Adequate nurse staffing for patient care has been a major difficulty in the health care system . Patients’ acuity continues to grow at a fast rate while hospitals continue to struggle with the adequate number for nurse-to-patient ratio, leaving nurses in a very difficult situation while trying to provide the best care possible to their patients. The low nurse-to-patients ratio can be remedied when public and private hospitals realize the negative impact on the outcome of care. This paper will try to point out the negative effects of low nurse-to-patient ratio has on outcome of care.
Like other professions that continue to face obstacles, nursing has its own obstacles that it must face from time to time. The world population increases so will the obstacles that nursing will have to face, but good administration can be used to defend the work conditions under which nurses are forced to work. Many studies have been done to point out the problem, with a pile of evidence to support the need to alleviate the burden on the nurses but to no avail. A study conducted in the Chinese hospital by Zhu, You, et al. (2012).
Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals proved, “more nursing staff per patient had statistically significant positive effects on all necessary nursing care, nurses’ reports of quality of care, their confidence on patients’ self-care ability on discharge from hospital, patient adverse events, as well as patients’ report of satisfaction (Zhu, You, et al, 2012, p. 266)”. The study was composed of 181 hospitals across mainland China. The sample that was used was 31provinces, municipalities and autonomous regions with level 3 hospitals.
To show the strength of the study, the researchers applied statistics to prove their results. As much as the hospitals may not see the need to improve on the nurse to patient problem, the evidence is there. It is something that must be dealt with because it is dangerous to both nurses and patients. Further studies were also conducted on the problem by Nantsupawat A, Srisuphan W, et al. (2011). Impact of nurse work Environment and Staffing on Hospital Nurse and Quality of care in Thailand. This study was to prove the impact of nursing staffing on the work environment, the cause of burnout and the impact on quality of care in Thailand.
Research elements was secondary data analysis of 2007 Thai Nurse Survey. The study took place at 13 general and regional hospitals in Thailand using a “multistage sampling”. Nurses were asked demographic questions about themselves both general and regional hospitals. Results shown the ratio of patient to nurse was 10:1. Nurses who worked in hospitals with fair patient to nurse ratio had less burnout. The study has great significance in nursing practice and can be used as proof to show the impact of high patients to nurses ratio. It was found that nurses in Thailand work environment have high burnout and great dissatisfaction of nurses.
Nurse to patient is very low with a total of 1:10 per shift. At times, a nurse ended-up having to care for more patients. The high patients to nurse ratio brought with it adverse outcomes on patients’ care and place the patients at high risk of occurrences such as: mistaken one patient for another, patient falls, medication errors, pressure ulcers, and urinary tract infection. Furthermore, in the study conducted by Cho, June, Kim, et al (2009). Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. This study measured the proportion number of patients to nurse.
As per the authors of the article, “nurses were more likely to rate quality of care as high when they care for two or fewer patients (odd ratio, 3. 26; 95% confidence interval, 1. 14-9. 31) or 2. 0-2. 5 patients (odd ratios, 2. 44; 95% confidence interval, 1. 32-4. 52), compared with having more than three patients (Cho, June, Kim, et al,, 2009, p. 1729)”. The research use for its design a “cross-sectional study with survey. Its method included 1365 nurses from 65 intensive care units in 22 hospitals in Korea, using “A Multilevel logistic regression model”.
Two indicators were used, which are the number of patients for each nurse on the ward and the way the staff viewed adequate staffing. The research took place in the ICU units. Hence, the study also reported that in table #4 in the Sole ICU, there were largest number of patient 2. 8 + or – 0. 4 ( Cho, June, Kim, et al, 2009, p. 1733)”.
What is proven is that when the ratio of nurses increases and the patient’s one decreases, there is a higher quality of care that takes place on the unit. This study has great significance to nursing and patient care, because nurses here in the U. S often have similar complaints. In addition, the study from Manojlovich & Sidani (2007). Nurse Dose: What’s in a concept. This is a pathway that the authors believed could alleviate the problem of nurse to patient ratio. The study provided an understanding between the link of nursing care and outcome of care. As stated by Manojlovich & Sidani (20097), “by clarifying the conceptual and operational definitions of nurse dose, we offer a unified view of the inter-relationships among variables, with the goal of advancing research on nurse staffing and patient outcome (p. 11)”.
