...HEAD: Nurse-to-Patient Ratios A Literature Review: Nurse-to-Patient Ratios and Their Relationships with Other Variables Since the times when Florence Nightingale took care of patients, there has been a question about what factors affect patient care. One of these factors, nurse-to-patient ratios, has gotten significant publicity over the last several years due to a change in legislation in California. This increase in publicity has sparked many researchers' interest to further evaluate these ratios in connection with patient outcomes and other variables. Through lots of research and analysis there is evidence that a lower nurse-to-patient ratio does reduce the negative patient outcomes in patient care. Some of these outcomes include urinary tract infections, upper gastrointestinal bleeding, shock, pneumonia, failure-to-rescue, and death (Curtin, 2008). Although lowering the ratio does show a decrease in these outcomes, it does not solve all the problems in the nursing profession (“Safety in Numbers,” 2008). The other variables that have a significant relationship with these nurse-to-patient ratios include retention and recruitment of nurses, malpractice, medical errors, and cost. In this review of literature, a direct relationship between nurse-to-patient ratios and other variables should be visible to readers to better understand the issues that are currently identified in nursing in the health care industry. One of the most referenced studies done on nurse-to-patient...
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...Registered Nurse to Patient Ratio LLM Various participants in different states across the nation has lobbied the state legislatures and the United States Congress to proclaim laws that will recuperate the overall working conditions of hospital and clinical staffing. Proposed nurse to patient staffing ratios has become a huge discussion in the healthcare field. It has developed a huge concern that patients and nursing staffs are being harmed related to the inadequate nurse to patient ratio staff. This issue alone has caused an increase in severity of illness, fatigue, hospital stay, and harm to patients. With the increase in complexity of care per patients, nurses grow weary thus increase the negative impact of the inability to improve the quality of hospitalization outcomes for the patients. It is prominent that we identify and maintain the appropriate number of the nurse to patient staffing ratio, as it is critical key of delivering the optimal quality patient care. In the pass few years and even up until now, there has been a massive growth in need for more registered nurses in hospitals and clinics due to the rising acuity of patients and shorter lengths of stay. More and more patients appear looking for healthcare assistance. The safety and quality of the care patients are looking for are becoming difficult to find as registered nurses grow exhausted and drained out of energy. Inpatient working conditions has weakened in various facilities, as hospitals cannot fulfill...
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...Nurse to Patient Ratios in Acute Care Hospitals Chamberlain College of Nursing NR 504: Leadership and Nursing Practice: Role Development Spring B 2011 My vision for nursing is a simple one. It is not grand or extravagant and therefore, should be easily attainable. The problem is, is that as with any vision, there will be obstacles along the way. I hope to be able to overcome these obstacles and make my vision become a reality. My vision is to establish a guideline to lower the nurse to patient ratios in acute care hospitals, so that the quality of care given to patients as well as employee satisfaction can be significantly raised. Key Concepts of Vision The current nurse to patient ratio at my hospital is 1 nurse to 7 patients. I do not feel that this ratio is appropriate. My vision is to implement a new ratio guideline, lowering the ratio to 1 nurse per 5 patients with the exception being made for high acuity patients. I would then like the ratio to be 1 nurse to every 4 patients. A high acuity patient with a major trauma would be harder to care for than someone admitted for dehydration. The charge nurse would be in charge of designating which type of acuity patients and how many are assigned to each nurse. This procedure is currently in place, but with the new guideline, there would be less patients assigned to each nurse. This would result in a safer work environment, better patient care, and a great recruitment incentive for nurses (Gonzalez...
