Implementation Plan Addressing a Issue of Nurse-to-patient Ratio

Implementation Plan Addressing a Issue of Nurse-to-patient Ratio

ImplementationPlan: Addressing a Issue of Nurse-to-patient Ratio

ImplementationPlan: Addressing a Issue of Nurse-to-patient Ratio

Thehigh ratio of nurse-to-patient is currently one of the key factorsthat threaten the delivery of quality healthcare to patients. Therapid increase in the ratio has been caused by different factors,including the desire of the health care facilities to control thecost of health care by reducing the number of nurses, assignment ofadministrative roles to the most experienced nurses, and a decline inthe number of qualified and registered nurses in the labor market(Hinno, Partanen, &amp Vehvilainen-Julkunen, 2012). Theimplementation plan addressed in this paper will seek to resolve thechallenge of a high nurse-to-patient ratio.

Methodsof obtaining approval and support from leaders as well as staff

Itwill be necessary to prepare a formal report, coupled with a powerpoint presentation and written handout materials on the causes,effects, and the possible solutions to the issue of a highnurse-to-patient ratio in order to get the approval of the leadershipas well as the required support. Most importantly, the report shouldcontain the details of the impacts (such as the decline in thequality of care and the treatment outcome) of a high ratio in clients(Shekelle, 2013), which should be supported by empirical evidence.The report should also reveal to the leadership and members of staffabout the relationship between the high ratio and nurse burnout, thelack of staff motivation, and eventual decline in the quality ofcare. The presentation will be made in a meeting attended by CFO,directors, CNO, assistant managers, managers, and charge nurses.

Descriptionof the problem

Ahigh nurse-to-patient ratio affects the clients, nurses, and theentire organization either indirectly or directly. When nurses arefewer than the number of patients, the available nurses are forced towork for long hours, which lead to their burnout (Teng, Shyu, Chiou &ampFan, 2010). Weary nurses are at a higher risk of having more errorswhen delivering health care services, which in turn leads to adverseeffects on the treatment outcome. In addition, the limited number ofnurses is not able to spend quality time with clients, which reducesthe ability of nurses to comprehend the health care needs of theirpatients (Hinno, Partanen, &ampVehvilainen-Julkunen, 2012). Forcingnurses to work for long hours and to attend to a disproportionatelylarge number of patients reduces their job satisfaction, whichresults in a high turnover rate of experienced nurses (Tellez, 2012).A combination of these factors (including the limited time spent onindividual patients, lack of job satisfaction, and the turnover ofthe most experienced nurses) reduces the treatment outcome anddissatisfaction of patients with the services offered by the healthcare facility. Therefore, it is evident that a high nurse-to-patientratio reduces the satisfaction of nurses, prevent patients fromaccessing quality care, and damages the images of the hospital.

Currently,the hospital does not have an effective policy or strategy to addressthe pressing challenge of a high nurse-to-patient ratio. Themanagement of the hospital has been determining the ratio of nursesto patients on the basis of the budgetary allocation for eachdepartment. The current ratio of patient-to-nurse on telemetry is 6:1during the day and 7:1 at night, but the ratio is at times pushed to8:1 at night.


Themanagement of the hospital will implement the following plan with theobjective of addressing the issue of a high nurse-to-patient ratio.

  1. Hiring new registered nurses as well as nursing assistants

Rationale:The high ratio of nurse-to-patient is mainly caused by a rapidincrease in the number of patients compared to the rate at which thehospital hires additional nurses (Teng etal.,2010). In the present case, the hospital has been constrained by thefinancial resources, which has limited its capacity to hire newnurses to cater for an ever increasing number of patients. Thisimplies that the scenario of a disproportionate increase in thenumber of patients compared to the increase in the number of nursescan be reversed by hiring additional registered nurses as well as thenursing assistants.

  1. Retaining current experienced nurses through motivation

Rationale:The turnover of experienced nurses is among the key factors that havecontributed towards the increase in the ratio of nurse-to-patient.Experienced nurses are more sensitive to the working conditions thanthe newly hired members of staff, which means that they are morelikely to leave their current job and find a new one easily.Similarly, excessive workload of nurses increases the turnover ofexperiences nurses, which affects the quality of services that thehospital offers (Garretson, 2004).

  1. Fostering a collaborative environment through communication

Rationale:Effective communication between the management and the members ofstaff is among the key factors that help organizations in monitoringthe unfolding of events at the hospital and detect problems as theyarise. This will help the hospital in detecting the shortage ofnurses and its negative effects in time since the collaborativeenvironment and effective communication will empower junior nurses toinform the management about the shortage and how it affects theircapacity to deliver quality care. Early detection of the shortagewill give the management of the hospital an ample time to takecorrective measures.

