Here is my term paper on an important professional nursing issue:
Staffing Ratios As A Professional Nursing Issue:
In today’s world, it is impossible to turn on the television and miss a lawsuit commercial. Even on public transportation, the amount of marketing for lawyers has risen. Many of the lawyer’s market lawsuits against healthcare professionals, whether it be for malpractice, adverse medication effects, or small medication errors that may have caused harm. This marketing seems appealing to the public because they think that they can win these lawsuits and gain monetary benefits, without considering the costs of filing for the lawsuit and lawyer costs. However, many lawyers market that the client would not have to pay lawyer fees unless the lawsuit is won, making this extremely appealing to the public. Nowadays, for healthcare providers, it is much easier to get sued for any care services provided, even years down the line. For nurses, this can mean losing their license. Many errors that the nurse may have committed could have been preventable mistakes that could have been avoided. Nurses are susceptible to many workplace stressors, poor work environments, nurse burnout, and unsafe staffing ratios. Patient acuity is also an important aspect to be considered when realizing the need for safe staffing ratios. Each patient has individual needs and levels of nursing care needed. Safe staffing ratios must account for these individual needs to not increase nurse burnout and/or workplace stressors. Today, nurse-to-patient ratios are much more important not only for the patient’s safety but for the nurse’s professional career as well.
In the nursing profession, there are nurse-to-patient ratios. These nurse to patient ratios consist of one nurse for x number of patients. If there are nursing shortages and no rules are put into place about safe nurse-to-patient ratios, patient safety is put at risk. This is because when a nurse has more patients than optimal, the nurse has an increased workload, thus increasing the potential for nurse burnout and stress. This allows for an increased chance of errors which then puts the patient at risk. This is the same when considering severity of illnesses. Different patients need different levels of nursing care and may need more time-consuming services. If there is not a safe nursing staff to patient ratio, the nurse may have an increased workload, increasing stress and burnout. There are many studies that suggest that nurse staffing is directly related to patient outcomes, thus enabling nurses to advocate for themselves and their patients by demanding safer staffing. Inadequate nurse staffing affects not only the patient, but their families, the nursing staff, the hospital staff, and the hospital or organization itself. This is an important professional nursing issue because it impacts patient safety and patient outcomes. There are many reasons that staffing ratios can become problematic, nursing shortages being one of them. There may be many reasons for nursing shortages. Reasons include: a rise in the demand of nurses, poor work environments, poor nurse retention, and much more. These shortages are important to address because with nursing shortages, requirements for staffing ratios would be difficult to meet. When a nurse calls out of work for the day, their patients would be split between the remaining nurses working that shift. With nursing shortages, it would be like one or multiple nurses call out at a time. This would then cause for the patients to be split up between the working nurses. This shortage puts more stress on the nurses as their workload increases. These unsafe staffing ratios caused by shortages, have severe consequences. Patient safety is put at risk the moment the nurse is overwhelmed with an increased workload. Nurses already encounter workplace stressors, but this increased workload puts the patient at risk, affecting patient safety and outcomes.
There is plenty of research proving that nurse staffing ratios are directly related to patient outcomes. For starters, nurse burnout is a factor that is related to patient outcomes. When nurses are burnt out, the possibility of errors increases, impacting both patient safety and patient outcomes. Nurse burnout is related with the number of hours worked and the workload given during work. Staffing ratios are related to nurse burnout, potentially increasing or decreasing the level of burnout depending on the ratio. Staffing ratio affects this because if there are too many patients per nurse, the workload for this nurse increases. The nurse will not only experience burnout much quicker, but stress levels will increase, and the nurse may feel rushed to finish duties, which leads to the occurrence of more preventable errors, and patient safety and outcomes is at risk. According to Knudson, hospital staffing levels have shown to be linked to nurse burnout and job dissatisfaction. This in turn means that ensuring optimal staffing levels will lead to decreases in burnout levels, an increase in patient satisfaction, and an increase in patient outcomes. (Knudson, 2013) Increasing staffing levels will allow nurses to have more time with their patients, decreasing preventable errors and improving patient outcomes and satisfaction. Higher nurse-to-patient ratios have been shown to increase nurse burnout. (Martin, 2015) However, inadequate staffing does not only affect nurses alone, but patients, their families, and the hospital in which they are employed at as well. (Martin, 2015) Safe nurse staffing ratios ensures that the safety of both the nurses and their patients are improved.
