The purpose of this paper is to discuss the nurse ratios and how management and leaders effectively incorporate theories, principles and leadership styles and qualities that are effective in providing quality leadership and management to staff. There are differences in leaders and managers, in the styles, goals and qualities that define leaders and managers. The effects of the nurse patient ratio can be seen as well as felt on multiple levels of the facility.
As far as nurse managers, they are on the closest level besides bedside nurses to see the effects of ratios.
Studies have shown that higher nurse patient ratios lead to higher adverse outcomes for patients, lower patient satisfaction as well as higher nurse turnover , which increases costs to the facility. The article in the Journal of Clinical Nursing (2011) investigates the relationships between nurse staffing, nursing activities and adverse patient outcomes in the acute care setting as reported by nurses in Finland and the Netherlands. The study was performed using a cross-sectional, descriptive questionnaire.
The study discusses tasks performed by nurses, as well as tasks performed by LPN’s and other staff. The studies show that nurses with higher patient ratio’s have higher incidence of medication administration errors, patient falls as lower patient satisfaction.
The nurse manager has direct impact on the development and implementation of tools such as the staffing matrix, acuities scores and what is the policy for staffing. The nurses should be able to go to the managers with concerns regarding staffing issues.
Nursing leaders look at the bigger picture, such as patient satisfaction but are also required to look at fiscal responsibilities that the facility has, as well as community events and support projects. Leaders look to improve and promote positive changes that will benefit the community served by the facility. Nurse leaders can evaluate how the policies and procedures are working, if they need to be changes to provide better quality of care. Nurse leaders also assist in educating staff on the reasons change is necessary and the steps that can be taken to effectively implement changes.
Nurse managers are there to provide direction on daily tasks, support and as a resource to staff. Typically, nurse managers deal with day to day running of the floor and issues that arise with staff and/or patients. Managers typically see issues that arise with current policies, provide direction to staff. It is understandable how management can be pulled in opposite directions such as what is best for nursing staff and patients may not be the same as what is good for the facility. Upper management does not always seem to have a grasp on the reality of the floor, the day to day issues of providing patient care and just what is necessary to maintain patient satisfaction.
The theories and principles that best describe this writers philosophy is a mix. One theory or principle does not fit. A mix of situational, servant and participative includes the theories followed. Different situations can bring out different needs. An example in my facility is, with concerns regarding financial changes occurring in healthcare, rising costs to healthcare, a poor economy and decreased reimbursments, the leaders have to look at all those aspects, and evaluate the risk vs. benefits to nurse ratios. The nurse managers have to follow the rules set forth, and try to comply with the demands from upper management.
It is expected by me that nurse managers look at the reality of the floor while keeping the needs of the facility in mind. Floor nurses are the advocates for the patient, and have a unique perspective of the needs of the floor. Managing staffing, acuities and patient care while also dealing with physicians, and upper management requires effort and active participation. Leaders need to think outside the box, look at the bigger picture and then convince everyone that the changes are necessary, needed and beneficial.
Both positions require skills such as good communication, good listening, being able to lead without dictatorship or by fear. Creating a positive environment while maintaining authority is not an easy task. Creating an atmosphere conducive to change while providing high quality care and keeping everyone happy is an even more difficult task. But both of these tasks require a relationship, trust and communication between all parties or departments involved. Staffing ratios have been studied, as seen in the study regarding work satisfaction (Nursing Economics, 2012) discusses the first staffing
law that went into effect in California in 2004. The study showed that nurses with a lower nurse to patient ratio had a higher job satisfaction rate, as well as better patient satisfaction. The costs associated with high nurse turnover include more than just monetary costs. The safety risks to patients can not be ignored. Nurse managers can evaluate the effectiveness of the policies as they are closest to the floor nurses and patients.
Nurse managers have a different and unique experience, as do nurse leaders. Both areas require active participation with daily interaction with staff. The staff needs to feel a part of the team, respected and listened to. To have an effective unit, collaboration between all levels needs to be in place. Effective managers and effective leaders can work together to achieve goals, while providing high quality patient care.
Hinno, S., Partanen, P., & Vehviläinen-Julkunen, K. (2012). Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. Journal Of Clinical Nursing, 21(11/12), 1584-1593. doi:10.1111/j.1365-2702.2011.03956.x
Tellez, M. (2012). Work Satisfaction Among California Registered Nurses: A Longitudinal Comparative Analysis. Nursing Economic$, 30(2), 73-81.