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...My Thoughts Advocating for mandated nurse-to-patient ratios is an easy choice because it saves lives. The nursing profession is founded on caring for others, providing and promoting the health, safety, and well-being of those in need and the best way to do that is with safe nurse-to-patient staffing. This mandate is a win-win for patients, staff, and facility. Patients get best care, staff has job satisfaction, and facility gets decrease costs from benefits that better health care and staff satisfaction will produce. References Agency for Healthcare Research and Quality. (2012). Retrieved from http://www.nationalnursesunited.org/news/entry/state-mandated. Clark, C. (2010, January). Does Mandating Nurse-Patient Ratios Improve Care? Health Leaders Media. Fraughton, H. (2014). Factsheet: Nurse to Patient Ratios are Cost-Effective. Retrieved from http://nsgeu.ca/factsheet-nurse-to-patient-ratios-are-cost. Gordon, S. (2009). Safety in Numbers Nurse-to-Patient Ratios and the Future of Health Care. Retrieved from http://www.cornellpress.cornell.edu/book/?GCOI=80140100337250 Rosseter, R. (2014). Nursing Shortage. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage Shekelle, P. G. (2002). Effect of Nurse-to-Patient Staffing Ratios on Patient Morbidity and Mortality. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0055923/ State Staffing Plans and Ratios. (2014). Retrieved from http://www.nursingworld.org/MainMenuCategories/Poli...
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...Lowering Nurse Staffing Ratios The growing need of more nurses in hospitals is becoming an issue in hospitals all over America. The patient’s safety is being put at risk due to the number of nurse to patient ratios (Welton 1). A low nurse to patient ratio will cause a lack of care for the patients. Nurses will have to take on more patients then they are capable of which will affect the health of the patient and the nurse. John M. Welton, an RN (Registered Nurse), said that “the safety of patients is directly related to the size and experience of the nursing staff” (Welton 1). A high nurse to patient ratio can be on the costly side for the hospitals. “Hospitals will not receive any additional revenue for providing more patient care”...
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...Examine Nurse-to-Patient Ratios Primary health care organizations such as New York Presbyterian (NYP) are impacted by low nurse-to-patient ratios. The recent implementation of the Patient Protection and Affordable Care Act (ACA) has required organizations such as NYP to explore many approaches to improve quality and patient outcomes that contain costs. “Numerous studies reveal an association between higher levels of experienced RN staffing and lower rates of adverse patient outcomes” (www.nursingworld.org, 2015, para. 1). For this reason, nurse-to-patient ratios is an issue that needs to be addressed at NYP in order to improve quality healthcare within their organization. The acuity of the unit in which patient care is being provided, should determine the acceptable nurse-to-patient ratio. According to the American Nurses Association (ANA), factors that influence the nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; availability of or proximity to technological support or other resources ("Optimal Nurse Staffing," 2015). Currently, New York is one of only fourteen states that addresses the nurse staffing issue in hospitals. New York State requires organizations such as NYP to disclose their nurse-to-patient staffing ratios to the public; however the state does not require a minimum nurse-to-patient...
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...Prevention estimate that approximately 1.7 million hospitalized patients acquire infections while being treated for other medical conditions. In 2011, there were an estimated 722,000 hospital acquired infections (HAIs) in United States Acute Care Hospitals. Additionally, about 75,000 patients with hospital acquired infections died during their hospitalization (CDC, 2018). (Note: To ensure consistency, we will use HAIs when referring to nosocomial infections, please refer to the definition section for further understanding of the terms) More than half of all the incidents occurred within the intensive care unit. HAIs can be associated with the devices used in medical procedures, such as central line-associated...
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...As a nurse many of us enter the profession because of our love of caring for others. In our day and time, healthcare has become less about caring and more about business. The healthcare that was once concerned with quality of patient care, is now concerned with the quantity of dollars received. John Kariben (2017), the executive director of the Michigan Nurses Association, explains that administrators of hospitals are balancing budgets without much thought of what’s going on at the bedside. As a result of this nurses and patients are suffering. Kariben (2017) goes on to describe some of the profit driven cuts, one of the major cuts being nurse staffing. Poor nurse staffing has been directly linked to poor patient outcomes. The Minnesota Department of Health (2015) found, “strong evidence that...
