Reducing Nurse to Patient Ratio to Improve Outcome

Reducing Nurse to Patient Ratio to Improve Outcome

ReducingNurse to Patient Ratio to Improve Outcome

ReducingNurse to Patient Ratio to Improve Outcome

Therapid increase in the ratio of nurse-to-patient has become acontroversial issue in both developed and developing countries. Thehigh ratio of nurse-to-patient simply means that the number ofpatients is extremely high compared to the large number of patients.The high rate of nurse-to-patient can be attributed to the tendencyof hospitals to reduce the number of nurses in order to controlcosts, the lack of adequate number of experienced nurses in themarket, and assignment of administrative roles to registered nurses,which consumes most to the time that should be spent on patients(Hinno, Partanen, &ampVehvilainen-Julkunen, 2012).This paper willreview fifteen articles with the objective of identifying what isalready known as existing gaps in the body of knowledge about therelationship between patient outcome and nurse-to-patient ratio.

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.

Thecross sectional study conducted by Hinno, Partanen,&ampVehvilainen-Julkunen (2012) in the Netherlands and Finlandfocused on the determination of the relationship that exists betweennurse staffing and adverse events. Although the researchers hadselected a reasonable number of study participants (535 in Finlandand 334 in the Netherlands), the low rate of compliance limited thecapacity of the findings to give the clear reflection of therelationship between the nurse staffing and the treatment outcome(Hinno, Partanen, &ampVehvilainen-Julkunen, 2012).

Thefindings reported by Hinno, Partanen, &ampVehvilainen-Julkunen(2012) indicated a positive relationship between a high nurse-patientratio with high chances of adverse events, like in the case ofFinland. The findings reported in the article expand the body ofknowledge by informing the stakeholders about the significance of thenurse-client ratio.

Mark,B., Harless, D.W., Spetz, J., Reiter, K. L., &ampPink, G.H. (2013).California’s Minimum Nurse Staffing Legislation: Results from aNatural Experiment. HealthServices Research,48 (2), 435-454.

Thepurpose of the study conducted by Mark, Harless, Spetz, Reiter, &ampPink(2013) was to determine whether a reduction in the nurse-client ratioin California was commensurate with the rate at which quality of careimproved. The use of data from records kept by the governmentagencies reduced chances for biased findings. The decreasing in thenurse-client ratio in California had a mixed effect where hospitalrelated infections increased in some California hospitals than inhealth care facilities in other states in spite of the increase inthe staffing levels (Marketal., 2013).

Thesefindings are critical because they question the correctness of thegeneral perception that the quality of care is always affected by thelevel of staffing. The stakeholders in the health care sector shouldconsider the possible outcome of increasing the level of staffingsince there is no guarantee that such a decision will improve thequality of care.

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

Areview of the literature conducted by Shekelle (2013) aimed atdetermining the effect of increasing the nurse staffing level onmortality of hospitalized patients. The study involved a review of 15articles. However, the credibility of the findings was affected bylimitations (such as a low response rate) of the original articlesthat were reviewed.

Thefindings reported by Shekelle (2013) confirmed the existence of astrong relationship between decrease inpatient mortality and anincrease in the nurse staffing. Although the researcher did notreview any article focusing on the effect of intentionalintervention, the findings support the reduction of the nurse-clientratio, which is a reliable way of reducing mortality of hospitalizedpatients.

Chapman,S., Spets, J., Seago, J., Kaiser, J., Dower, C., &ampHerrera, C.(2009). How Have Mandated Nurse Staffing Ratio Affected Hospitals?Perspectives from California Hospitals Leaders. Journalof Healthcare Management,54, 321-355.

Theaim of the study Chapman, Spets, Seago, Kaiser, Dower &amp Herrera(2009) was to determine the effect of the mandatory legislationenacted in California requiring hospitals to maintain a givennurse-client ratio per care unit. However, the researcher interviewed23 leaders from different hospitals, while neglecting the opinions ofthe nurses on the impact of a low client-patient ratio.