Evidenceto support the solution

Studieshave identified a positive relationship that exists between thetreatment outcome and the level of staffing. For example, a casestudy conducted by Shuldham, Parkin, Firouzi, Roughton, &ampLau-Walker(2009) revealed that a high level of nurse staffing leads to animprovement in the quality of health care as well as the patientoutcome. In addition, the findings of the case study indicated thatincreasing the number of registered nurses resolves the challenge ofnurse shortage while enhancing the patient outcome at the same time.However, the results are much better when the health care facilityincreases the number of permanently employed nurses compared toincreasing the number of temporarily employed nurses. This confirmsthat fact that the pressing issue of a high nurse-to-patient ratiocan be resolved by hiring new registered nurses. However, thehospital can address the issue more effectively by employing the newregistered nurses on a permanent basis.

Retainingthe current workforce is an effective strategy that can help thehospital prevent further increase in the nurse-to-patient ratio. Thisis based on the notion that a high rate of turnover of experiencednurses has played a key role towards higher nurse-to-patient ratiothat has continuously affected the quality of health services offeredby the hospital. A literature review conducted by Garretson (2004)revealed that a high nurse-to-patient ratio reduce the morale ofnurses and increase their intention to leave their current job.Consequently, motivating the current workforce can give them a reasonto continue serving the hospital, thus preventing a further rise inthe nurse-to-patient ratio. Motivation of nurses may be achieved byrewarding nurses depending on their time they have worked with thehospital and their performance. This is an effective way of ensuringthat the hospital retains the most experienced and the bestperforming nurses.

Descriptionof the implementation logistics

Theprocess of implementing the proposed changes will start by informingthe members of staff about the anticipated changes. This will beachieved by organizing staff meetings, which will also give nurses anopportunity to contribute their views. The hospital management willthen review the hospital’s annual budget and allocate morefinancial resources to the department of human resources with theobjective of increasing its capacity to hire new registered nurses aswell as nurse assistants.

Hiringnew nurses, while letting the experienced nurses leave the hospitalmay not solve the underlying challenge of a high nurse-to-patientratio. Consequently, the hospital will revise the compensation systemin order to reward nurses depending on their work experience andperformance. This will reduce the rate of turnover of experiencedregistered nurses.

Thehospital will then develop a policy that will facilitate effectivecommunication between the charge nurses, bedside nurses, and themanagement, especially on matters pertaining to the acuity of theirclients. This will enable the management in adopting the suitableshift plan that will in turn ensure that the hospital has adequatenurses in each shift.

Resourcesrequired for the implementation of the plan

Thehospital will need to train nurses and other members of staff aboutthe anticipated changes in order to reduce resistance and acquiretheir support. Resources required for the training activities, inaddition to the meetings with the management include PowerPointsoftware, a quarterly review of HCAHP scores, and Bi annual survey ofregistered nurses (RGs), focusing on areas that improvements in jobsatisfaction and information on nurse workload.

Financialresources will also be required to fund internal meetings and theprocess of hiring new registered nurses and assistant nurses.However, the hospital will utilize its administrative staff toperform a quarterly review of HCAHP and perform a biannual survey ofregistered nurses. The use of hospital staff will reduce the amountof resources required to implement the plan successfully.


Thehigh nurse-to-patient ratio is a critical challenge affecting thehealth care facilities in the contemporary world. The increase in theratio can be attributed to numerous and complex factors that includethe industry-wide shortage of trained and experienced nurses.However, some health care facilities make deliberate measures toreduce the number of registered nurses in an attempt to control thecost of delivering health care services. A high nurse-to-patientratio is associated with numerous problems that affect patients, thehealth care facility, and nurses. This implies that all stakeholdersin the health care system are affected by the increase in the ratioof nurse-to-patients. The present implementation plan offers a viablesolution to that the hospital can use to address the issue of theshortage of nurses. The management can address the issue byrecruiting new registered nurses and motivate the current experiencednurses in order to reduce their intention to leave their presentjobs. A successful implementation of the plan will ensure that thehospital has adequate number of nurses, who will attend to the needsof all patients adequately.


Garretson,S. (2004). Nurse to patient ratio in American health care. NursingStandard,1, 33-37.

Hinno,S., Partanen, P., &ampVehvilainen-Julkunen, K. (2012). Nurseactivities, nurse staffing and adverse patient outcome as perceivedby hospital nurses. Journalof Clinical Nursing,21, 1584-1593.

Shekelle,P, G. (2013). Nurse-Patient Ratio as Patient Safety Strategy. Annalsof Internal Medicine,158, 404-409.

Shuldham,C., Parkin, C., Firouzi, A., Roughton, M., &ampLau-Walker, M.(2009). The relationship between nurses staffing and patient outcome:A case study. Journalof Nursing,46, 986-992.

Teng,C., Shyu, Y., Chiou, W., &ampFan, H. (2010). Interactive effects ofnurse-experienced time pressure and burnout on patient safety: Across-sectional survey. InternationalJournal of Nursing Studies,47, 1442-1450.

Tellez,M. (2012). Working Satisfaction among California Registered Nurses: ALongitudinal Comparative Analysis. NursingEconomic,30 (2), 73-81.