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...Caring Theory to the Nurse Staffing Ratio in Practice Chamberlain College of Nursing NUR501: Theoretical Basis Advance Nursing December 05, 2015 Introduction Nursing theory impacts the practice of nursing in many different ways that can have a great influence. Theory provides a structure to support and shape nursing practice, encourage quality of patient care, and can be utilized in practice situations to give solutions to problems in nursing practice. Utilizing theories to solve nursing obstacles can be used in educational settings, research environment, direct patient care, informatics, as well as in administration and management of nursing care services. The advantages of applying theory to resolve a challenge in nursing practice can be demonstrated by applying Jean Watson’s theory of human caring. Jean Watson’s theory of human caring is a grand theory that provides to the empirical stand point of nursing. It emphasizes on genuine caring about the human being as whole; meaning caring about the human’s mind, body and spirit in order for the healing process to sustain at highest level. Her theory is portrayed as a model of caring which art and science are both included; presenting a framework that involves and divides art, science, humanities, spirituality, mind-body-spirit in medicine, and nursing (Watson, 2000). Nursing practice today is impacted by Watson’s caring theory. It does not only enable nurses to improve care for patients as a whole, but it...
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...Qualitative Methodology: Hospital Nurse Staffing and Quality of Care Keli Feathler, RN Grand Canyon University NRS 433v Nora Bazydlo RN MSN October 29, 2011 Introduction Does the issue of nurse staffing have an effect on quality of patient care? This study addresses the topic of nurse staffing, which includes nurses (RN and LPN) and nurse’s aides. Research in Action: Agency for Healthcare Research and Quality (AHRQ) presents the study “Hospital Nurse Staffing and Quality of Care”. Nurse staffing is measured in one of two ways: nursing hours per patient day and nurse to patent ratio (Stanton, 2004). The article looks at periods of high vacancy rates, assesses the patients needs, the development of care plans and administration of medications and treatments in factoring the quality of care. It shows the effect lower staffing levels and its direct link to higher adverse outcome rates. The study of staffing and quality of care is essential, to link the two together, and prove that the issue needs to be addressed in all forums of nursing. The way to making improvements in nurse staffing is to present documentation/research that supports the issue at hand. With factual information, ways to improve the problem can be formed. Higher levels of nurse staffing at all levels showed a 2-25% reduction in adverse patient outcomes. In order to improve the quality and delivery of health care staffing needs to be addressed, and by performing research...
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...Adequate Nurse Staffing Improve Patient Outcomes? Nursing is more than caring for the sick and injured. It is a twenty-four hour inpatient monitoring system. It is well known that nurses spend significantly more time caring for and looking after patients than any other profession. They routinely monitor and report changing patient conditions around the clock that aid physicians in modifying and updating treatment plans to improve health and prevent complications. The level of safety of hospitalized patients and the degree of quality care that they receive has more to do than fixed nurse-to-patient ratios. It has been well established in the literature that when nursing workload increase to unmanageable levels; weather it be from the addition of patients, increases in acuity and/or care complexity, or from high levels of fluctuation in patient turnover, that nurses ability to perform patient surveillance is disordered, putting patients in undue risk (Needleman, et. al, 2011). Furthermore, excessive workloads contribute to burnout and dissatisfaction leading to nurse attrition that further compounds to the staffing problem. Hospitals need to be held accountable for providing safer nurse staffing levels. Payers and purchasers of care should demand compliance, but should also stimulate better quality and patient safety by providing financial incentives. In addition, a more comprehensive, proactive team approach to nurse staffing can help keep patients safer and...
