Ratio Analysis In Nursing

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?

Since the times when Florence Nightingale took care of patients, there has been a question about what factors affect patient care. One of these factors, nurse-to-patient ratios, has gotten significant publicity over the last several years due to a change in legislation in California. This increase in publicity has sparked many researchers' interest to further evaluate these ratios in connection with patient outcomes and other variables. Through lots of research and analysis there is evidence that a lower nurse-to-patient ratio does reduce the negative patient outcomes in patient care. Some of these

Goal three by the National Patient Safety Goal for 2014 is to use medicines safely. Many errors occur regularly with medications which is why communication is so important with the doctors, nurses and patients. One process that Joint Commission requires in accredited HCO’s is medication reconciliation “creating the most accurate list possible off all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing that list against the physician’s admission, transfer, and/or discharge orders with the goal of providing correct medications to the patients at all transition points within the hospital (Finkelman & Kenner, 2012, p. 388)”. Ensuring medication reconciliation to the patient, health providers and any new consults that are

"To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value” (Jointcommission.org, 2015). These requirements are regimented in the National Patient Safety Goals and are enforced via surveys and internal inspections to ensure that healthcare institutions abide by the safety mechanisms put in place to facilitate the optimal patient outcomes and environments.

Medication Reconciliation is defined by the Joint Commission as the process of checking and rechecking a patient’s current medication list to the patient’s orders. Within a MedRec program, three steps must be followed to ensure patients have the correct medications at admission and discharge: Verification, Clarification, and Reconciliation (Greenwald et al., 2010; Ruggiero et al,. 2015). MedRec should not occur once, but multiple times especially when a patient moves from department to department. The more a patient moves, the more liable they are for a medication error due to poor communication. MedRec is done for the simple reason of catching those medication errors and correcting them before they can do any harm (The Joint Commission, 2006). Medication errors effect nearly 1.5 million people who enter the hospital setting in the USA. At least every patient has one medication discrepancy between admission and discharge, which leads to rehospitalizations due to hospital-setting medication errors (Institute of Medicine as cited by Wilson et al,. 2015). With nurses at the forefront of a patient’s medication regime, pressure is put on them to provide the necessary education and safety to prevent medication related rehospitalizations. Included in the causes for medication errors is miscommunication between departments taking care of the same patient (Allison et al., 2015). Many medication errors are preventable by the implementation of electronic orders. The use of electronic

A quality improvement (QI) project involves data-guided activities with short timelines to improve health care delivery systems (Arndt & Netsch, 2012). The setting of QI projects take place in a single setting and are monitored in the institution where the QI project is conducted. The purpose of a QI project is to change practice outcomes and apply known solutions to a known problem in that institution (Arndt & Netsch, 2012). Data obtained from the activities is disseminated through newsletters, flyers, through staff meetings, or submitted for publication and presented in

Effective financial management is the basis of thriving health care organizations. Organizations must make good investment decisions based on objective analysis (Healthcare Financial Management Association [HFMA], 2005). Integration of financial management principles provides decision makers with guidance to make capital decisions maximize mission-based benefits at effective costs (HFMA, 2005). An operating budget is the statement of profit and loss for the entire organization. Various health care entities prepare operating budget for the following year for discussion and approval by top management (Academic Writing Tips, 2011). At the end of the year, departmental managers provide an account for the previous year’s

The National Quality Measures Clearinghouse (NQMC) is an initiative of the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services (U.S. Department of Health & Human Services, 2015). NQMC is a website and database for information on evidence-based health care quality measures and measure sets (U.S. Department of Health & Human Services, 2015). “The NQMC mission is to provide practitioners, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining detailed information on quality measures, and to further their dissemination, implementation, and use in order to inform health care decisions” (U.S. Department of Health & Human Services, 2015). There are several measures established in the NQMC that deal with prescribing the correct medications for hospitalized patients.

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.

A strong operating and capital budget should align with the strategic goals of Creekside Community Hospital, as well as ensure operational efficiencies and financial longevity. Planning capital purchases continually and for future years will allow Creekside to be competitive, which is a crucial factor in capital budgeting (Gapenski & Reiter, 2016). Vianueva (2011) suggests an inadequate capital budget process leads to a key problem area for hospitals. Cost allocation is a vital component of the capital budget process. Costs must be allocated to the appropriate departments or areas where they are incurred, as well as where revenues are generated. With Creekside Community Hospital exhibiting higher inpatient costs than outpatient costs, the hospital leadership should ensure accuracy so that managers have the information necessary to make sound, financial decisions currently and in the future related to staff support, equipment and supply purchase to name a few.

The delivery of healthcare has evolved and changed over the years and with the advances in science and technology, the ability to provide safe, quality care to all patients has been impacted by the changes. With the rising healthcare costs and decrease in reimbursement for care provided, organizations must look for ways of cost containment to maintain viability for the future. Fabre (2005) noted that administrators are struggling to maintain financial stability and retain competent nurses during these difficult

Quality measures are strategies that gauge, evaluate or compute health care processes, results, discernments, patient insight, and administrative structure. In addition, quality measures are frameworks that are connected with the capacity to deliver first-class health care and/or that are able to identify with one or more quality objectives for medicinal services. These objectives include: compelling, protected, effective, quiet focused, impartial, and opportune consideration. Quality measures can be used to measure quality improvement, public reporting, and pay-for-reporting programs specific for health care providers (CMS.gov, 2016). There are an assortment of quality measures in which health care organizations can use to determine the status of the care they are delivering. Many are appropriate, but few are chosen for this research paper. Among them are: National Health Care Surveys, Hospital IQR Programs, Scorecards, and Political, Power, and Perception/Data for Decision-making tools.

Moreover, the PQIs can be used as an assessment instrument to help highlight potential healthcare quality concerns and challenges that require further analysis and provide effective data for planning and improvement of health care quality; and provide information to the consumers (U.S. Department of Health & Human Services, 2014). The Inpatient Quality Indicators (IQIs) measures also provide a perspective that includes inpatient mortality for certain procedures and medical conditions; application and utilization of certain procedures for which there are questions of uses

Ratio analysis is the fundamental indicator of company’s performances for so many years; it is also can be seen as the very first step to measure a company’s performance along with its financial position. Moreover, ratio analysis has been researched and developed for many years, Bliss had presented the first coherent system of ratios, and he also stated that ratios are “indicator of the status of fundamental relationship within the business” Horrigan (1968). However there are some arguments on whether the ratio analysis is useful or not since to conduct these analyses will be costly to the company, also there are several limitations on how these ratios work. Therefore, the usefulness and the limitation of ratio analysis will be discussed further in this essay, with the use of easyJet’s annual report as examples.