Essay on The Impact of Nurse Staffing on Patient Outcomes

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?

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).

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 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).

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.

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.

Current nurse-to-patient ratios is a topic that has constant focus on today’s patient outcomes and safety. There have be many studies and there continues to be studies done on how a higher nurse to patient ratio effects not only patient and nurse safety and patient outcomes once they leave the hospital, but also patient mortality rates as well. When a nurse has been assigned more of a patient load than they can safely handle, whether it be because of a large patient volume or patient acuity, patients suffer and the quality of care declines. With the higher ratio,

The American Nurses Association supports a legislative model in which nurses are encouraged to create staffing plans specific to each unit. This approach will aide in establishing staffing levels that are flexible and can be changed based on the patients needs, number of admissions to the unit, discharges and transfers during each shift (“Nurse staffing plans,” 2013). This model will assist in keeping the unit staffed appropriately and organized in need of a change during each shift. Without an organized plan like this, a nurse may be required to take on a new admission and already have too big of a workload.

In an article published by Applied Nursing Research the authors point out that nurse staffing is related to patient outcomes, “lower levels of RN staffing are associated with higher rates of OPSN (Outcomes Potentially Sensitive to Nursing) in both medical and surgical patients treated in hospitals, U.S. Medicare, and other publically available administrative data” (Duffield et al., 2011, p. 245). The writer of this paper researched 5 relevant articles regarding the relationship between nurse to patient ratio, morbidity, and mortality, every article related similar information. “A systematic review of 102 studies concluded that increased RN staffing levels are associated with lower rates of morbidity and mortality” (Ball, Murrells, Rafferty, Morrow, & Griffiths, 2013, p. 2).

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 refers to the ratio of nurses to patients in a particular unit. The current global nursing shortage is simply wide spread and dangerous lace of skilled nurses who are needed to care for individual patients and the population as a while. A study on the nursing shortage by Linda Aiken of the University of Pennsylvania School of Nursing, fund that an estimated 20,000 people die each year, because they have checked into a hospital with overworked nurses. (The American Nurses Association, Inc., 2010).

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Nurses are crucial in providing quality care in the health care industry. It is imperative to maintain the proper staffing ratio to ensure that nurses can maintain high quality care for their patients. Studies have shown that the increasing workload of nurses can be linked to increased patient deaths, medical errors, hospital-acquired infections, longer hospital stays, and many other complications. (National Nurses United n.d. ) Leaders and managers play a vital role in developing

The American Hospital Association have universally opposed laws mandating any specific nurse-to-patient staffing ratio. The American Organization of Nurse executives also oppose mandatory ratios. I agree with them that there should not be set ratios in hospitals as this inhibits healthcare advancement considering the rapid development in technology. Hospital administrators and associations maintain that they cannot operate under mandatory staffing and if forced to do so they might have to increase ER bypass, limit access to services and procedures or end up closing hospital units (Welton, 2011).

“The first is to require hospitals to have a nurse driven staffing committee which create staffing plans that reflect the needs of the patient population and match the skills and experience of the staff. The second approach is for legislators to mandate specific nurse to patient ratios in legislation or regulation. A third approach is requiring facilities to disclose staffing levels to the public and /or a regulatory body” (para. 4).