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Quality improvement in health delivery system
How to improve the delivery of healthcare
Quality improvement in health delivery system
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A New Health Policy in Texas
To: Legislator/Policy Maker
Thank you for taking time out from your busy schedule to review this policy proposal. We are nurses practicing in the Galveston Area and would appreciate your consideration of the following proposal.
The Problem:
Inadequate levels of registered nurse staffing for patient care in hospitals and acute care facilities are having a negative impact on nursing professions and patient outcomes.
• Hospitals and nursing homes that have consistently unsafe nurse-patient staffing ratios experience higher than normal mortality and morbidity.
• Research indicates that decreasing patient-nurse staffing ratios by one patient per nurse, results in a 7% decrease in in-house hospital mortality.
Background:
Several states
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Why Standardize the Patient-Nurse Ratio?
• A standardized patient-nurse ratio would positively affect nursing practice, healthcare delivery, and health care consumers.
o Nursing practice: Increased and standardized patient-nurse ratios would lessen work fatigue and would improve job satisfaction as nurses would have more time with patients,
o Healthcare Delivery: The proposed solution would decrease nurse turnover and burnout rate. This would lead to a retention of staff and decrease dependence on costly supplemental nurses. This would also lead to less resources spent on training replacement staff. Nurses would be able to spend more time educating and caring for their patients, which would reduce the length of hospital stay and decrease the likelihood of a patient returning to the hospital due to inadequate discharge education.
o Healthcare Consumers: Mandatory patient-nurse ratios will optimize patient outcomes, minimize complications due to error, and decrease the hospital morbidity.
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,
Monitoring staff levels is an important factor. Also leveling the flow of patients in and out institutions could help to reduce wide fluctuations in occupancy rates and prevent surges in patient visits that lead to overcrowding, poor handoffs, and delays in care. Studies show that overcrowding in areas such as the emergency rooms lead to adverse outcomes, because physicians and nurses having less time to focus on individual patients. One study found that for each additional patient with heart failure, pneumonia, or myocardial infarction assigned to a nurse, the odds of readmission increased between 6 percent and 9 percent (Hostetter and Klein, 2013). All of which costs the hospital money.
For my research paper, I will be taking the position that low nurse-patient ratios (the number of patients a nurse is assigned to care for during their shift) are beneficial to patient safety and should be adopted on a larger scale.
Identifying and maintaining the appropriate number of mixed nursing staff, RN/LPN/CNA, is critical to the delivery of quality patient care. Many studies reveal an association between a higher level of experienced RN staffing and lower rates of adverse patient outcomes (“Nurse staffing plans,” 2013). The nurse-patient ratios will in turn improve the nurses working conditions, decreasing the risk of errors to patients.
"State Legislative Initiatives to Address the Nursing Shortage." American Association of Colleges of Nursing. Oct. 2006. 11 Dec. 2012 .
...be beneficial for the hospital. The nurses are the front runners in patient care, and their input should be taken into serious consideration. Testing this plan, and revising it before it is fully implemented, can only have positive outcomes for the hospital and patient care.
There is a shortage of all health care professions throughout the United States. One shortage in particular that society should be very concerned about is the shortage of Registered Nurses. Registered Nurses make up the single largest healthcare profession in the United States. A registered nurse is a vital healthcare professional that has earned a two or four year degree and has the upper-most responsibility in providing direct patient care and staff management in a hospital or other treatment facilities (Registered Nurse (RN) Degree and Career Overview., 2009). This shortage issue is imperative because RN's affect everyone sometime in their lifetime. Nurses serve groups, families and individuals to foster health and prevent disease.
...staff would not be required to put in the overtime to compensate for the lack of workers. Patients would no longer have to suffer the neglect of the staff because he or she was too busy. Making sure the patient gets the best quality care reduces the time spent for recovery. Reducing the time spent for recovery increases the organization’s finances. Providing a safe facility also reduces the expenses on the private hospital’s budget. Ensuring a patient is safe can reduce potential use of ongoing treatment and services. Hiring the appropriate nursing staff needed can save the organization money. Instead of cutting back on staff, more staff needs to be hired to fulfil the needs of the patient. In the economy today, private hospitals need to focus on the overall long term effects of each action opposed to quick reactions resulting in financial strain for the facility.
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.
The administrators must reduce the ratio of nurse to patient because the current nurses' workload can lead to nurses' burnout, patient dissatisfaction, and negative patient outcomes.
This article is skeptical of mandated nursing ratios, and discusses some outside factors that may be biasing the other studies I plan to cite. This article's strengths are that is from a peer-reviewed journal and written by a recognized expert, which makes it a credible source. Rather than simply supporting or opposing mandated maximum ratios, it introduces the idea that the other ratio studies may have missed some important considerations. The main drawback to this source is that it's a short article and doesn't go into a lot of detail. I may have to end up using other sources to supplement the ideas it proposes.
Nurse to patient ratios are extremely paramount in assisting with overall patient mortality and wellness of our nurses. It is an issues which unfortunately affected by legislation of our government (which is affect specifically on a monetary basis). My research via Academic Search Complete allowed me to identify topics that assist my PICOT question, and enables me to further analyze and research to find out what issues directly affect is matter. Proper nurse to patient ratio, operational costs, government regulation, nurse work life and health, patient wellness, and nursing procedures and duration of those procedures are all affected by this topic and we must ensure that all are properly balanced.
Hospital understaffing nurses increases the workload and the patient-to-nurses ratio makes a difference in patient outcome. In hospital with high patient-to-nurse ratios, surgical patient experience higher risk and failure-to-rescue rates and nurses are more likely to experience burnout and dissatisfaction. Nurses nationwide consistently report that hospital staffing levels are inadequate to provide safe and effective care (Cimiotti et al., 2012). In 2004, California was the first state to implement minimum patient-to-nurse staffing ratios. The legislation was motivated by an increasing hospital nursing shortage and perception that lower nurse retention in hospital practice was related to burdensome workloads and high level of job dissatisfaction. California fully mandated the patient-to-nurse ratio for every surgical patient is 1 to 5 (American Nurses Association, 2016). California is the only state that stipulates in law and regulations a required minimum nurse-to-patient ratio to be maintained at all times by the unit (American Nurses Association, 2016). Based on the result in California, the Registered Nurse Staffing Act has resulted in states taking action to ensure there is optical nurse staffing is appropriated to patients’ needs, however not all states have as strict regulations as California (American Nurses Association, 2016). Thus, the California
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: