Improving Nurse to Patient Ratio

Introduction

Nurses across the nation are stressed, burnt out, and even considering leaving the profession for a new career change. A nurse’s workload, his or her balance between work and life, the long twelve-hour shifts, constant overtime, and the shortage of nurses within the medical facility are just a few of the major contributing factors to the stress a nurse must experience day to day. When a unit is understaffed, patients do not fully receive the quality of care from his or her nurse that they should when admitted into the hospital.

Patients hold high expectations of his or her assigned nurse and expect the nurse to be there at his or her every need and want. Patients do not realize that majority of the time their nurse will be covering a whole floor alone, and this causes nurses to become overwhelmed with the profession because they are trying their best to meet the needs and wants of thirty or more other patients at once.

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To simply this, medical facilities should consider recognizing and maintaining a suitable number of a mixed nursing staff of Registered nurses, Licensed Practical Nurses, and Certified Nursing Assistants to each floor of the hospital to be a critical delivery of quality patient care.

Background

The idea for this change comes from patients being admitted into the hospital, and how they are not getting their full quality of care from nurses. This change also come from nurses needing a less rigorous workload, and a smaller amount of patient responsibility to their shift.

The care for patients is being put last, and in a recent study shows that nurses spend on average 33% of their interacting with technology, 11.5% on documenting, 9.1% on reviewing the Electronic Health Record (EHR); patient assessment and interaction, 8.9% on in-person communication with healthcare workers about patients or patient care, 7.5% on patient care, and 7.2% on bedside procedures (Advance Staff, 2016).

Overview

The entire purpose around a hospital is to provide the community with a safe place to come and receive treatment, so that the patient can properly heal from his or her illness. Even though hospitals are a place to provide treatment to the community, the healthcare system is diminishing this very purpose with the lack of staffed experienced nurses. For example, “each additional patient per nurse was associated with a 7 percent increase in the likelihood of mortality within 30 days of admission and in the likelihood of failure to rescue (Carayon & Gurses). With each patient that becomes an additional responsibility to a nurse’s workload, decreases the time the patient’s family has to ask their questions and the less quality of care that the patient receives from his or her nurse. Patients are not feeling as important in today’s medical facilities because it is as if they are invisible to the nurses. From first hand, When I got admitted into the hospital and had to stay overnight I did not genuinely get the compassion and care that I was looking to receive because my nurse was either late to get to me, stuck doing paperwork, or juggling other patients needs and wants.

Importance of Change

Implementing a mandatory nursing safe staff and lowering nurse-to-patient ratios, decreases nurse burnout including, chronic fatigue, depression, weight gain, and other health risks that come from being overworked in a stressful environment. It will also greatly impact the safety and quality of patient care. Current unstaffed facilities across the nation are putting patients at a higher risk for infections, cardiac arrest, medication errors, falls, bedsores, and even unintentional death of the patient due to massive reductions of experienced nurses. In 2004, After legislators enacted California safe staffing ratios, patient mortality events within thirty days of hospital admission decreased notably, and nurse-patient rapport improved significantly (“Regis College). Nurses employed at extremely understaffed medical facilities are also being put at a higher risk for musculoskeletal disorders (neck, back, and shoulder injuries), hypertension, cardiovascular disease, and depression. In a 2016 survey, there are more than 35,000 back and other injuries among nursing employees every year (Department of Labor's Bureau of Labor Statistics (BLS), 2016).

Leadership Behavior

For this change to be made, effective leadership from healthcare professionals and having a nurse driven unit is critical for reinforcing the quality and integration of patient care. Lenders would have to provide a budget to increase the funding of the nursing program in order to have a fully staffed facility, and the hospitals would be required to hire more nurses into the facility. To meet the suitable ratio, hospitals must attract more registered nurses, certified nursing assistants, and licensed practical nurses into the facility by increasing their salaries and benefits. Patient safety must be the hospital’s priority; therefore, the outcomes of the patients would compensate the expense of more money being spent to begin with for more nursing staff. After ratios were implemented in California, hospital income rose dramatically from $12.5 billion to more than $20.6 billion (NYSNA).

Timeframe

The average timeframe for a hospital to fully implement a safe nursing staff can depend on how quickly the state can come together to pass the law. Once the law is passed, it could take a state up to as long as three years to properly established it throughout every hospital.

Conceptual framework

California is the only state in the country with mandatory limits on the number of patients a nurse can be assigned at one time. The regulations were enacted in 2004, after nurses with the California Nurses Association/National Nurses United fought for years to achieve them. Patients in every other state do not have the same safety protections—although nurses in other states have been fighting for similar legislation (Castillo, 2017).

Conclusion

Every patient deserves full quality of care, without fear of hospital-acquired infections, unmet needs, or delayed care by overworked Registered Nurses. Nurses nationwide consistently report that hospital nurse staffing levels are insufficient to provide safe and effective quality of care. If leaders can resolve this issue, and improve the nurse-to-patient ratio, both nurses and patients will benefit greatly.