Summary: The Issue Of Staffing

Many nurses face the issue of understaffing and having too much of a workload during one shift. When a unit is understaffed not only do the nurses get burnt out, but the patients also don’t receive the care they deserve. The nurse-patient ratio is an aspect that gets overlooked in many facilities that could lead to possible devastating errors. Nurse- patient ratio issues have been a widely studied topic and recently new changes have been made to improve the problem.

When was the last time you were in the hospital or a loved one was in the hospital, and ever wondered where the nurse is, and they haven 't returned for hours. You finally push the assistance button several times, and they open the door and hurriedly say, “I will be right back”, then you don 't see them for a while again. When they come back to check up on you, you explain to them what you need, and then they send in a less qualified staff member to assist you. At this point, you become very annoyed and frustrated not to mention scared to be admitted in the hospital to begin with. Little do you know, your nurse has ten other patients and other non-nursing tasks that they are responsible taking care of. They have been working a double shift and are extremely exhausted, and a large stack of charts that they will have to do before their shift is over. As a patient, you now become frustrated and are not happy about this; as a nurse, they are just as frustrated as you are, not only because the amount of work they have but more importantly they can 't deliver the appropriate care they long to give. For most hospitals they do not hire enough registered nurses for reasons that are good and bad. This is an issue that needs to be addressed not only locally but nationally and on a constant basis. When there are too many patients for one registered nurse to attend to, nurses become exhausted, mistakes are made, and patients are unsatisfied. A minimum nurse to patient ratio needs to be

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.

Nurse-to-patient ratios is not a new topic of debate for all of us who deliver care to patients every day. Only lately it has been a big issue that have caught the attention of many. Demands by the medical community for changes concerning staffing, asking for the government interventions in minimum staffing laws. Registered nurses have long acknowledged and continue to emphasize that staffing issues are an ongoing concern, one that influences the safety of both the patient and the nurse. (ANA, 2015) .nowadays hospitals are running for profit and the emphasis is not put on job burnout, stress, and endangerment of patients. Nursing shortages is a very pertinent problem, it will be optimum to have laws in place to help with the issue, however meanwhile leadership and management methods to the matter can help to mend the nursing situation and avoid many of the damaging effects of unfitting nurse-to-patient ratios.

Mandatory staffing ratios have been suggested as a way to meet nursing staffs’ concerns of high nurse to patient ratios. Mandatory staffing ratios are used as a way to reduce workload and patient mortality and are aimed at addressing the perceived imbalance between patient needs and nursing resources. (American Nursing Association, 2014). However, issues have been raised on applicability of staffing ratios since it could lead to increased costs without the guarantee of improvement in the quality of health care and could also lead to unintended consequences including unit closures, limited infrastructural development and limited access by patients (American Nursing Association, 2014).

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 literature review studies discuss the recurrent issue of higher and lower staffing ratios and how they affect patient outcomes. The studies show how several factors affect the nursing workload and the adverse results of the patients. The information is investigated under several methods that range from level one to a level five on the pyramid. The extensive research studies provide the support and the evidence on the issue needing change.

This is a sobering statistic: “the odds of a patient dying in hospitals with an average workload of 8 patients per nurse are 1.26 times greater than in hospitals where the mean workloads of 4 patients per nurse” (Aiken, Clarke, Sloane, Lake & Cheney, 2008). A rubber band can only stretch so far before it breaks. It would follow that attempts to improve patient care must address adequate patient-to-nurse ratios and workload.

In a different review of literature on staffing and patient outcomes, Heinz (2004) describes the relationships between staffing and mortality, length of stay, and complications of patients. At first the article paints a clear picture of the future of nursing as it starts to feel the shortage which is approaching due to aging of present nurses, lowered nursing school admissions, and other hospital issues including financial hardships. In looking at the impact of ratios on mortality there were five different studies identified that showed that the lower the ratio, the lower the risk of mortality of patients. A patient's length of stay was also influenced negatively with higher nurse-to-patient ratios and positively with specialized units and care from nurses. The impact of staffing on patient complications also showed that there was an inverse relationship between the two. Heinz concludes that the key to solving these problems in nursing and reducing negative patient outcomes is nursing recruitment and retention (Heinz, 2004).

For the past decade, nurse-patient ratios have been a widely controversial debate as to whether it should be mandated by law across the United States. Studies have shown nurse-staffing levels are a critical component of determining patient outcomes (Hertel, 2012). Advocates supporting minimum staffing levels argue that it can ensure better quality care, better working conditions, positive patient outcomes and improved rates of nursing retention. Those opposing minimum staffing levels argue that it would be expensive and reduces management flexibility. This topic was chosen because of how essential it is for this issue to be resolved in nursing. Within the past decade, only one state, California, has adapted to this unique law

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

One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.

Nursing is the powerhouse in the delivery of safe, quality patient-centered care in the healthcare industry. To ensure continued safety of the patient and nursing staff, the issue of inadequate staffing must be addressed. Consequently, patient’s mortality rate has been linked to the level of nursing staff utilized in ensuring an utmost outcome (Aiken, 2011). This paper will outline the issue associated with inadequate nurse to patient staffing ratios in the hospital setting; essential factors such as economic, social, ethical and political and legal affecting the issue will be established; current legislature and stakeholders will be ascertained and policy option, evaluation of bill and the results of analysis will be reviewed.

According to L.H. Aiken et al., there is strong evidence that supports a connection between better nurse staffing and better patient outcomes. Scientists argue that a higher amount of nurses on staff allows for a lower rate of overall patient mortality. The reasoning behind this point is the fact that higher nurse rates correlate with “better nurse care environments.” Patient to nurse ratio, highly educated nurses, and increased nurses on staff during a single period of time effects the environment that allows for proper patient care. If there are too many patients assigned to a single nurse it will lead to increased patient complications (medical care/ medication errors, mortality rates, etc.) increased nurse fatigue, and decreased nurse retention/job satisfaction. Scientists argue that these issues must be looked at immediately because there are “numbers of lives that would be saved through improved care environments.” Scientists also argue that the way to improve care environment is by having hospitals become “magnet