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Nurse to patient ratio and patient outcomes
Patient safety key words
Nurse to patient ratio and patient outcomes
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An English Nurse who laid the foundation for professional nursing, Florence Nightingale stated, “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.” Acute care facilities try to maintain low costs and employ quality nurses, making the nurse-to-patient ratio become more of an issue with patient care. Nearly every person’s health care experience involves the contribution of a registered nurse, and the effects of not having an appropriate nurse to patient minimum ratio affects not only the patient and nurse physically, medically, but also the hospital financially.
Determining nurse-to-patient ratios is a difficult task with no single or definite solution and many variables exist to develop guidelines to cover every possible situation in an acute care facility. There are two boards of the state of Ohio that help with patient safety and keeping a safe workplace for the healthcare professional such a nurse. The first board is the Ohio board of Nursing, and the following is their description of what they are responsible for:
The Board exists solely to enforce the law and rules regulating practice. The Board has authority to establish requirements individuals must meet to obtain a license or certificate to practice nursing or provide dialysis care in Ohio. The Board approves pre-licensure nursing education programs and dialysis training programs, oversees the licensure examination of nurses, and takes disciplinary action when a licensee or certificate holder violates the law. These activities help to assure that only qualified individuals provide care to the public. The Board does not exist to advance the interests of the nursing profession or dialysis t...
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...s, C., & Hess, R. (2009). Registered Nurses' Perceptions of Nurse Staffing Ratios and New Hospital Payment Regulations. Nursing Economic$, 27(6), 372-376. Retrieved from Academic Search Complete database.
Costello, M. (2002). JCAHO workforce report says staff levels affect quality, safety. AHA News, 38(31), 1. Retrieved from Health Source: Nursing/Academic Edition database.
Garretson, S. (2004). Nurse to patient ratios in American health care. Nursing Standard, 19(14-16), 33-37.
Griffiths, P. (2009). Staffing levels and patient outcomes. Nursing Management - UK, 16(6), 22-23. Retrieved from Academic Search Complete database.
...atistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, “Registered Nurses”, on the Internet at http://www.bls.gov/oco/ocos083.htm, 17 Dec. 2009. Web. 09 March. 2012.
This is directly related to my nursing major and current practice as an RN. I have a personal interest in making sure I am practicing in a way that is safe for my patients. What exactly is the problem? The problem, as defined in my argument research paper, is that to cut costs, hospitals have been steadily increasing the number of patients nurses must care for. In many areas, it's not uncommon for one nurse to have to assess, give medications to, and manage the care of as many as 12 patients.
Nursing standards are the building blocks that lead to excellent patient care. The ANA (American Nursing Association) has standardized sixteen common practices for the best quality care of patients by nurses. Nurses are only able to facilitate minimal standards to patients due to time restraints derived from patient ratios and lack of support from administration. The hope to achieve the best possible outcomes in patient care are limited to the minimal standards expected of nurses from the National Council of State Boards of Nursing (ANA, 2010). Patient ratios have been seen as a huge issue across the realm of nurses and health care facilities in deliverance on patient care. Addressing the issue of nursing shortages and the effects on ...
Needleman, J., Buerhaus, P., Pankratz, S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. England Journal of Medicine, Retrieved from http://www.nejm.org/doi/full/10.1056/nejmsa1001025
Current literature continues to reiterate the indicators of a major shortage of registered nurses (RNs) in the United States. The total RN population has been increasing since 1980, which means that we have more RNs in this country than ever before (Nursing Shortage). Even though the RN population is increasing, it is growing at a much slower rate then when compared to the rate of growth of the U.S. population (Nursing Shortage). We are seeing less skilled nurses “at a time of an increasingly aging population with complex care needs and an increasingly complex technological care environment” (Mion). According to recent data from the Bureau of Labor Statistics and the Department of Health and Human Services, it is estimated that “more than a million new and replacement nurses will be needed over the next decade” (Diagnosis: Critical).
Needleman, J., Buerhaus, P., PKankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse Staffing and Inpateint Hospital Mortality. The New England Journal of Medicine , 364, 1037-1045.
The nurse to patient ratio is unrealistic in many hospitals. In most cases it is almost impossible to give each patient the true amount of detailed care they really need. This is seen in most cases where there is one nurse assigned to 16 patients and each patient requires a different level of attention. Nurses are pressed for time, forcing them to cut corners, resulting in an increase in nosocomial infections and patient deaths. “The past decade has been a unsettled time for many US hospitals and practicing nu...
