Improving Patient Care and Safety through Patient-Nurse Ratios
Introduction
The quality of healthcare services and the quality of healthcare outcomes are greatly dependent upon staffing ratios. In acute care settings, for instance, nurses can get overwhelmed because patients in acute care settings usually require high levels of care. To minimize challenges that may arise from insufficient patient-nurse ratios, experts suggest that healthcare institutions should increase staffing ratios. This suggestion stems from the fact that inefficient staffing ratios result in health professionals being overworked, and it can also affect bedside reporting during handoffs, leading to medical errors. This essay describes a picot statement that relates to the improvement of patient care and safety through efficient nursing ratios.
PICOT Components
P, this component describes the focus population. In this case, the focus population is patients in a hospital.
I this component describes the interventions to increase patient safety: Increasing staffing ratios.
C This component describes the contrasting factors that could jeopardize the safety of patients in care settings: Insufficient staffing rations.
O This component describes the expected outcomes of care interventions, which is improved care and safety of patients.
T This component describes the time element, which, in this case, is the time when patients are hospitalized.
PICOT Question
How can sufficient staff-patient ratios (I) at the time of hospitalization (T) contribute to improved care and safety (O) of patients (P), as compared to when staff-patient ratios are insufficient (C)?
Importance of Sufficient Staffing Ratios
According to Aiken et al. (2002), the worsening situation of nurse shortening ratios calls for an investigation into how nurse shortage affects patient care and nurse retention. One of the areas that get affected by insufficient staffing ratios is collaboration and communication between providers. The quality care and safety of patients depends greatly on collaboration between providers and communication, especially during handoffs and bedside reporting. Patient handoff involves the essential transfer of information when care responsibility shifts from one provider to another. Bedside reporting, on the other hand, is a term used to describe the change of shift between oncoming providers and off going providers. During handoff and bedside reporting, providers must ensure that they transfer all the necessary information in order to facilitate continuity of care. Overworking nurses can affect their ability to communicate effectively, leading to communication breakdowns and medical errors. The reason for this is that during handoffs and bedside reporting, certain crucial information about the patient’s care is transferred to incoming providers. If communication is not clear enough or if certain crucial details are withheld, then the continuity of care is affected, and this is something that can result in medical errors. To increase the quality of care and care outcomes in care settings, therefore, nursing professionals must ensure that they effectively communicate all details pertaining to the health of patients under their care. However, they may not be able to do this if they are tired.
A number of factors mar the process of patient handoff and bedside reporting. When the number of nurses in a healthcare setting is not sufficient, the few available nurses are forced to do more work for longer periods of time. Sometimes, the few nurses become so overwhelmed that they avoid sickbeds. When this happens, even handoffs become affected, and incoming nurses may not be provided with all details about treatment plans, thus endangering the safety of patients, the quality of care, and the continuity of care. In other words, a collaboration between off-going nurses and incoming nurses becomes difficult because of insufficient staffing ratios, which lead to high exhaustion due to increased workloads. The risk of patients dying also increases when healthcare settings have insufficient patient-staff ratios. Health providers must, therefore, pay attention to the nurses’ work environment because it is also significant in ensuring they deliver the best services (Coetzee et al., 2013)
Implications for the Nursing Profession
Sufficient nurse-patient ratios are very critical in ensuring that the safety of patients is maximized. With good staffing ratios, medical errors are minimized, patient care is maximized, and nurses are able to achieve job satisfaction (Rahman & Shamsudin, 2015). On the other hand, insufficient patient-nurse ratios and inefficient bedside reporting during handoff can increase mortality rates. For these reasons, therefore, healthcare agencies must come up with strategies to minimize the number of patients that get hospitalized. When the Affordable care Act was signed into law, one of its main goals was to minimize hospitalization rates. Re-hospitalization is perceived to be a sign of the poor quality of patient care.
According to Needleman et al. (2002), with good ratios, healthcare services, and the safety of patients also increases because the presence of more nurses also means that the probability of adverse effects occurring is minimized. Some of the signs or indications of poor staffing ratios in healthcare institutions or facilities include increased fall rates among acute patients, increased re-hospitalization rates, high mortality rates, and high nurse turnover rates; these are also the adverse effects insufficient staffing ratios. On the other hand, the indicators of good or excellent staffing ratios include decreased medical errors, patient satisfaction, and decreased costs of medical services, high quality of healthcare services and outcomes, sufficient bedside reporting during patient handoff, among other advantages of benefits. To maximize benefits and minimize bad effects, therefore, healthcare institutions must work on increasing their nurse ratios.
The vigilance of nurses is very important in ensuring the safety of patients by the bedside. Therefore, assigning more and more work to already strained nurses compromises their ability to deliver quality and safe care. When the number of patients assigned to nurses increases, the safety of patients is also put at risk. The reason for this is that overworked nurses are at risk of being stressed and burned-out, factors that often result in a medical mistake. Hospitals and other health providers must, therefore, hire more nurses instead of overworking the few nurses they have in the hope that they will save on costs. Hiring more nurses is even less costly in the long run because it leads to reduced errors, satisfied nurses, low nurse turnovers, satisfied patients, among other factors (Aiken et al., 2012). But when the opposite of this is true, health providers risk losing public trust.
Conclusion
The purpose of this essay was to analyze a PICOT statement related to the improvement of patient care in care settings. As explained, staffing ratios play a significant role in ensuring the quality of healthcare services and the quality of care that patients receive. When a healthcare facility has enough staffing ratios, its benefits are many, ranging from improved quality of care, satisfied patients and nurses, reduced errors in healthcare, low mortality rates, among others. The consequences of having insufficient staffing rations, on the other hand, include high nurse turnover, poor care, poor collaboration between providers, etc. to maximize benefits and to minimize risks. Therefore, health institutions and facilities must consider increasing their staffing ratios instead of overworking their already strained care providers. Doing this will ensure that nurses have time to rest and take care of themselves and, in the process, be more vigilant by the bedside. Instead of assigning more patients to nurses, health providers should consider increasing their ratios to enhance efficiency. The move might be costly, but it will eventually pay off.
References
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993.
Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., … & Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. Bmj, 344, e1717.
Coetzee, S. K., Klopper, H. C., Ellis, S. M., & Aiken, L. H. (2013). A tale of two systems—Nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: A questionnaire survey. International journal of nursing studies, 50(2), 162-173.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346(22), 1715-1722.
Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: a cross-sectional study. Asian Social Science, 11(9), 326.