Theresponses given by the hospital leaders indicated that increasing thenumber of registered nurses reduce workload and increase thesatisfaction of health care providers, which in turn enhance thequality of care (Chapman, 2009). The article supports the idea thathospitals should focus on reducing the nurse-client ratio, since thisis one of the most effective ways of enhancing the satisfaction ofthe health care providers and the therapeutic outcome.

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

Thelongitudinal comparative study conducted by Tellez (2012) aimed atdetermining the effect of implementing the mandatory nurse-clientratio laws in California on the satisfaction of registered nurses.However, the use of an unrepresentative sample in the study affectedthe credibility of the findings reported in this article.

Tellez(2012) identified that reducing the ratio of registered nurses to thenumber of clients improves the satisfaction of nurses, which reducesthe rate of their turnover. Consequently, hospitals are able toretain experiences registered nurses, who deliver quality services toclients. These findings can be used to advance the argument that aminimum nurse to client ratio is the way forward in increasing thestaff satisfaction and the treatment outcome.

DeMeester, K., Van Bogaert, P., Clarke, S., &ampBossaert, L. (2013).In-Hospital mortality after serious adverse events on medical andsurgical nursing units: a mixed methods study. Journalof Clinical Nursing,22, 2308-23117.

Aresearch conducted by De Meester, Van Bogaert, Clarke, &ampBossaert(2013)focused on the investigation of circumstances surroundingnursing care about eight hours before the occurrence of some adverseevents. The use of a mixed method allowed the researcher to offsetthe weaknesses of either a qualitative or a quantitative approach.

Thearticle revealed that nurses could hardly detect that the health ofthe clients was deteriorating. However, increasing nurse staffing canaddress this situation since there will be sufficient health careproviders to monitor the progress of each client (De Meester etal.,2009). The findings are relevant to the modern clinical practicebecause they emphasize on the significance of early detection ofdeteriorating health of hospitalized patients, which can be achievedin the presence of adequate number of health care providers.

Kaddourah,B., Khalidi, A., Abu-Shaheen, A. &ampAl-Tannir, M. (2013). Factorsimpacting job satisfaction among nurses from a tertiary care center.Journalof Clinical Nursing,3153-9.

Kaddourah,Khalidi, Abu-Shaheen, &ampAl-Tannir, (2013) aimed at assessing thesatisfaction of nurses and factors (including the work environmentand personal characteristics) that influence satisfaction. Althoughthe cross-sectional design (with a sample of 178 nurses) allowed theresearcher to minimize expenses and complete the research faster, itreduced their capacity to monitor trends over time as in the case ofa longitudinal study.

Theresearchers identified that about half of the nurses felt unsatisfiedwith the nurse-client ratio, which means that their ability todeliver quality care could be affected negatively (Kaddourah et al.,2013). These findings gave a significant implication in the nursingpracticebecause they inform that reducing the nurse-client ratiocan motivate nurses and enhance the quality of care.

Meyer,R., Wang, S., Li, X., Thomson, D., &amp O’Brien-Pallas, L. (2009).Evaluation of a patient care delivery model: Patient outcomes inacute cardiac care. Journalof Nursing Scholarship,41 (4), 399-410.

Thepurpose of the article published by Meyer, Wang, Li, Thomson &ampO’Brien-Pallas (2009) was to assess the influence that the workenvironment and nurse staffing has on the treatment outcome. Thedecision to use a correlational design that combined the elements ofa longitudinal and a cross-sectional design allowed the researchersto identify trends on the relationship between the patient outcomeand nurse staffing.

Meyer(et al., 2009) identified that patient outcomes are influenced bystaffing practices, in addition to the nurse and patientcharacteristics. The findings inform the stakeholders in the healthcare sector regarding the significance of adopting effective staffingpractices in order to enhance patient outcomes.

Knudson,L., (2013). Nursing staffing linked to patient outcomes, nurseretention. AORNJournal,97 (1).

Thearticle published by Knudson (2013) assessed the relationshipexisting between the nurse staffing level and nurse retention as wellas treatment outcome. The purpose of the article was achieved byreviewing other articles, which means that the author did not useempirical or statistical data to support the findings.

Thearticle contains significant information that links higher nursestaffing with a high retention or experienced nurses and an increasein patient outcome in spite of the weaknesses of the research designadopted by the author. The article has useful information thatinforms the management’s decisions regarding the significance ofmaintaining a reasonable number of nurses in the health carefacilities.

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

Thearticle published by Garretson (2004) evaluated the impact of a highnurse-client ratio in American health care facilities. However, theresearcher relied on literature review, which was subject to theweaknesses of the original articles, including the probability ofbias. Many health care facilities reduce the number of nurses withthe objective of containing the escalating cost of delivering healthcare.

Garretson(2004) identified that the decision to reduce the number of nursesincreases the workload of the remaining members of staff, whichreduces their morale, increase their rate of turnover, and reducesthe patient outcome. The article contains sufficient evidence thatcan be used to inform management’s decision regarding the intentionto reduce the staff levels as a method of controlling costs.

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.

Teng,Shyu, Chiou, &amp Fan (2010) conducted a cross-sectional study of458 nurses working in 90 different units with the objective ofassessing the relationship between the nursing burnout and timepressure. Time pressure and the burnout of nurse are associated witha low number of nurses compared to the number of patients, whichincreases the workload. The use of the cross-sectional study allowedthe researchers to complete the research in time and spend limitedresources.

Theregression analysis of the data collection by Teng, Shyu, Chiou, &ampFan (2010) indicated that time pressure cannot be significantlyassociated with a decline in the safety of patients, but itscombination with the nurse burnout had some interactive effect on thesafety of patients. These findings have profound implications becausethey inform the management about the possible negative impact of highnurse-client ratio on the safety of clients.

West,E., Mays, N., Rafferty, A., Rowan, K., &ampSanderson, C. (2009).Nursing resources and patient outcome in intensive care: A systematicreview of the Literature. InternationalJournal of Nursing Studies,47, 993-1011.

West,Mays, Rafferty, Rowan, &amp Sanderson (2009) evaluated the availableempirical evidence that establishes the association between nursingresources and safety as well as the outcome of treatment. Thisobjective was accomplished by reviewing literature, which impliesthat the credibility of the findings was limited by the weaknesses ofthe articles reviewed.

However,the researchers managed to identify that 15 of the articlesconsidered confirmed the relationship between the nursing resourcesand patient outcome (West etal.,2009). A decline in the nursing resources leads to adverse events anda decline in the quality of client outcome. The findings emphasize onthe significance of ensuring that each of the health care facilitieshas an adequate nurse resource.

Cimiotti,J., Aiken, L., Sloane, D.M., &ampWu, E. (2012). Nursing staffing,burnout, and Healthcare-associated infection. AmericanJournal of Infection Control,1, 486-490.

Cimiotti,Aiken, Sloane, &amp Wu, (2012). Evaluated the relationship betweenhospital-based infections and the patient-nurse ratio. The decisionto rely on the data from two professional agencies (includingAmerican Hospital Association Annual Survey and Pennsylvania HealthCare Cost Containment Council) enhanced the credibility of thefindings.

Cimiotti(etal.,2012) identified that the nurse-to-patient ratio was positivelyassociated with infections on the surgical sites and urinary tractinfections. These findings are crucial in the health care sectorbecause they provide a proof of the fact that addressing the issue ofstaff burnout through a decrease in the nurse-client ratio is aneffective method of enhancing the treatment outcome and safety ofhospitalized clients.

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.

