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
Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care (pp. 1-2). Ithaca, NY: Cornell University Press.
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.
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,
Shekelle, P. (2013). Nurse-patient ratios as a patient safety strategy. 158, 404-409. Retrieved from http://eds.b.ebscohost.com
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 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
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).
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
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/
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.
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.
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.
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.