All nurses have a set of principles that they should follow. One of these principles is nonmaleficence, which means to do no harm. This is important because the main goal for nurses is to promote safety and to advocate for their patients. When the issue of nursing shortages arises, the nurse is given a higher workload that they must comply with. When nurses have more patients to care for than they can handle, they begin to look for time management strategies to reduce the amount of time spent on the noncritical duties. This in turn potentially increases the possibility of making errors to save time. With this increased possibility of errors being made, patient safety is at risk. This would not only risk the patient’s health and safety, but it also increases the possibility that the principle of nonmaleficence will not be met. According to Martin, safe staffing acts and the principle of nonmaleficence complement each other. (Martin, 2015) Safe staffing acts improves outcomes for nurses and patients alike.
Safe staffing ratios not only protects patient safety outcomes, it also decreases the risk of preventable hospital deaths. Not all errors lead to death, and not all errors do harm. However, this is not true in South Korea. Nurses in South Korean hospitals have twice the amount of patients than nurses in hospitals in the United States do. (Eunhee, et al., 2014) This fact alone puts patients at an immediate risk. Patient safety is at risk when there are high staffing ratios in the United States. The fact that South Korean nurses have twice that amount is a dangerous fact. In South Korea, nurse staffing is associated with patient mortality. This study suggests that the higher the patient-to-nurse ratio, the more workloads, the poorer the work environment and the fewer nurses may be responsible for many of the preventable hospital deaths in South Korea. (Eunhee, et al., 2014) To decrease patient mortality, the work environment in South Korea must be addressed and policies should be put in place to prevent deaths and increase patient safety. Improving nurse staffing, work environments, and increasing the number of nurses in these hospitals would surely serve as an important strategy to improve patient outcomes, safety, and quality of care.
A similar study done in California has shown similar results. California passed a nurse to patient staffing legislation and the study was conducted to see the success of this implementation. Although the nurse-to-patient ratios were not as drastic as those in South Korea, this study did provide adequate evidence based on the legislation. The purpose of the study was to explore the effects of the legislation passed on the working registered nurse populations. (Tellez & Seago, 2013) According to Tellez and Seago, the results they found were impressive. The findings showed an increase in work satisfaction after the minimum staffing law was implemented. In addition, this study found that for nurses to practice to the full extent of their training and education, the workplace must change and adapt to work with the minimum staffing law. (Tellez & Seago, 2013) As the nursing workforce ages, the number of nurses retiring will increase. This will increase the nursing shortages and this minimum staffing law will ensure that patient safety is not risked due to these shortages. To adapt, more nurses must be hired to meet the demand. According to this study, the minimum staffing requirements have increased workplace satisfaction in hospitals. (Tellez & Seago, 2013) This increased workplace satisfaction will increase patient outcomes, thus improving patient satisfaction as well.
Even people against nurse staffing acts agree that under unsafe practices, a ratio put into place makes sense because in this case they would be beneficial. (Buchan, 2014) However, all researchers believe that nurse staffing acts/requirements should be put in place. For example, many of them believe that when speaking about unsafe nurse-to-patient ratios, the question of what is safe and what is not safe arises. Determining a universal indicator of a safe nursing staff ratio is difficult because of the lack of research, evidence, and the differences between universal definitions and standards. (Buchan, 2014) Not only is there lack of agreement about a universal ratio, there are also worries about an increase in costs. If there is a certain nurse ratio and it cannot be met, more nurses would have to be hired. This would mean that there is a devaluation of the nursing profession with high opportunity costs. (Buerhaus, 1997) To supplement the nursing shortages, nurses must be hired, and this increases the costs of employment. To adjust for this, the government would have to be involved more than usual. This is problematic because government intrusion is not something the public enjoys, nor will they be content about this change. Instead, the public may view nurses as having the goal of keeping their jobs rather than their goal being to provide care for the public. (Buerhaus, 1997) For some people, fighting for nurse staffing acts may seem to have more negatives than it does benefits.