With this concept of “Nurse Dose” future nurse staffing may greatly improve. Furthermore, in the research conducted by Al-Kandari &Thomas (2008). Perceived Adverse patient outcomes correlated to nurses’ workload in medical and surgical of selected hospitals in Kuwait. It is understood that the proportion of patient to nurse ratio plays a vital part on the outcomes of care. The study shown that there is clear correlation that exist between the work load of the nursing staff and the outcomes of care.
The research elements utilized for this study was “across-sectional survey conducted between RNs on medical and surgical units in five governmental hospitals. The result shown three major faulty outcomes were reported by nurses from their previous shift which were patients’ complaints and family concerns. The limitation of this study reports were only from the nurses on the units and future researches would need further details (Al-kandari &Thomas, 2007, p. 589). It is impossible for nurses to give adequate care and expect good outcomes when nurses are stocked with non-nursing tasks to do.
It was found that patients and families and medication miss dose were the two primary outcomes that added on the nurses’ workload. Second, occurrences tend to increase on the units as the workload of the nurses increased, and non-nursing tasks heavily impacted the workload of the nurses in Kuwait. The study shown great relevance to nursing practice, because it shows that hospitals need to employ other people to carry out non-nursing duties on the unit such as clerical work; which would alleviate the workload from nurses responsibilities.
Hence, the article Relationships between Registered Nurse Staffing, Processes of Nursing Care, and Nurse-Reported patient outcomes in Chronic Hemodialysis Units by Thomas- Hawkins, Flynn, &Clarke (2008) shown the importance of a high nurse to patient ratio in hemodialysis units. The authors reported in hemodialysis units, “higher RN staffing levels have lower odds of experiencing skipped dialysis treatments (Hawkins-T, Flynn, & Clarke, 2008, p. 124)”.
The study shows that it is to the benefits of the patients when there is a higher nurse to patient ratio on hemodialysis units because, patient will less likely experience any untoward events that are associated with the side effects of hemodialysis therapy. The study utilized a “cross-sectional method” for data collection which focused on the hemodialysis patient population. The study demonstrated the importance of having a high nurse to patient ratio in dialysis units. The higher the nurses to patient ratio, the less occurrences the patients will experience during hemodialysis treatment.
The research used a type of questionnaire in order to find the most accurate adverse events that took place in the dialysis units. The limitations of this study was conducted with nurses who belong to an organization, the adverse patients’ outcomes were gathered from the nurses’ reports. The findings from this research were as follow: the nurse staffing levels played a significant role on patients’ outcomes during treatment. The ratio between patients and nurses is high, and each nurse had a patient load that consisted of 12 patients and sometimes more.
This study has very good relevance to nursing practice due the fact that it shed light on a particular unit because it is a specialized unit. The study also demonstrated the importance of having professional RNs to perform such duties. Nurse staffing levels and Nursing outcomes: A Bayesian analysis, of Finnish-registered nurse survey data by Tero-h, Kiviniemi, et al (2009). Journal of Nursing Management, 17, 986-993. This report pointed out the impact of high patients to nurse ratio have on the nurses and their performance on the unit. Therefore, it is inevitable this kind of nurse staffing would bring negative patients’ outcomes.
The design of this study used a survey of date collection from RNs in 46 units at five hospitals. The study found that many elements were contributed to occurrences on the unit such as mortality, failure to rescue, had a very closed correlation to the number of patients to nurse ratio. The study relates significantly to nursing, because it displayed the stress levels that nurses experienced due to heavy patient load assignment. Macphee, Ellis, & McCutcheon (2005). Nurse Staffing and patient Safety. The Canadian Health Services Research foundation.
This article brought up evidences of events that may occur in relation to lower nurse patient ratio. It is evident that with a lower nurse to patient ratio, patients are at greater risk of adverse outcomes such as increased rate of mortality, nosocomial infections. It is also proven that with a higher nurse to patient ratio, incidents can be greatly reduced. The study utilized sets of data collected from other researches. No specific population group was chosen for this research but the impact of having high patient to nurse ratio were strongly presented. The article displayed its use to the nursing practice with enough substantial facts.
Ke-p. (2003) Relationships between Nurse Staffing and Patient Outcomes. Journal of Nursing Research, 11(3). The study was conducted on a medical –surgical unit in Taiwan with analyzed data from a “descriptive and multivariate inferential statistics”. The rational of this study was to demonstrate the co-relation that exised between high patients to nurse ratio and its impact on patient care outcomes. The results of this study were astounding. It was found that acquired infections, falls, pressure ulcers were the outcome results of inappropriate nurse to patient ratio.
