Inappropriate Nurse Patient Ratios And Provide Suggestions That May Improve The Problem

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).

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).

Understaffing of nursing services is one of the prime issues affecting the profession presently. Hospital operations and patient outcomes are dependent on the number of nurses available to deliver the required outstanding care to diverse critical ill patients. Nursing shortage in various healthcare facilities leads to work overload thus reduces the productivity of the available nurses. According to Glette, Aase & Wiig (2017), patient safety is compromised by understaffing. Their research established that there is a relationship between the shortage of nurses in a hospital and the adverse events that occur. The adverse events such as the incidence of nosocomial infections cause a direct impact on the patient outcomes.

Nurse-Patient staffing ratios have created debate among health care professionals for years. Who determines where, when and how many patients a nurse can handle on any given shift? Who determines the acuity of the patients handled by the nurse? Does the floor nurse have a say in what she or he can feasibly handle during their shift? At what point does patient care begin to suffer? These questions and many others have led to federal and state legislation coming to light to better serve the care of a patient. “The varied agendas and the inability of nurses, hospital administrators, and financial experts to communicate toward a single purpose, as well as the complexity of meeting staffing needs, have moved the issue into the political arena (Hertel, 2012, p. 1)”. Several states have already instituted mandatory nurse-patient ratios. While you can debate for or against political involvement, I will look at many factors regarding care and safety of patients.

The contrast between an adequately staffed ward and one with a low nursing staffing level is tangible. Staff nurses and patients have expressed how inadequate staffing levels affect them and there is a substantial amount of evidence-based research showing the negative effects of low nursing staffing levels on patient and nursing outcomes. Nursing resource allocation and reallocation of staff nurses is a time consuming and challenging task for nurse leaders, who must ensure safe staffing levels are upheld (Ball et al. 2014). With an increasing constraint on health expenditure, nursing staffing levels in hospitals has become a main target for financial limits and spending reductions. To the extent of which the nursing profession has been called a ‘soft target’, for it is easier to reduce nursing staffing level, as opposed to other means of cutting costs, such as improving efficiency (Aiken et al. 2014b).

Striving for excellent patient care is the cornerstone of nursing. However, delivery of innovative care requires nurses to take initiative in finding issues and concerns in current clinical practices to promote change that leads to optimal patient outcomes. One current issue in clinical practice is the varying patient-to-nurse ratios (PNRs) amongst different hospitals (Aiken et al., 2012). Having high PNRs may lead to nurse burnout, medical errors, and ineffective nursing care (Aiken et al., 2012; Karavasiliadou & Athanasakis, 2014). The solution would be to regulate PNRs, especially in areas such as the emergency room. To initiate this change, a task force would have to be established to use current data and research as evidence to propose the change, implement the change and evaluate its effectiveness.

In the health care industry, nurse to patient ratios is often a controversial issue related to the cost involved to maintain a safe staffing level. Registered nurses know and continue to reiterate the importance of safe staffing levels in health care facilities. However, reductions in nursing budgets, coupled with the expanding nursing shortage, have resulted in a reduction of available nursing staff. As a result, the nursing staff at most health care facilities are forced to work longer hours with more acutely ill patients. Consequently, patient care is compromised and this ultimately perpetuates the nursing shortage because of this negative work environment.

Safe nurse-patient ratio is a complex issue debated on for many years. Due to inadequate staffing registered Nurses are faced with high patient ratios, and nurse burn out everyday. According to the American Nurses Association, “Massive Reductions in nursing budgets combined with, the challenges presented by a growing nursing shortage have resulted in fewer nurses working longer hours for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside”. (2012) Through the nurse’s process, the essential role of the Registered Nurse is to assess, diagnose, and plan based on outcomes, implement and evaluate the effectiveness of nursing care. However, it is not realistic to thoroughly implement these core guidelines in a safe and effective way, when you are responsible for an inadequate patient load.

When it comes to nurse-to-patient ratio, safety is the number one priority. An article published in the National Nurse journal in 2010 discusses the impact of decreasing the maximum number of patients a specific nurse can safely take care of. At the core of the article’s argument is analysis of Boxer’s effort to introduce the National Nursing shortage reform and patient advocacy act 1031 and the impact it has on the nursing fraternity. According to Smith (2010) “mandatory nurse-patient ratios is that minimum, specific, guaranteed nurse staffing will produce better patient outcomes and alleviate nurse workloads and increase job satisfaction” (Smith, 2010, para. 14). While Senator Boxer is reported not to have enough sponsors for the new bill, the author concludes that passing the legislation will play a critical role in transforming the services offered by registered nurses in the United States (Smith, 2010). Second article that talks about safe staffing levels and mandatory nurse-patient ratios is from the MEDSURG Nursing journal published in 2011. This article assesses the impact of extending the Californian legislation that mandates patient nurse ratio on other states in the United States of America. The author concludes by arguing that passage of regulations that mandate nurse patient ratio promotes the value of the

According to The Journal of the Medication Association (2002), Hospitals, which routinely staff with 1:8 nurses to patient ratios, experience five additional deaths per 1,000 patients than those with 1:4 nurse to patient ratio. Safe nurse staffing ratios has been a significant issue that, registered nurse professionals have been struggling to overcome for many years. In the randomized research study, “Nurse Staffing Levels and The Quality Care in Hospitals”, by Needleman, J, Buerhaus, P, Maureen, S, and Zelevinsky, K, administrative data was collected from hospitals based in 11 states, to determine the correlation between the amount of care provided by nurses, safe staffing levels, and adverse patient outcomes. According to this study, “Among

Mandated nurse-to-patient ratios are a controversial topic in healthcare. In this practice, state laws are established that require a certain level of staffing within a particular unit. Organizations such as hospitals must balance income with expenditures, and nurses and patients may be affected by these decisions. Mandating ratios is one attempt at ensuring nurses’ workloads do not exceed what is needed for adequate patient care. However, these ratios are not without consequences. This paper explores both sides of the issue, presenting arguments in support of and opposed to mandated ratios. Throughout this paper you will see

The greatest common risk to patients is the understaffing of nurses. “ A nurse may make a critical mistake, and a patient might die. They have to live with the error, but the real culprit, the cause is that they were understaffed and overworked and a mistake was made”(Institute of Medicine). On average when health providers work over twelve and a half hours they are three times as likely to make medical errors. Health care providers should not perform more than four extra hours of overtime work, because when they are exhausted they are less perspective with details. When nurses are understaffed they do not recognize when a mistake or malpractice is made that can negatively impact a patient. According to Healthline, “Inadequate nurse staffing

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).

Increased patient to nurse ratios has the potential to produce negative outcomes for the patients, families, health care staff, and the health facility. The overabundance of patients and decreased nursing staff leads to increased morbidity and mortality rates for the patients and healthcare facilities. Nurses with increased workloads become physically and mentally exhausted, which leads to inadequate nursing care and hazardous errors. The incidence of falls increase when efficient time is not permitted for the individual care that is needed. Improper maintenance and protocol adherence increases the rate of infections, such as: pneumonia, urinary tract

Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to research funded by the Agency for Healthcare Research and Quality (Stanton, 2004). The number of qualified nurses continues to diminish as nurses leave the field due to burnout (Carayon & Gurses, 2008). Nurses who work in understaffed hospitals report a greater workload and greater instances of work-related stress than do nurses in well-staffed hospitals (Carayon & Gurses, 2008). These issues stem from dysfunctions in healthcare management, prompting a focus on the considerations made by a hospital 's Chief