Shuldham,Parkin, Firouzi, Roughton, &amp Lau-Walker (2009) evaluated therelationship that exists between characteristics nurse staffing(including nursing hours per staff) and treatment outcome. The mainvariables considered in the case study include patient falls,pressure scores, deep vein thrombosis, and upper bleeding ofgastrointestinal part of the body. Case study is a useful studydesign that collects more detailed information that could not beobtained when using other designs, such as a qualitative approach.

Thefindings of the case study indicated that there was a very weakassociation between most of the outcomes and nurse staffing. However,a higher ratio of permanent nurses was associated with better patientoutcomes compared to a higher proportion of temporary nurses. Thefindings provide a new dimension of the topic by indicating thatpatient outcome can be enhanced by increasing the number of nurses,but such a measure can be more effective if more permanent nurses arerecruited compared to temporary ones.

Dumpel,H. (2003). California’s new nurse to patient ratio law becomeseffective this January. NursingLaw,12, 1.

Dumpel(2003) evaluated the effectiveness of the new mandatorynurse-to-client ratio law enacted in California. The article wasbased on other publications, which denied the researcher theopportunity to find empirical evidence and apply statistics to makeconvincing conclusions.

However,the article provided useful guidelines on applicable nurse-to-patientratio in the state of California. The information documented in thearticle can help health care facilities in delivering quality care byreducing the nurse-to-patient ratio with the recommended ratio.

Conclusion

Theshortage of nurses is a global challenge that has continued to affectthe quality of health care. Thirteen out of fifteen research articlesreviewed in the present paper indicated that a high ratio ofnurses-to-patient reduce affect the patient outcome in a negativeway. The other two articles authored by Mark (etal.,2013) and Shuldham (et al., 2009) indicated that a highnurse-to-patient ratio has an effect on the patient outcome, but theimpact is weak or statistically insignificant. Therefore, it can beconcluded that all articles supported that the idea that the ratio ofnurses-to-patients is negatively correlated with the level of patientoutcome.

References

Chapman,S., Spets, J., Seago, J., Kaiser, J., Dower, C., &ampHerrera, C.(2009). How Have Mandated Nurse Staffing Ratio Affected Hospitals?Perspectives from California Hospitals Leaders. Journalof Healthcare Management,54, 321-355.

Cimiotti,J., Aiken, L., Sloane, D.M., &ampWu, E. (2012). Nursing staffing,burnout, and Health care-associated infection. AmericanJournal of Infection Control,1, 486-490.

DeMeester, K., Van Bogaert, P., Clarke, S., &amp Bossaert, L. (2013).In-Hospital mortality after serious adverse events on medical andsurgical nursing units: a mixed methods study. Journalof Clinical Nursing,22, 2308-23117.

Dumpel,H. (2003). California’s new nurse to patient ratio law becomeseffective this January. NursingLaw,12, 1.

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.

Kaddourah,B., Khalidi, A., Abu-Shaheen, A. &ampAl-Tannir, M. (2013). Factorsimpacting job satisfaction among nurses from a tertiary care center.Journalof Clinical Nursing,3153-9.

Knudson,L., (2013). Nursing staffing linked to patient outcomes, nurseretention. AORNJournal,97 (1).

Mark,B., Harless, D.W., Spetz, J., Reiter, K. L., &ampPink, G.H. (2013).California’s Minimum Nurse Staffing Legislation: Results from aNatural Experiment. HealthServices Research,48 (2), 435-454.

Meyer,R., Wang, S., Li, X., Thomson, D., &amp O’Brien-Pallas, L. (2009).Evaluation of a patient care delivery model: Patient outcomes inacute cardiac care. Journalof Nursing Scholarship,41 (4), 399-410.

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.

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

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.

West,E., Mays, N., Rafferty, A., Rowan, K., &ampSanderson, C. (2009).Nursing resources and patient outcome in intensive care: A systematicreview of the Literature. InternationalJournal of Nursing Studies,47, 993-1011.