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nurse staffing ratio and patient outcomes
nursing errors in a clinical setting
nurse staffing ratio and patient outcomes
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In recent years there has been a marked change in the inpatient hospital experience. Many of these changes are related to funding and payment. Insurance companies no longer reimburse hospitals for providing services, but have begun to provide payment based on hospital performance measures (Knudson, 2013, C8). Adverse events that occur during a patient’s stay now leads to financial loss. Hospitals have to absorb the additional treatment cost of “never events” such as injuries from falls, infections from urinary catheters, and pressure ulcers that are acquired during a patient’s admission (Agency for Healthcare Administration, 2012). Patient perception of the hospital environment is increasingly important with the ability of potential consumers …show more content…
(2011), patient mortality increased by 2% when nurse staffing was below target and increased by 4% when the patient was on a unit with “high turnover”, which refers to the admissions and discharges. The authors also point out that nursing workload increases when admitting, discharging, and transferring patients (p. 1039). Once a patient arrives to the unit, the nurse has to perform physical assessments, obtain a detailed health history, document home medications, orient the patient to the room and unit, provide education regarding their conditions, initiate doctor orders for procedures and medications, initiate vascular access, and so forth. During this lengthy period of time, the other patients are not directly receiving care. If the acuity level of those other patients is high or there are many other patients, adverse events may occur. Hinno et al (2011) states that this increase in workload increases risk for hospital acquired infections, falls, pressure ulcers, and medication errors (p. 1585). By staffing appropriately, the authors state a decrease in mortality, nosocomial infections, and failure to rescue rates. This translates into financial loss as insurance does not pay for “never events” (Needleman et al.
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.
Over the past years, there has been a nursing shortage which has led to the need of more registered nurses in the hospital setting. This is the result of higher acuity of patient care and a decrease in their length of hospital stay. In order for the patients to get safe and quality care, the staffing, education and experience of the nursing staff needs to be made a priority. Because of the lack of nurses, patient quality of care has suffered.
Nurses are the largest and the most trusted professional group in the health care system. They are highly educated and skilled in their areas of practice. However, today’s nurses are experiencing an ever increasing workload, which negatively impacts their ability to deliver safe patient care (Berry & Curry, 2012). This paper explores four published journals that report on survey results on nursing workload and their direct correlation with patient care outcomes. The purpose of this paper is to address the ongoing nursing workload issues and explore the reasons behind it.
First, the increased workload due to staff shortage is putting patient care in jeopardy. Sue need to be aware of facility policies and guidelines about staffing flexibility and accepting an assignment to provide safe care. As stated by Martin (2015),”When nurse staffing is inadequate, the ability to practice ethically is questionable” (p. 4). The Safe Harbor Act protects nurses from the unsafe nurse-patient ratio, but the nurse should be aware when to utilize this resource to protect patient safety and her for liability is compromised due to staff shortage. In this situation, nurse staffing in an ongoing problem and Sue should discuss with the management to employ the policies such as the Nurse Reinvestment Act, the Registered Nurse Safe Staffing Act, and mandated nurse-patient ratio (Martin, 2015). Also, the Guide for the American Nurses Association (ANA) Principles for Nurse Staffing should be utilized in this situation (Cherry & Jacob, 2014). Secondly, Sue’s stress is to provide quality care to indigent patients who are uninsured or underinsured. The uninsured population cannot afford preventative care, and by the time they come to the hospital, the acuity level is high, and treatment is expensive. Many facilities have policies regarding indigent population care. Some facilities have charitable policies to pay medical bills for uninsured or underinsured patients. Sue also needs to be aware of any policy related to lowering
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 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,
...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.
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.
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.
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
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
What comes to mind when you think of at the average United States hospital room? White walls, squeaky green but easy to clean linoleum flooring, frightening medical equipment, a tiny television, and one small chair for visitors are often some of the items that come to mind. Patients are placed in an environment with an institutional feel and little emphasis on aesthetics and are expected to heal, recover and rehabilitate as quickly as possible. The measure of success for healthcare organizations had a primary
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
Hospitals play an important role in the health care system (Hospitals, n.d.). They are health care institutions that have an organized medical and other professional staff, and inpatient facilities, and deliver medical, nursing and related services 24 hours per day, 7 days per week. Hospitals offer a varying range of acute, convalescent and terminal care using diagnostic and curative services in response to acute and chronic conditions arising from diseases as well as injuries and genetic anomalies. In doing so they generate essential information for research, education and management. Traditionally oriented on individual care, hospitals are increasingly forging closer links with other parts of the health sector and communities in an effort