Nurse staffing ratio's in healthcare is an ongoing issue throughout the country. With healthcare being run like a business, the bottom line is sometimes thought to be more important than the safety of the patients. One will see through this paper by reviewing patient outcomes and mortality, nurse staffing ratios can affect the quality and safety of patient care. II. Literature Review The sources used were retrieved from the online Shapiro Library. Electronic databases, including CINAHL were used to do a multi-search for sources. Key works used included nursing safe staffing and nursing staff ratios and patient safety. The criteria used to select the articles were peer reviewed articles within the last five years. Martin (2015) looks at the effect that nurse staffing has on quality care of patients. Using numerous studies, the article reviews nurse under-staffing in hospitals and how it not only impacts the care the patient receives but also the nurse’s well-being. This article supports that staffing has a direct impact on patient care and safety and This theory “Focuses on the human component of caring and the moment-to-moment encounters between the one who is caring and the one who is being cared for, especially the caring activities by nurses as they interact with others” (Kearney-Nunnery, 2016, p. 49). Healthcare systems have been focusing more on curing than caring. The costs of non-caring are quality, safety and medical errors. Inadequate staffing further distances the relationship between nursing and patients. When the patient feels like an object, they become dissatisfied (Pajnkihar et al., 2017). If management can apply a caring approach to administration, they will see the benefits of nurses spending more time with patients. This restores nursing to promote wholeness and healing. Focusing on a caring approach promotes adequate staffing to facilitate the nurse patient
In the case of nurse staffing, the more nurses there are the better outcome of patient safety. When there enough staff to handle the number of patients, there is a better quality of care that can be provided. The nurses would be able to focus on the patients, monitor the conditions closely, performs assessments as they should, and administer medications on time. There will be a reduction in errors, patient complications, mortality, nurse fatigue and nurse burnout (Curtan, 2016). While improving patient satisfaction and nurse job satisfaction. This allows the principle of non-maleficence, do no harm, to be carried out correctly. A study mentioned in Scientific America showed that after California passed a law in 2014 to regulate hospital staffing and set a minimum of nurse to patient ratios, there was an improvement in patient care. Including lower rates of post-surgery infection, falls and other micro emergencies in hospitals (Jacobson,
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
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.
In the past two decades, there has been a push for appropriate staff to client ratios. However, measuring client needs and nursing efforts have been around since 1922 (Lewinski-Corwin, 1922, pp. 603-606). The earliest recorded effort was by the New York Academy of Medicine. Superintendents and nurses from ten training schools documented the time spent providing bedside care. From complied information, the researchers revealed each client required an average of five hours and four minutes of care in a 24-hour period. From these observations, they evaluated staffing issues in New York City. At that time, none of the hospitals were sufficiently staffed (Lewinski-Corwin, 1922, pp. 603-606).
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/
The United States offers some of the most established and advanced health care in the world. Practitioners and administers are constantly trying to improve the quality of care received by patients in the US. Data has consistently shown that the presence of a registered nurse contributes directly to positive patient outcomes (Cho et al., 2016). The debate across the country, however, concerns the precise number of staff required to provide safe, high-quality care. The issue of safe staffing is one that is of great importance to all involved in the delivery of health care across the country.
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.
Poor staffing stresses every nurse and makes them despite what they once loved to do. Nurses are overworked and because of that they may not provide adequate patient care.
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.
In conclusion, Jean Watson’s theory of caring, a middle-range theory, provides essential framework and guidelines in nursing shortage problem. Nurses who exposed to caring theory have moral and ethical obligations to care for others during challenging situations. Patients, families and other professionals depend on nursing profession, their expertise and knowledge for best patient
The specific clinical question regarding the search for a quantitative question is as follows: Will a higher nurse to patient ratio decrease the mortality rate of discharged patients? The intervention of such a method would definitely allow nurses to balance out more time to ensure each patient is properly treated and assist to prevent work overload that leads to slight but very risky errors that lead to death. This would also allow nurses to do more observation and help to educate patients to preform proper movement to assist in recovery and prevent injury while in their care (for example, proper bending, avoid movement that could be harmful post surgery).
These articles have many similarities when discussing the issue of staffing shortages. For patients, their loved ones and the general population, they don’t understand the ramifications and strain that staffing shortages have on nurses. People expect and deserve complete, competent and safe care when they are patients. These articles bring to light all the struggles that nurses have to deal with. Nurses are fearful that they will make mistakes, will harm patients, and will harm themselves. (Bae, 2012; Erlen, 2001; Martin, 2015) Overtime can be overwhelming and exhausting, which can lead to errors being made. (Bae, 2012; Erlen, 2001) These articles perceive that it may be beneficial for nurses, patients, and healthcare facilities to decrease the nurse-to-patient ratio, however, this option is not always
The staffing effectiveness report is used by hospitals to assess how nurse to patient ratios and nurse work hours are associated with patient outcomes. Further, the staffing effectiveness report allows hospital leadership to identify areas which need improvement and monitor areas that are operating within acceptable standards. The safety and quality of patient care are directly related to the number of staff as well as their competency and skill level (A.H.R.Q., Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 2017). NCH uses the clinical indicators of fall prevalence, falls with injuries, and ventilator-associated pneumonia and the human capital indicators of nursing care hours and overtime, to measure the effectiveness of the staff.
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
As reported by Bowron (2010), hospitals will benefit from reducing patient-nurse ratio by saving money. Bowron point out that an adequate staffing ratio could lower hospitals’ costs significantly in the following ways: