Nurse-to-Patient Ratios and Effects on Healthcare
Introduction
A nurse-patient ratio is the number of patients a nurse can care for at a given time. The phenomenon depends on several factors, such as the disease’s severity, the nurse’s skills, and the availability of other support staff. There is a variation in the number of patients assigned to a certain nurse, and the ratio depends on the underlying factors. A nurse can be guided by regulations that suggest or guide the ratio parameters, such as reduction of staff and overhead costs, whereby a clinical provision operates at a lower rate.
Staffing is essential for nurses because they are responsible when offering care for patients since doctors and doctors may not be fully available to offer the same (McHugh et al., 2021). For example, a nurse who works in an intensive care unit (ICU) may be allocated two patients, whereby the ratio becomes 1:2. On the other hand, a nurse working in other units may be allocated between four and five patients (McHugh et al., 2021). The minimum nurse-patient ratio varies, but according to the California Nurses Association (CNA), nursing facilities should have a ratio of one registered nurse per three patients (Samuel, 2022). Figure 1 below suggests the proposed federal registered nurse-patient ratio.
Effects of Nurse-patient Ratio on Overall Healthcare to Patients
Improved or Limited Patient Care
When sufficient numbers of nurses take care of patients, the patient may recover from their ailments. However, for the patient to survive, the nurse must follow hospital-mandated patient-nurse ratios. According to the Agency for Healthcare Research and Quality (AHRQ), there is a compatibility and link between nurse staffing ratios and care success. AHRQ’s website says, “It is logical, therefore, that assigning increasing numbers of patients eventually compromises nurses’ ability to provide safe care. Several seminal studies have demonstrated the link between nurse staffing ratios and patient safety” (Heath, 2019 par. 7).
That means if there is a low number of nurses attending to a given set of patients, there shall be an increased risk of patient morbidity and mortality. The entire matter is influenced by the shift time, the understanding of hospitalized individuals, and other environmental factors. Hospitals must consider patient traffic times using forecast analytics to properly address the nurse-patient ratios. When that is done, there is a guarantee of improved patient care and vice versa. Hence, tangible progress in terms of the delivery of clinical services in society.
If a specific number determines nurse-patient ratios, there is a risk of limited patient care access. Therefore, patients will have consequences that may affect their performance levels in care provision. Research by Health (2019) suggested that mandatory nursing ratios may hurt hospitals’ financial implications, limiting concrete patient care delivery. Its report indicates that a one-size-fits-all statewide implementation will be a costly and poor allocation of resources, leading to greater inequality in the provision of care, less local access to healthcare, and reduced patient choice” (Heath, 2019 par. 12). Thus, hospitals may be probed to hire less-experienced nurses, and that puts clinical service quality in dire straits. In this case, patient care is limited in that decreased nurse staffing may lead to a negative outcome of the hospitalization. That constraint may affect the way medical delivery is undertaken.
In-hospital Mortality
Nurse-to-patient ratios determine the patient outcome, mostly defined by the in-hospital mortality rate. That means the number of patients who die during admission in a care facility or the hands of a registered nurse. Driscoll et al (2017) study determined the effect of nurse-to-patient ratio on patient outcome. Their research was to find the way forward on nurses providing high-quality care to patients. The study involved a meta-analysis comprising 175755 patients from six studies admitted into the ICU (Driscoll et al., 2017). From the report, Driscoll et al. (2017) found that high nurse staffing levels decreased the risk of deaths that occur while one is hospitalized.
From their study, there was a decrease of about 14% in terms of mortality rates with high heterogeneity (Driscoll et al., 2017). Although it is hard to determine the optimal ratio required, patient mortality is affected by the number of nurses who attend to a given set of patients (Driscoll et al., 2017). Therefore, if a hospital stabilizes its Nurse-patient ratios (NPRs), it is guaranteed to decrease the risks of mortality while a patient is admitted.
The measure of in-hospital deaths is key when determining the number of nurses deployed to care for hospitalized individuals. There is a statistically significant link regarding ratios between registered nurses and in-patient mortality. According to Zaranko et al. (2017), an extra 12-hour shift by a registered nurse is associated with reduced odds of patients’ death by 9.6%. Their study brings the aspect of empirical observations since the authors researched approximately 4400 nurses’ information (Zaranko et al., 2017).
As seen in Figure 2 below, the data provided details on patient demographics and discharge status, which measure the impact of staffing ratios for nurses in hospitals. The study found that teams that filled a low rate of rostered registered nurse hours observed a significant patient death than those with a high staffing ratio (Zaranko et al., 2017). Their study also checked on the seniority levels of the nurses, whereby senior personnel was linked with twice the effect on lowering the chances of patient mortality (Zaranko et al., 2017). Therefore, that is evidence-based research that shows the effect of NPRs specifically leaning on patients’ mortality rate in a clinical context.
Reduced Length of Stay and Readmissions
The ration policy in a given healthcare firm can impact the number of days a patient is admitted and the readmission rate for the same problem. Nursing ratios impact the patient as far as the two elements above are concerned. For instance, the length of stay (LOS) decreases when patients are assigned enough care professionals. With an intervention based on the number of patients a given hospital has, even readmissions will go lower compared to where there are staffing problems (McHugh et al., 2021). The costs that come with readmissions to both the hospital and the patient are lowered hence, becoming an improvement which means the NPRs must be checked well. The minimum nurse-patient ratios should be set but with a feasible approach that intends to improve the matter so that patients can be satisfied and clinical provision is relevant for that matter.
