Nurse-patient Ratio and Patient Safety Outcome
Evidence-based practice guidelines are consistently fostering delivery of quality, cost-effective, and competent care to patients in the health care industry. In a bid to formulate the best evidence-based guidelines for implementation in clinical practice, stakeholders have a critical role in identifying a clear correlation between a clinical problem and the associated outcomes. Establishing and incorporating the best evidence into practice is often initiated by identifying questions that guide initiatives. This paper aims to identify and introduce a conspicuous practice-related issue in my health care practice setting, its significance, and the rationale of addressing the problem using scholarly articles. Additionally, it will include a PICOT statement with a discussion of its elements.
Practice-Related Issue
Staffing is an essential element of any organizational consideration of the levels of human resources required for input that impact the delivery of quality services. In the healthcare sector, the number of nurses matters a lot to the quality of services clients receive. According to the University of New Mexico (2016), nurses spend most of the time closer to patients when providing primary care than other professionals in the hospital. Nurse-patient ratios/ nursing staffing is an issue that has spiked heightened debates in the international health platform because of its direct impact on the quality of care and safety patients. Understaffing of nurses is one of the most significant contemporary challenges facing nursing in the world of health care (Catalano, 2019). The United States has, over a long time now, experienced a shortage in healthcare providers, especially nursing shortages (Thakkar, 2019). In my health care practice setting, the nurse to patient ratios is high, averaging 1: 8 in the inpatient units.
Efforts to ensure the delivery of quality and seamless care to clients seeking healthcare services should include soughing out nurse staffing by relevant authorities. The latter is because the quality of healthcare services relies on the numbers and level of specialization of the health care providers, notably registered nurses.
Significance of the Issue
Cho, Sloane, Kim, et al., argued that considering the proportionality of the number of nurses in hospital set-ups directly influence the quality of care patients receive (2015). The researchers conclude that there is an association of high nurse/patient ratios to increased patient mortality. Nonetheless, nurse-patient ratios do not only impact patient outcomes but also the welfare of nurses. A study published by Gutsan, Patton, Willis, & Coustasse-Hencke provides a backdrop on the increased complaints by registered nurses in the United States concerning burnout. The burnout syndrome is claimed to have risen by about 60% to 70% recently across the U.S. The study also highlighted that high nurse-patient ratios contributed to increased mistakes and a surge in incidences of malpractice apart from mental exhaustion and high-stress levels. In California state, for example, a law was passed on the recommended registered nurse/patient ration of 1:4. The policy reduced nurse staff turnover and influenced high rates of job satisfaction.
Besides, organizational features related to nursing, such as better staffing ratios and nurse work environment, are linked to reduced readmission rates. Literature from a cross-sectional study on the quality of hospital work environments and missed nursing care and the link to heart failure readmissions indicate that nursing care omissions leading to poor patient outcomes get attributed to inadequate staffing (Carthon, Lasater, Sloane & Kutney-Lee, 2015). Also, when nurses cared for lesser patients, few elements of care were missed and improved outcomes (J.M. et al., 2020). Poor patient outcomes, poor patient experiences of care, and increased readmission rates translate to penalties imposed to hospitals by the Centers for Medicare and Medicaid Services (CMS). Reimbursement rates to health care facilities and physicians decrease, and insurers such as Medicare refuse to pay for such services. Increasing financial resources for the procurement of adequate nurses gets associated with reduced CMS readmission penalties and that the return offsets such investment costs in savings due to reduced readmissions.
According to Burns, Grove & Gray (2015), efforts geared towards changing the number of nurses to accommodate the number of patients in health care settings will ultimately improve patient outcomes, including reduced medication errors and patient falls. Martin asserts that low or inadequate levels of hospital staffing of registered nurses translate to adverse patient outcomes, including increased morbidities, high mortality rates, increased readmission rates, and increased cases of nosocomial infections (2015). A quantitative study done to assess the impact of heavy perceived nurse workloads on patient and nurse outcomes got conducted among acute nurses from British Colombia, Canada. (MacPhee, Dahinten, & Havaei, 2017). Results indicated that nurses have heavy workloads that prompt leaving essential tasks undone, leading to adverse patient and nurse outcomes, medical errors, UTIs, patient mortality, and poor emotional and job satisfaction.
Discussion of PICOT Elements
P- High nurse to patient ratios leading to the increased link of missed care opportunities for nurses. Such gets linked to adverse patient outcomes and poor emotional effect and low job satisfaction among nurses.
I-Advocating for the implementation of low nurse-patient ratios of 1:4 through policies for hospitals to reduce heavy workloads, improve working environments for nurses.
C– the implementation and adherence of nurse/patient staffing ratios of a minimum of 1:4 versus the current high nurse-patient ratios in my health care facility and globally.
O– to improve the quality and safety of care provided to patients and improving job satisfaction and retention of nurses in health care settings.
T-Timeframe of 60 days after the project implementation. The period is essential in measuring patient outcome measures such as measuring readmission rates, mortality rates, nosocomial infections, and patient satisfaction.
PICOT Question
PICOT Question: In patients receiving inpatient healthcare, what are the effects of implementing lower nurse to patient ratios of 1: 4 on quality of care and safety, job satisfaction, and nurse retention compared to high nurse to patient ratios of 1:8 within 60 days?
P-High nurse to patient ratios of above 1: 4 and its impact on patients and nurses
I-Implementation of policies for the lower nurse to patient ratios of 1:4
C- As compared to the high nurse-patient ratios of 1:8
O- Improved quality and safety of care to patients and improving job satisfaction and retention of nurses
T- Within 60 days.
References
Burns, N., Grove, S. K., & Gray, J. (2015). Understanding nursing research: Building an evidence-based practice. Missouri: Elsevier
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of U.S. hospitals. BMJ Quality & Safety, 24(4), 255–263. https://doi.org/10.1136/bmjqs-2014-003346
Catalano, J. T. (2019). Nursing Now: Today’s Issues, Tomorrows Trends. FA Davis.
Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, I. Y., … & Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: an observational study. International journal of nursing studies, 52(2), 535-542.
Gutsan, M. S. H. A., Patton, J., & Willis, W. K. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace
J.M., B. C., Hatfield, L., Brom, H., Houton, M., Kelly-Hellyer, E., Schlak, A., & Aiken, L. H. (2020). System-Level Improvements in Work Environments Lead to Lower Nurse Burnout and Higher Patient Satisfaction. Journal of Nursing Care Quality.
MacPhee, M., Dahinten, V. S., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 7.
Martin, C. J. (2015). The effects of nurse staffing on quality of care. MedSurg Nursing, 24(2), S4-S4.
Thakkar, A. (2019). Examining the Demand for Higher Education Nursing in Relation to the Nursing Shortage.
The University of New Mexico. (2016, October 14). Nurses Are the Future of Healthcare. https://rnbsnonline.unm.edu/articles/nurses-are-the-future-of-healthcare.aspx.