author concludes that passing the legislation will play a critical role in transforming the services offered by registered nurses in the United States (Smith, 2010). Second article that talks about safe staffing levels and mandatory nurse-patient ratios is from the MEDSURG Nursing journal published in 2011. This article assesses the impact of extending the Californian legislation that mandates patient nurse ratio on other states in the United States of America. The author concludes by arguing that passage of regulations that mandate nurse patient ratio promotes the value of the

Health care administration is a very important and crucial role in today’s healthcare system. With an ever-changing national health care system, the role of a Health care Administrator or Healthcare Executive more than ever is needed. Healthcare facilities, organizations, and or offices rely on health care administrators to plan, direct and coordinate all medical health services (United States Department of Labor , 2014). Some areas where one might find administrators are managing entire medical facilities, specialized clinical departments, or a medical practice for a group of physicians (United States Department of Labor , 2014). The need for high-quality health care administers is more now than ever with the fast-changing health care laws.

Low nurse staffing levels are credited for the reduced rates of patient outcome. Therefore, there is a need for improved nurse staffing levels to meet the growing demand for health care delivery services in the hospitals. Currently, there is the need for higher staffing levels to serve the growing global population. However, improving the staff levels is not as straightforward and easy as it sounds in theory. Staffing levels are low in most states in the US and most countries in the world. The main factors that contribute to the low staffing levels include but not limited to the big gap between the number of registered nurse and the industry requirement and the rising needs of the acuity patients present in the US today. In other words, there

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 greatest negative impact that affects me as a primary healthcare provider is the nurse to patient ratio. This is a historical and modern day issue that has been in contention well before the 17 years that I have practiced. Physicians and nurses are in agreement that the major impediment on quality care is inadequate staffing and unrealistic workloads (Carlson 2010). An issue with nurse patient ratios primarily exists because the formula used for staffing a facility overlooks a patients’ acuity level. The acuity level is based on the overall condition of the patient and the time needed to safely provide patient care. Patients with a higher acuity are generally more time consuming because they require more care due to the seriousness of their condition. This can leave lower acuity patients with minimal care, minimal education, and a feeling of rejection. If the right nurse to patient ratio is not achieved patient outcomes suffer and readmissions increase.