Staffing ratios should be implemented to keep patient safe. However, when considering the nurse to patient ratio, management must take patient acuity into account. Patient acuity changes the different levels of care that a patient may need. If patient acuity is not considered, patient safety may be risked even if safe nurse to patient ratios are implemented. If the severity of illness is high, staffing is a bit more difficult to plan for. Normally with safe nurse to patient ratios are planned/assigned, it is determined based on staff and patient census, rather than patient acuity and patient needs. (Dumpel, 2005) If patient acuity is not considered, the safe staffing ratios may not be effective in keeping patients safe. The main important thing to remember with safe staffing should be the needs of the patient. Safe staffing ratios allow for nurses to have enough time with each of their patients to provide the care needed, however, this can only be done when severity of illness is considered. All patients have an individual amount of nursing care they need, which is why it has been difficult to decide on a universal definition of a safe staffing ratio. (Dumpel, 2005) Safe staffing ratios should be more about patient numbers and census, but about patient needs and nursing care.
Although the different studies have different opinions on the benefits or consequences of nurse staffing ratios, it seems that the benefits outweigh the negatives. Many of the studies mentioned have had results that suggest that improving nurse staffing ratios would improve patient outcomes. All the studies agree that unsafe ratios increase the possibility of preventable patient mortality and in this case, a set ratio would be beneficial. Aside from those that disagree with it, the studies show promising results from having safer nurse-to-patient ratio. Having safe nurse staffing acts have shown an increase in workplace satisfaction, a decrease in nurse burnout, and an increase in patient safety and outcomes.
In conclusion, although a few researchers are against nurse staffing acts for cost-containment and political reasons, there is adequate evidence that suggests that nurse-to-patient ratio requirements should be put into place. Nursing shortages is a problem that will keep on evolving with time as more nurses begin to retire. As these shortages grow larger, so will the need for healthcare with the aging population. These shortages will impact nurse staffing in that there will not be enough nurses to fulfill safe nursing ratios. This in turn will lead to poorer outcomes with patients, while risking patient safety. Staffing ratios must be more than just numbers and they must be created and implemented according to patient acuity. Nurse staffing is an important professional nursing issue that must be addressed to promote and improve patient advocacy, outcomes, and safety.
Buchan, J. (2014). Getting staffing levels right. Nursing Standard, 28(49), 30. doi:10.7748/ns.28.49.30. s36
Buerhaus, P. (1997). What is the harm in imposing mandatory hospital nurse staffing regulations? Nursing Economic$, 15(2), 66-72.
Dumpel, H. (2005). The California Nursing Practice Act: safe staffing standards by scope, ratio, and acuity, part II (continued). California Nurse, 101(1), 20-27.
Eunhee, C., Sloane, D. M., Eun-Young, K., Sera, K., Miyoung, C., Il Young, Y., & … Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies, 52(2), 535-542. doi: 10.1016/j.ijnurstu.2014.08.006
Knudson, L. (2013). Nurse staffing levels linked to patient outcomes, nurse retention. AORN Journal, 97(1), C1-9.
Martin, C. J. (2015). The Effects of Nurse Staffing on Quality of Care. MEDSURG Nursing, 24(2), 4-6.
Tellez, M., & Ann Seago, J. (2013). California Nurse Staffing Law and RN Workforce Changes. Nursing Economic$, 31(1), 18-26.