Effects of Nurse-patient Ratio on Overall Healthcare to Nurses
Nurses Workloads
There is a causal association between NPRs and the nurses’ outcomes. When there is a low staffing ratio, nurses will be affected by huge workloads that limit the quality offer of medical care (Heath, 2019). If a nurse is overloaded in terms of the duties that they have to perform, there is a risk of developing mental issues which affect the overall care provision as the patient is affected as well. Having a wide array of tasks to perform for many ailing persons in a clinical facility may lead to erroneous implications, meaning nurses may find themselves holding personal or group work-related liabilities (Heath, 2019). There is a possibility of operational success where nurses are assigned a manageable number of patients to care for, meaning that they will not experience interruptions due to piled workload when working.
Long shifts and overtime for nurses are linked with high risk of error. A double shift nurse may be criminally prosecuted if an error is committed. Phillips et al. (2021), in their study on nursing and patient safety, found that medication errors are three times more likely to occur when a nurse is overworked for a shift that is more than 12 hours in a back-to-back context. In this case, fatigue is the key matter that leads to the intention where a nurse may have poor judgment, which results in medical mistakes due to huge workloads. Therefore, for this problem to be combatted, there is a requirement that nurses should be well-staffed so that they do not become second victims of a clinical error (Phillips, et al., 2021).
It is essential to have a balanced NPRs because while on duty, nurses come across many disruptive behaviors by physicians and other working colleagues, meaning that they are exposed to burnout if overloaded with work. If the nursing ratio is high, there is no risk of making errors since the workload can be managed without work-based constraints.
Nursing Care
An omission that occurs when the right action is not taken or delayed is known as missed nursing care. This phenomenon is evident when there are many patients per nurse at a given time. Omission of care may also be associated with nurses’ absenteeism, whereby team stability is affected because there are no definite plans to cover the spaces left when a nurse is off or on leave, as seen in Figure 3 below (Thériault et al., 2019). Therefore, NPRs impact how nurses deliver their clinical duties to patients, which is a measure of how competent a healthcare provider is in clinical services. When the nurse-to-patient ratio is balanced, there is a low likelihood of missed nursing care, and there are predictors of success in treating patients in a given firm.
Nursing care is a predominant issue structurally prioritized to avoid medical challenges in a clinic. There is a need to have strong process measures that focus on standardized care improvement such as reduced pressure on work which is influenced by the ratio of nurse to the patient (Thériault et al., 2019). One way to boost this matter is for a hospital to have acquired procedures that keep nurses engaged every time as the management waits to increase nursing staff where there are high levels of patient traffic.
Conclusion
Nurse-patient ratios (NPRs) are the number of patients a nurse is expected to give care to at a time. This element is crucial for both patient and nurse outcomes regarding overall healthcare. NPR’s are affected by various factors, such as the extent to which the patient is suffering from a given ailment, the education and skills of a nurse, and the support team available for a given care. Nurse-to-patient ratio affects healthcare in various ways.
First, patient care is influenced by how a hospital deploys its nursing staff. A patient will likely have high-quality care if the nurses caring for them do not have huge workloads. There can be improved or limited care access for patients depending on the number of nurses who give care per head. Second, the rate of in-patient mortality is affected by NPR. If nurses have many patients to care for, there is a high chance that the mortality rate may go high and vice versa.
This essay has found that where there is a low nursing staff, patients may risk losing their lives under critical care. Additionally, the LOS and readmissions are impacted by NPRs. If a nurse is given about 2 or 3 patients to care for, they will likely stay within the expected period, depending on their problems. Similarly, a well-combined NPR ensures readmissions are lowered so that the cost for patients and hospitals are reduced. The nurse-to-patient ratio affects the nursing staff whereby workload affects the performance of nurses. An overloaded nurse may make medical mistakes that put them into a personal liability.
Few errors are expected if a hospital deploys a sufficient number of staff because the workload is manageable. Furthermore, nurse care is affected by NPR where there is the likelihood that if healthcare is understaffed, various tasks may be omitted while caring for patients. It is high time that healthcare institutions determine the minimum ratio of nurses to the patient to deliver quality clinical services.
References
Phillips, J., Malliaris, A., & Bakerjian, D. (2021). Nursing and patient safety. Patient Safety Network. Web.
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2017). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6–22. Web.
Heath, S. (2019). How nurse staffing ratios impact patient safety and access to care. Patient Engagement. Web.
McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. The Lancet, 397(10288), 1905–1913. Web.
Samuel. (2022). The nurse-to-patient ratio. Excel. Web.
Thériault, M., Dubois, C. A., Borgès da Silva, R., & Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing Open, 6(3), 1218–1229. Web.
Zaranko, B., Sanford, N., Kelly, E., Rafferty, A., Bird, J., Mercuri, L., Sigsworth, J., Wells, M., & Propper, C. (2017). Nurse staffing and in-patient mortality in the English National Health Service: a retrospective longitudinal study. BMJ. Web.