Reflection On Reflective Practice

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?

The nurse manager in today’s health care has a solid role in providing a healthy working environment. Healthy working environment is the basis for safe and better patient outcomes. Healthy working environment in a unit depends on the inspiration, motivation and support from the nurse manager and the management in all the ways. So as a nurse manager in a unit, the change I wish to initiate is the safe staffing patterns. Safe staffing patterns are always important for safe working environments to deliver excellent patient care. Staffing and scheduling means providing an adequate staff mix to meet the needs of the patients (Grohar-Murray & Langan, 2011). Nurse manager should know how to schedule and skill mix to provide adequate

Nursing to patient ratio can have a direct impact on patient safety. Studies have been done that show that these ratios impact patient outcomes and mortality rates when nurses are understaffed and are given a larger patient load than they can handle safely. Nursing education level has also shown to play a role in patient outcomes. Whether they are an unexperienced nurse or the patients are at a higher acuity and require more time for care, these larger ratios can be detrimental to the nursing quality of care that can be provided. These larger nurse to patient ratios can also play a part in nurse burnout leading to medical errors, negative patient outcomes, and higher health care costs in the future.

Primarily, it is crucial for health care organizations to focus on ensuring safe and quality patient care, as well as improved job satisfaction by enforcing an optimal and adequate nurse-to-patient ratio and creating innovative and long-term strategies through a collaborative effort. In order to ensure the safety of patients and nurses, state-mandated safe-staffing ratios are necessary. Adequate nurse staffing is key to patient care and nurse retention, while inadequate staffing puts patients at risk and drives nurses from their profession. As baby boomers age and the demand for health care services grows, staffing problems will only intensify. Consequently, safe-staffing ratios have become such an ever-pressing concern. In 2004, California became the first state to implement minimum nurse-to-patient staffing ratios, designed to improve patient care and nurse retention. Subsequent studies show that California’s program measurably improved patient care and nurse retention.

Mandatory staffing ratios may improve the working conditions of nurses, provide safety to patients and achieve desirable outcomes for everyone involved in health improvements. One might assume quality health with lower nurse to patient ratios could reduce complications, shorten patients’ stays at the hospitals and lower nurse turnover rates. Lower turnover rates may be much more cost effective then adding additional staff for each shift. Safe training ratios identify the fact that shortage in nurses endangers the lives of patients while at the same time driving nurses from their professions (Silvestre, Bowers & Gaard, 2015). With increasing populations and

Duffin (2012) stated, “The California Nursing Association argues that this [mandated nurse-to-patient ratios] reduces mortality levels and allows nurses to spend more time with patients” (p.7). Duffin also quoted the co-president of the California Nursing Association, who said “A study from the University of Pennsylvania which concluded that New Jersey hospitals would have 14 percent fewer deaths if they matched California’s surgical unit ratios” (p.7). Increased nurse-to-patient ratios have been shown to decrease the infection risks in facilities. The Centers for Disease Control and Prevention (2004) stated, “They have identified a link between improved nurse to patient ratios and lower hospital outbreaks of bloodstream infections”(p 1). Mandated staffing ratios have shown to have many positives but they are not without flaws.

Dr. Linda Aiken is the leading researcher in nursing staffing rates within the United States (Kerfoot & Douglas, 2013). She suggests that each state follows California’s example of conducting research to determine a minimum staffing ratio and making it a law (Kerfoot & Douglas, 2013). The California legislation enhanced nurse staffing in hospitals across the state and improved the patient care results of millions of patients (Kerfoot & Douglas, 2013). After the bill went into effect, job satisfaction increased, and the nursing shortage ended (Kerfoot & Douglas, 2013).

The final bill mandates minimum, specific and numerical nurse-patient ratios in hospitals. For example, a mandated nurse patient ratio of 1:5 was set for medical surgical units and smaller ratios were assigned to specialty units (Tevington 2011). Today, California is the only state with mandated nurse-patient ratios. 14 other states have set laws and regulations addressing nurse staffing in hospitals but they all address the issue differently and have set different requirements (ANA,

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.

One the most important issues facing nursing these days is the changing healthcare insurance industry. I saw how these changes affected staff firsthand. I worked at Quincy Medical Center for three years until it closed in December of 2014. The Affordable Care Act led to cuts to Medicaid supplemental payments for the uninsured and has forced many hospitals to reduce staff or close like Quincy Medical Center. This is a concern for nurses because under current federal regulations there are no specific requirements for nurse to patient ratios. Multiple research studies demonstrate that lower nurse-patient ratios save both lives and money long term. For example, hospitals that routinely staff with 1-to-8 nurse-to-patient ratios experience five additional deaths per 1,000 patients than those staffing with 1-to-4 ratios, according to the Journal of the American Medical Association. Higher nurse to patient traditions lead to higher burnout

Safe nursing ratios provide better outcomes for patients and provide better working conditions for nursing staff. Unsafe nursing to patient ratios have detrimental and negative outcomes in the nursing care that patients can receive in the hospital. For example, medications that are administered to patients late can alter their drug administration schedule. The late administration of cardiac drugs can be detrimental to patients’ well-being because this can cause a failure in maintaining the drugs therapeutic serum levels and consequently increasing the likelihood of arrhythmias. High patient to nurse ratios can also cause nurse burnout. Nurse burnout is precipitated by the increased physical and emotional exhaustion from being assigned too many patients depending on the type of floor that one is working. This causes nursing staff to leaves the nursing field due to the undue stress and look for positions that aren’t as stressful. This will only contribute to the nursing shortage. Patient hospital stays can also be effected due to the number of days that a patient stays in the hospital. This leads to an extended number of days in the hospital which can cause a loss of money that insurances would not agree to pay. The safety of the patients need to be a nurse’s priority and this can be a great cause of concern with an unsafe number of patients being cared for by the nurse. As nurse timing becomes a priority, it becomes important to be able to take care of each patient that is

making Practice-Based Learning work Reflection on PRACTICE A resource commissioned by the Making Practice Based Learning Work project, an educational development project funded through FDTL Phase 4 Project Number 174/02 and produced by staff from the University of Ulster. www.practicebasedlearning.org Author Patricia McClure School of Health Sciences, University of Ulster www.practicebasedlearning.org contents Reflection on Practice 02

One of the greatest challenges in healthcare, as well as the biggest threat to patient safety, is staffing and the nurse to patient ratio on hospital floors. Studies have shown that low staffing levels lead to increased mortality rates in patients, as well as multiple other adverse effects including falls and pressure ulcers. These adverse effects are all preventable, but policies on staffing must be in place to ensure safety for staff and patients.

A load of research has been done on learning and reflective practice and its effectiveness on the practitioners and one of the first people to research reflective Practice was Donald Schon in his book “The Reflective Practitioner” in 1983. Schon was an influential writer on reflection and had two main ways of identifying reflection and they were reflection in action and reflection on action.

Professional knowledge is no longer viewed as just consisting of a standardised, explicit and fixed knowledge base. It is now seen as knowledge which exists in use, is ethical in its use and is changed by experience.