Nursetraveler. (1999). The original bill that put staffing ratios in place! Retrieved September 10, 2011, from http://nursetraveler.org
O’Daniel, M., & A.H., R. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2637/
Without participating in a longitudinal study, it is difficult to truly assess the efficacy in mandating nurse staffing ratios. It is difficult to measure the benefits of mandated staffing due to numerous confounding variables. These confounding variables include the resources available at specific hospitals in addition to the populations that they serve. Hospital volume, RN job satisfaction and the relationship between physicians and nurses have also been shown to affect patient outcomes (Duval et al., 2007).
Patient’s safety will be compromised because increase of patient to nurse ratio will lead to mistakes in delivering quality care. In 2007, the Agency for Healthcare Research and Quality (AHRQ) conducted a metanalysis and found that “shortage of registered nurses, in combination with increased workload, poses a potential threat to the quality of care… increases in registered nurse staffing was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stay.” Intense workload, stress, and dissatisfaction in one’s profession can lead to health problems. Researchers found that maintaining and improving a healthy work environment will facilitate safety, quality healthcare and promote a desirable professional avenue.
This article is a comprehensive look at staffing on hospital units. It used a survey to look at characteristics of how the units were staffed – not just ratio, but the experience and education level of the nurses. It evaluated several different categories of hospital facilities – public versus private, academic medical centers versus HMO-affiliated medical centers, and city versus rural. It is a good source because it shows what some of the staffing levels were before the status quo of the ratio legislation passed in California. It’s main limitation as a source is that it doesn’t supply any information about patient outcomes.
The purpose of this paper is to address the issue of nursing staffing ratios in the healthcare industry. This has always been a primary issue, and it continues to grow as the population rate increases throughout the years. According to Shakelle (2013), in an early study of 232,432 surgical discharges from several Pennsylvania hospitals, 4,535 patients (2%) died within 30 days of hospitalization. Shakelle (2014) also noted that during the study, there was a difference between 4:1 and 8:1 patient to nurse ratios which translates to approximately 1000 deaths for a group of that size. This issue can be significantly affected in a positive manner by increasing the nurse to patient ratio, which would result in more nurses to spread the work load of the nurses more evenly to provide better coverage and in turn result in better care of patients and a decrease in the mortality rates.
Factors such as, heavy workloads, stress, job dissatisfaction, frequent medical errors, and intention of leaving the job are all common for nurses to experience, especially during the nursing shortage crisis. Not only do the nurses suffer during a shortage, but the patients ' health outcomes suffer even more. For instance, there are higher rates of infectious diseases and adverse patient outcomes, such as urinary tract infections (UTIs), upper gastrointestinal bleeding, shock, pneumonia, prolonged hospital stays, failure to rescue, and mortality. As a result, this leads to higher re-admission rates for patients. Furthermore, high patient-to-nurse ratios cause heavy workloads due to an inadequate supply of nurses, an increased demand for nurses, a reduction in staffing and an increase in overtime, and a shortened length of stay for patients. Without the heavy workloads that nurses have to endure on a daily basis, there would more time for nurses to communicate more effectively with physicians, insurance companies, and patients and their families. Those heavy workloads are the result of hospitals reducing the nursing staff and implementing mandatory overtime policies just to meet unexpectedly high demands. Unfortunately, the nursing shortage has affected nurses ' mental and physical health. For example, the most common health concerns for nurses include cardiovascular health, occupational injuries and illnesses, and emotional and physical exhaustion. Therefore, safe-staffing ratios/levels have to become the main
Bedside nurses want to change staffing levels to assure that they have enough time to both keep up with the constantly evolving health care and to provide safe patient care. Yet, healthcare employers consider that reducing nurse patient ratio is an unnecessary expense that has not been proven to improve quality of patient care (Unruh, 2008). Employers emphasize that raising nursing staffing level is not cost-effective. In fact, in accordance with ANA’s report (2013), a study, in the Journal of Health Care Finance, confirmed that reducing patient-nurse ratios increased hospital costs, but did not lower their profitability. Higher hospital costs were attributed to wages and benefits allocated to newly hired nurses. Yet, according to Cimiotti et.al (20112), it is more costly for hospitals to not invest money on nursing.