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...screen page 1 Summary “INSERT PULL QUOTE HERE. DELETE BOX IF NOT IN USE.” Mandatory Nurse-to-Patient Ratio right screen page 2 Negative Influences Positive Influence of Mandated Ratios Is mandating ratios the answer. currently in California the mandated ratios are: !:2 for ICU, Critical Care, NICU, PACU, Labor & Delivery, and with ED patients requiring intensive care 1:3 for Stepdown Units 1:4 for Ante & Post partum, Pediatrics, ED, Telemetry, and other specialty units 1:5 for Medical Surgical units 1:6 for Psychiatric units. Has these ratios changed patient care and nurse satisfaction? Hospitals and nursing organizations are divided on how this change has effected patients and nurses. The California Nurses Association states that nurse retention, burnout, and morale have improved (Clark, 2010). Advocates also say that medical errors have reduced and patient satisfaction has improved. Although several states have attempted to pass laws mandating nurse-to-patient ratios, only California has successfully passed one. California Assembly Bill 394, mandating minimum, specific, and numerical nurse-to-patient ratios in hospitals, passed in 1999. left screen page 2 Nursing has seen many changes with the increase in medical treatments available. This has led to nurses caring for patients with higher acuity than ever before. Patients that might not have lived before are recovering in the ICU, those that might have required...
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...Nurse Burnout and Its Impact on Patient Safety Georgetown University Foundations of Health Systems and Policy NURO-624 September 12, 2013 Nurse Burnout and Its Impact on Patient Safety Patient safety encompasses the application of best practices that are geared towards achieving positive outcomes and promoting safety, and can serve as an indicator of quality in healthcare institutions; sustainable nursing workloads improve the quality of health care by reducing unsafe conditions, as well as reducing mortality and morbidity. Several literature reviews have clearly identified the consequences for patients when nurses are overtaxed or over utilized to bridge the gap of nursing shortages. According to Mckee et al, each patient added to nurses’ workloads (beyond four patients) is associated with a seven percent increase in mortality following common surgical procedures (McKee, M. 1999). Recent health reform legislation has further stimulated increased awareness and focuses on patient centered care, and emphasizes on the importance of the patients’ experience. Moreover, patients’ expectations of their caregivers to be positively engaged in their work and performing efficiently and effectively in a supportive environment are prudent. However, several challenges are being encountered by nurses, as they strive to meet the mandates of the aforementioned health care reform. Challenges resulting from unfavorable working conditions that are not conducive to the provision of patient...
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...Nurse to Patient Ratio 1 Safe Nurse to Patient Staffing Ratios A Qualitative Summary Introduction to Nursing Research Grand Canyon University Nurse to Patient Ratio 2 Abstract The healthcare industry stands in the face of many changes, one of which is the forecasted shortages of registered nurses in acute care settings. Unless action is taken and resolutions are not put in place evidence shows that this problem will only worsen in the coming years. Left unaddressed this shortage deprives the acute care patient of quality care, overburdens current staffing and detracts from the facilities overall performance. A further complication to the already strained workforce is the predicted retirement of the “ baby boomer” generation, which is forecast to increase the patient care needs at a rate that cannot be met by the current staffing levels. According to the “United States Registered Nurse report Card” issued by the American Association of Colleges of Nursing (2012) this shortage is predicted to spread across the United States through 2030. Nurse to Patient Ratio 3 Summary A quantitative approach to understanding this problem is the most appropriate choice to gather information such as low morale, increasing workload, high attrition levels and difficulty hiring replacement staff. The previously mentioned problems need to be understood...
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...or not there should be mandatory nurse-patient ratios. The article titled, “Mandatory Nurse-Patient Ratios” discusses the controversy about whether there should be mandatory ratios and how they can affect nurses and patient outcomes. Currently the state of California is the only state in the United States with mandatory nurse-patient ratios while 17 others have introduced legislation. Since California has passed legislation in 2005 there has not been any experimental evidence reported to support these ratios with more desirable patient outcomes. One of the positive outcomes for nurses is that it has made more jobs available but unfortunately has increased their workload because employers are reducing the number of ancillary staff which can lead to increased stress and burnout. The mandatory nurse-patient ratios claim to address the imbalance between patient needs and nursing resources but do not address the different levels of complex treatment required among patients. Nurses must understand their importance and advocate effectively for themselves and their patients. Providing quality research, lobbying, collaborating among members of the healthcare team and becoming more powerful with the help of special interest groups will help to make employers responsible for their legal obligations. This issue will affect me professionally because I am about to graduate from nursing school and will be actively looking for a position as a registered nurse. I am nervous about starting a new...
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