This study definitely has very good relevance to nursing practice. Curtin L. (2003). An Integrated Analysis of Nurse Staffing and Related Variables: Effect on Patient Outcomes. Online Journal of Issues in nursing, 8(3), 10913734. In this his study, the author shows a good co-relation between nurse staffing and the outcomes of care on medical patients. He also pointed out an increase in nurse staffing, that was associated with a reduction of 3 to 12 % in occurrences on the hospitals units. (Curtin, 2003). Here again it shows that the greater is the nurse to patient ratio, the better the outcome.
Although, this study did not use a specific design, but the analysis it used shows the importance of having a low patient to nurse ratio. Therefore, it is vital for the hospitals to realize the great pain that are imposed on patients and nurses. It is time to remedy the problem. Aiken L. (2010). Safety In numbers: A mandatory minimum nurse to patient ratio improves outcome. Nursing Standard, 24(44). The author reported, “International Hospital Outcomes Study revealed that in England and the United States, hospitals with higher nurse staffing levels had lower mortality rates, nurse job dissatisfaction and burnout (Aiken, 2010, p. 2)”.
The study was conducted in five different countries which survey 22,000 RNs in 604 hospitals in California, Pennsylvania, and New Jersey. It was found that nurse in California and the two other states that are closed to California with similar staffing mandatory rules had decreased their workload subsequently providing better care. Duffield C, et al. (2010). Staffing, Skill mix and the model of care. Journal of Clinical Nursing, 19, 2242-2251 dio: 10. 1111/j. 1365-2702. 2010. 03225. The study design was based on secondary analysis collection of data on selected medical/surgical units in 19 hospitals in South Wales, Australia.
The experienced nurses worked during the night while the least experienced nurses worked day or evening shift. The limitation of this study was that skill mix RNs was beneficial to outcomes, but the number of years of experience on a unit were not studied. (Duffield, et al, 2010, pp. 2246, 2249)”. The relevance of this study to nursing was that it shows how a unit can benefit from having different levels of experienced skill nurses give care to patients. Sidani S, Manojlovich M, & Covell C. (2010). Nurse Dose: Validation and Refinement of a Concept.
Research and Theory for Nursing Practice: An international Journal, 24(3), dio: 10. 1891/154-6577. 24. 3. 159. The study used “Anonexperrimental, modified survey” a questionnaire was used with four sections that participants used to answer the questions. The targeted population was nurse researchers who are experts in services related to healthcare (p. 163)”. The result of this study shows how important it is for nurses to spend time with their patients to bring an effective outcome.
The study shows great significance of this study in nursing. Welton JM. 2007). Mandatory hospital nurse to patient staffing ratios: Time to take a different approach. Online Journal of Issues in Nursing, 12(3). (13p) (52 ref) This article did not show a specific design that was used. The article stressed another component of the problem, the fact that hospitals are being pressured to increase their staffing without any reimbursement. The article presented two arguments one for and the other against the problem. As a result, hospitals diminished their staff from other area which helped them to compensate for the deficit.
Although the acuity of patients continue to rise, hospitals failed to increase nurse to patient levels to enable good outcomes. Currie V, Gill V, et al. (2005). Relationship between quality of care, staffing levels, skill mix and nurse autonomy: Literature review. Journal of Advanced Nursing, 51(1) 73-82. Using a “cross-sectional analysis design and magnet hospitals, the article poke through between the problem of patient to nurse ratio and the level of occurrences such as, mortality and failure to rescue. The findings were that units with higher nurse to patient ratio experienced lower occurrences.
Yes, the article did prove its significance into nursing and patient care. In conclusion, studies are not always conclusive on a particular problem or issue. Further studies are often needed to shed new light on the problem. Hospitals have their parts to play in order to bring a higher nurse to patient ratio to fruition. It still remains that nurses have the responsibility to provide safe and effective nursing care to their patients, regardless of the environment. As a reminder, nursing is a humanistic profession, and its aim has always and will continue to focus on human needs, without regard to ratios.
Nonetheless, nurses own it to themselves to be steadfast and never to soften their stand on their demands. Nurses to patient ratio is of utmost importance in the health care and patient outcomes depend on safe nursing staff. It is undeniably true that most professions are facing their own obstacles, and nursing is no different. Nursing has its own obstacles that it has been fighting and must continue to fight for, but a higher nurse to patient ratio is a must win fight, because the end result will be good patients’ care.
Courtney from Study Moose
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