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Nurse to patient ratio quality improvement project
Nurse to patient ratio quality improvement project
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People are living longer and healthier lives now more than ever before. Much of this can be attributed to the advances in modern medicine over the past few decades. However, in healthcare, there is now a growing population of patients that are becoming sicker and more complex to care for. With the new generation of sick patients present in the hospitals, today’s nurses are stressed and fatigued more than ever before. Much of the stress and fatigue can be attributed to the nurse to patient ratio and the associated workload. Traditionally, the nurse to patient ratio is determined by the supervising nurse’s (charge nurse) best judgment or an established acuity protocol (Kidd, Grove, Kaiser, Swoboda, & Taylor, 2014). A multitude of factors
As defined by the American of Nurses Association (ANA, 2002), “Nursing-Sensitive Indicators are those indicators that capture care or its outcomes most affected by nursing care.” The ANA uses the National Database of Nursing Quality Indicators (NDNQI) to statistically test the relationships between nursing interventions, staffing levels, and positive patient outcomes (Nursing Quality - NDNQI, 2016). These indicators utilize unit specific data enabling action planning and intervention according to the unit if improvement is needed (Nursing Quality – NDNQI, 2016). The purpose of this paper is to show how Good Samaritan Medical Center’s 5th floor, pavilion 2, Medical Surgical/Oncology unit uses nurse sensitive indicators such as pain management,
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.
In the recent past, nursing has come to the forefront as a popular career amongst students across the globe. The demand for nurses has kept increasing gradually over the years. In fact, the number of registered nurses does not meet the demand of the private and public health sector. This phenomenon has resulted in a situation where the available registered nurses have to work extra hours in order to meet the patients’ needs. With this in mind, the issue of nurse fatigue has come up as a common problem in nursing. According to the Canadian Nurses Association (CNA), nurse fatigue is “a feeling of tiredness” that penetrates a persons physical, mental and emotional realms limiting their ability to function normally. Fatigue does not just involve sleepiness as has been assumed before. It involves utter exhaustion that is not easily mitigated through rest. When nurses ignore the signs of fatigue, they risk the development of chronic fatigue and other health problems that may not be easily treated. Additionally, fatigue may cause nurses to lose more time at work as they may have to be away from work for several days to treat it. The issue of nurse fatigue has permeated the nursing profession to the extent of causing errors in the work performed by nurses. Fatigue causes a decrease in a nurse’s ability to make accurate decisions for themselves and their patients. It is therefore important to find ways to curb nurse fatigue such that it is no longer a problem. Nurse fatigue is a danger to the patients, organizations and to the nurses themselves and must be mitigated adequately.
Many nurses face the issue of understaffing and having too much of a workload during one shift. When a unit is understaffed not only do the nurses get burnt out, but the patients also don’t receive the care they deserve. The nurse-patient ratio is an aspect that gets overlooked in many facilities that could lead to possible devastating errors. Nurse- patient ratio issues have been a widely studied topic and recently new changes have been made to improve the problem.
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.
By understanding nursing sensitive indicators nurses would be more able to utilize these indicators to provide the best possible care for patients. Nurse sensitive indicators are a variety of indicators which are shown to be directly impacted by nursing staff and are different than medical indicators (Sauls, 2013). Such indicators can be utilized by nurses to provide quality care for their patients by helping to guide their care by using evidence-based quality measures which have been standardized with the goal of optimal patient safety and outcomes being the first and foremost on the list.
Working in long-term care can be overwhelming. Imagine you are a new graduate nurse putting your new found knowledge and skills to practice for the first time. Your orientation lasted three days which is standard for nurse home orientation compared to hospital orientation that last approximately six to eight weeks for new grads. The shift has just begun and already you have a new admit, new found pressure ulcer to assess, a possible medication reaction, several new orders to take off and eight patients to document on for varying reasons. Feelings of frustration and confusion take over as you are the only nurse on the unit along with a Certified Medication Technician (CMT) and three Certified Nursing Assistants (CNAs) taking care of 47 patients. Ideal nurse-to-patient ratio continues to be a national issue in both the hospital and long-term care setting (LTC). In the LTC setting there is no official nurse-to-patient ratio; there is a suggested staff-to-patient ratio. This issue not only affects the new licensed nurses but the seasoned nurse as well. Recently, there has been controversial debates as to whether heavy workloads are detrimental to patients. The federal, state, and local government regulates many aspects of healthcare. However, it is the physicians, nurses and other healthcare professional that provide care directly to patients. Consequently, does insufficient staffing, heavy workloads, and unsupportive work environment directly contribute to poor patient satisfaction, nurse burnout, high turnover and job dissatisfaction?
Nurse leaders must have a thorough understanding of variance reporting because these reports provide information about the differences between an actual budget and a forecasted budget (Finkler, Jones & Krover, 2013). A nurse leader can use data gathered from these reports to better understand budgetary deficiencies, hence allowing him or her to develop more accurate budget forecasts in the future. Variance reports can also help a nurse leader identify the causes of variances. By recognizing the causes early on, nurse leaders can put appropriate actions in place to prevent further exacerbating existing variances. Nurse leaders can also use variance reports as a tool with which to gauge work center productivity.
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.
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
Prioritizing care is one of the first things that nurses learn in their career. Prioritizing requires critical thinking whether it comes to discharging a patient, caring for a patient, or delegating a task to a LPN or CNA. As the charge nurse they must look at the whole picture and not just the tasks that need to be done. The charge nurse is the one makes the assignments for the individual nurses, so if there happens to be a float nurse from a different department they might give them the patients with the lowest acuity depending on the nurse’s experience. The charge nurse must know which patients could be discharged if there was an emergency to arise or not enough hospital beds for those patients who need to be admitted. For example, the nurse is not going to recommend someone who came in with a heart attack; they would most likely recommend someone who is two days post op and is being discharged to a rehab facility in a couple of days. It is the charge nurses duty to make that everyone providing great and safe care to the patient.
Recent literature reports that there is a nursing shortage and it is continually increasing. Data released by the American Association of Colleges of Nursing (2011) projects that the shortage, would increase to 260,000 by the year 2025. AACN (2011) also reported that 13% of newly registered nurses changed jobs and 37% were ready to change within a year. A study conducted reports that there is a correlation between higher nursing workloads and nurse burnout, retention rates, job dissatisfaction and adverse patient outcomes (Vahey & Aiken, 2004). Among the nurses surveyed in the study, over 40% stated that they were suffering from burnout while 1 in 5 nurses intended
Nurses want to give complete and quality care, but are unable to, due to the constant needs of their workload and inadequate staffing. They have to prioritize their patients needs based on the most critical treatments first. Then whatever time is left, they fill in what treatments they can. Some reasons that nursing treatments are missed include: too few staff, time required for the nursing intervention, poor use of existing staff resources and ineffective delegation.” (Kalisch, 2006) Many nurses become emotionally stressed and unsatisfied with their jobs. (Halm et al., 2005; Kalisch,
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
Several consequences of high nursing workload have been proven to hinder the quality of patient care. Carayon and Gurses’s research (2008) indicates that heavy workload can contribute to errors, shortcuts, guideline violations, and poor communication with physicians and other providers, thus compromising the quality and safety of patient care. In addition, the research not only implies that patients may not receive proper care, but also they can experience less satisfaction with