Nurse To Patient Ratio

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

Dr. Linda Aiken is the leading researcher in nursing staffing rates within the United States (Kerfoot & Douglas, 2013). She suggests that each state follows California’s example of conducting research to determine a minimum staffing ratio and making it a law (Kerfoot & Douglas, 2013). The California legislation enhanced nurse staffing in hospitals across the state and improved the patient care results of millions of patients (Kerfoot & Douglas, 2013). After the bill went into effect, job satisfaction increased, and the nursing shortage ended (Kerfoot & Douglas, 2013).

Through all the research, in regards to Safe Harbor, important information was obtained and some misconceptions were set straight. At the facility that this nurse works, it has always been threatened to claim Safe Harbor and the nurse to walk out. Recently, this was done when the medical-surgical nurse was asked to accept an admission on top of the other patients already being cared for by her, which would increase her patient load to a total of six patients. Acuity of the patients was not taken into account by the nurse. According to facility policy, this is an adequate staffing ratio. Staffing 1:5 or 1:6 for nurse-patient ratio is a recommend ratio for a medical-surgical unit (Tevington, 2011). Once researching Safe Harbor, there were multiple

The final bill mandates minimum, specific and numerical nurse-patient ratios in hospitals. For example, a mandated nurse patient ratio of 1:5 was set for medical surgical units and smaller ratios were assigned to specialty units (Tevington 2011). Today, California is the only state with mandated nurse-patient ratios. 14 other states have set laws and regulations addressing nurse staffing in hospitals but they all address the issue differently and have set different requirements (ANA,

When done accurately, acuity based staffing can be very beneficial for the nursing staff. Illinois is one of many states that have implemented laws requiring hospitals to base staffing on acuity systems and then report compliance on a quarterly basis. Illinois Hospital Association supports acuity based staffing over nurse-to-patient ratios. (Anonymous. 2008)

In the profession of Nursing, we are faced with different challenges daily. Some of the most common problem that we faced today are patient workloads, unit dynamics, new interns, difficult family members, and patient safety. I believe the most significant difficulty nurses faces today is the nurse-patient ratio. In New York, we currently do not have a legislation that sets the number of patients assigned to a nurse. The ratio is set by the administrators and nursing managers of different units. In California on the other hand; legislation has been passed in 1999 and revised on 2008 that sets the cap of nurse-patient ratio in a Medical Surgical Floor at 1:5 (Kasprak, 2004). Currently in my unit, the nurse-patient ration ranges between 1:6 to 1:8, ratios that render care that is not safe for the patient and nurses; which can result to negative patient outcomes. Meeting the needs of each patient in a 1:6 ratio is both difficult and unfair for the patient, it makes me feel that I am ignoring patients need. The Transitions Theory by Afaf Meleis which is a middle range theory and Human Needs Theory by Abraham Maslow a which is a Humanistic Theory both supports the need for regulation of Nurse-Patient ratio in New York.

The purpose of this paper is to illustrate and demonstrate the significance of lowering the nurse to patient ratio, while implementing quality health improvements. Today’s complex healthcare system faces a number of difficulties that affect the quality of patient care and safety. Current nurse to patient ratios are of increasing focus in today’s healthcare system. Nursing staffing ratios have an effect on numerous areas within nursing; however, one of the most profound is the effect on the quality of care delivered to the patients. For example, medication errors and prevention are important in all aspects of care. Appropriate time is needed to administer medications; however, with overworked nurses and overextended patients loads, nurses are pressed for time. Nurses have the opportunity and responsibility to make sure that their patients obtain quality of care through interventions that keep patient safety a priority. Strategies should include keeping nursing staffed at adequate levels and appropriate to the type of patient care. Furthermore, the patient’s acuity and the nurse’s assignment should be taken into consideration.

Support for mandatory nurse-patient ratios is primarily based on the ideal that minimum, specific, guaranteed nurse staffing will increase positive patient outcomes, decrease nursing shortages, and alleviate nurse workloads to increase nurse retention and job satisfaction (Tevington, 2011).

Currently, there are only 13 states that have addressed these laws and regulations in hospitals: CA, CT, IL, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA. California is the only state that requires specific minimum nurse-patient ratio in all units. Supporters for this law argue that it is important to for all states to adapt to these laws and regulations because it can improve quality patient care. Although there are several issues surrounding the idea of mandating nurse-patient ratios, the “American Nurse Association (ANA) endorses staffing systems with requirements that RNs who provide direct patient care have input into staffing decisions and that the level and intensity of care can be reflect in the staffing system” (Manjlovich, 2009).

Nurse-Patient staffing ratios have created debate among health care professionals for years. Who determines where, when and how many patients a nurse can handle on any given shift? Who determines the acuity of the patients handled by the nurse? Does the floor nurse have a say in what she or he can feasibly handle during their shift? At what point does patient care begin to suffer? These questions and many others have led to federal and state legislation coming to light to better serve the care of a patient. “The varied agendas and the inability of nurses, hospital administrators, and financial experts to communicate toward a single purpose, as well as the complexity of meeting staffing needs, have moved the issue into the political arena (Hertel, 2012, p. 1)”. Several states have already instituted mandatory nurse-patient ratios. While you can debate for or against political involvement, I will look at many factors regarding care and safety of patients.

No question about it, there are some agencies that offer more money than others. So the first thing to remember is that agencies may base salaries upon things like location availability, need-to-fill assignments, and cost of living.

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

Presently in the health care field there is a push for safe nurse to patient ratios in acute care settings to provide quality and safe practices that will reduce the risk of complications and adverse effects as the acuity of patients continue to increase. As patients are staying in acute care facilities for less time resulting in the need for continued care after discharge. The fluctuation of higher rates of acuity of patients in the skilled nursing faculties and nursing home setting are placing higher demand on staffing, which is already at higher ratio levels of nurse to patient.

Studies have shown that increase RN client ratios results in a reduction of 5.7% in patient days spent in hospital. The trend toward higher RN staffing levels has been shown to decrease avoidable never events such as inpatient falls and hospital acquired pressure ulcers. He, J. (2013).Too much burden on nurses tends to negatively affect productivity which compromises patient’s safety and quality of healthcare. In California, the mandatory nurse patient ratio was implemented at the time of severe registered nurse shortage and worsening of financial position of many hospitals. This legislature has been found to improve the health care system in many ways.

Keywords: Patients-to-one-nurse Ratio, Nurses, Low Nurse Staffing, Nurse to Patient Ratio Law, El Paso, California