The Nurse/Patient Ratio

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

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.

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.

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.

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.

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 California law has a relatively brief history, starting with the passing of AB 394 in 1999, when the state established the idea of nurse-to-patient ratios before working out the details of implementation or the actual ratio parameters.

A manager should make sure that the resources that are provided to the staff are useful, effective, and helpful. The manager should ensure that they have the adequate amount of resources and tools in order to complete there work and job. When it comes to the issue of nurse staffing ratios, the manager has the responsibility of making sure that the unit is staffed to meet the demands of the patients and there level of care, or acuity (GCU, 2011). Utilizing there skills in leadership, quality care, people and communication can all be of benefit. Leadership skills, such as leading by example, are necessary for nurse managers. Quality care skills can be beneficial to gather the necessary data and provide adequate staffing to promote and improve overall performance. People skills are used to interview new employees and hopefully increase staffing

According to Martin (2015), California is the only state that stipulates that in law and regulations have a required minimum nurse to patient ratios to be maintained at all times by unit. Nurses across the United States are talking to their Senators to help them lobby bills that would help establish a minimum nurse to patient staffing ratios for all hospitals in the country, among other improvements of nursing rights. Nurses from around the country also visited Congressional Representatives on Capitol Hill and urged them to support

With the support of the National Nurses United, the largest nurses union in the country, strikes have been organized in and carried out in California, Pennsylvania, Maine, Michigan and Minnesota (NPR, 2010). The union has also sported a high-profile campaign during recent midterm elections by attacking Republicans for their positions on healthcare. The NNU now claims over 155,000 members and plans to advocate for healthcare reform across the country. With the 12,000 nurses that went on strike from 14 Twin Cities hospitals, the largest nurses’ strike in U.S. history had taken place. As a result of the following strike, a longer strike in July was to take

Despite many efforts to improve staffing numbers, there is often still a staff shortage among staff in hospitals and acute care settings. While the most obvious solution to short staffing is to hire more nurses, there are also other ways to make staffing more effective. A patient acuity tool is a staffing instrument that can be used to decide how much time and attention each individual patient requires. By knowing the acuity level of each patient, charge nurses can decide how many patients each nurse can be assigned to at a time. This essay describes the way a patient acuity instrument improves healthcare outcomes by promoting patient-centered care and improving on key nurse competencies including teamwork and collaboration, quality improvement, and safety measures.

Brooke, you made some good points. I agree, despite the decline in unionization in the United States, it has be on the rise in the healthcare industry with nurses among the larger portion of unions. Unionization in healthcare is steadily progressing, because they see a future need to this segment of the labor force with organizing of nurses and other healthcare works. (American Medical News, February 22, 2010).

Based on the reading Unions in the Healthcare Industry, written by Sanders and McCutcheon, nurses under the National Labor Relations Act has the right to form and join unions, right to collective bargain, right to engage in concerted activity with coworkers for their mutual benefits or protection, and right to refrain from participating in union activities. The idea of unions interest is based on employee's interest collectively, not each individual employee. It's a clear assumption that union nurses have greater job satisfaction and autonomy based on the spirit about what’s best for the patient. The concept that everyone is under a union would predict job satisfaction based on secure benefits, acceptable nurse-patient ratio, and job protection.

But unionization has not been easy. As membership has grown, so has the “bully on the street” mentality. Some associations do not want to be part of such a large organization and may feel that they will be under represented in specific issues, and not all nurses are for unionization. Many feel that unionization with suppress their opportunities to seek promotions, raises and benefits as funds are watered down to cover many professions covered in the services industry.

It has always been difficult to answer the question whether or not union are part of nursing or labor. In my opinion the effectiveness of union can be determine when there is a demand for change by staff with an ongoing issue and the union are able to push for the benefit of the staff and the patient. I work for company that is unionized; regularly things are done by management with disregards to union rule and regulation. Staffing ratio has been an ongoing issue within the organization especially in the emergency unit where the ratio is eight patients per a nurse majority of the time because the facility serves many areas. Union has been in constant fight with management in other to resolve the issues but up to date no solution has been implemented.