Safe Nurse to Patient Ratios

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Finding Safe Nurse to Patient Ratios
Augsburg College

Abstract
Determining nurse-to-patient ratios in nursing facilities remains a challenge for the nursing profession. Two main staffing methods that are currently used in most nursing facilities are staffing by patient acuity using patient classification systems and staffing by mandated nurse-to-patient rations. Each method has an impact on patient outcomes, safety and overall satisfaction determined from different articles and studies done on each staffing method. There are pros and cons to each staffing methods. Nursing facilities look at many of these pros and cons when determining staffing methods that are used, cost, patient outcomes, nursing satisfaction and safety. Staffing is a big issue in nursing, if left unresolved can have major consequences for patients and nursing staff.

Keywords: Acuity, mandated nurse-to-patient ratios

Finding Safe Nurse to Patient Ratios
Currently there is no set approach used to determine how to decide nurse-to-patients ratios in health care. The two most common staffing methods used are staffing based on patient acuity and mandated nurse-to-patient ratios. The debate over how to best decide nurse-to-patient staffing ratios has been an ongoing issue. ANA President Barbara Blakeney(2012) stated “Inappropriate nurse staffing is the number one concern of nurses today. More than a decade of research has shown that RNs make the quality difference in patient care and that when RN care is insufficient, patient safety is compromised and the risk of death is increased” (p.1). Patient outcomes, nursing staff satisfaction, and cost are all things considered when evaluating the outcomes of the different staffing methods. There have been on going studies into the effects of both staffing methods on patient care. Research needs to continue to find a safe way to staff nursing facilities. Staffing by nurse-to-patient ratios or by patient acuity have pros and cons, making a combination of the two approaches a possible solution.

Mandated nurse-to-patient ratios are a mandated number of patients that a nurse can have at one time. These mandated numbers are determined by the state, in some cases, or by the hospital administration. Mandated nurse-to-patient ratios have shown to improve patient outcomes in many studies. However, no research has shown the optimal nurse-to-patient ratio; therefore, the mandated nurse-to-patient ratio can vary depending on location or specialty. For example, California has over 17 different mandated staffing levels in the different areas of nursing across their many nursing facilities (Coffman, 2012). Many people are in support of moving towards mandated nurse-to-patient ratios in all health care facilities. Duffin (2012) said, “Florence Nightingale Foundation trustee, Elaine Maxwell believes mandatory nurse-to-patient ratios should be enshrined in law” (p.4). Mandatory nurse-to-patient ratios may sound like the answer to the nursing staffing issue but along with the pros, there are cons to this method of staffing.

Mandated nurse-to-patient ratios has many positive aspects. Mandatory nurse-to-patient ratios limit the number of patients that a nurse is responsible for reducing stress on that nurse and improving patient outcomes. Aiken, L H., Busse, R., McKee M., Kuntney-Lee, A., Sloane, D., Sermeus, W.,…& Van den Heede, K. (2012) stated, “ Adequate nurse to patient ratios are associated with decreased nurse burnout and improved patient outcomes including mortality and patient satisfaction, a research study across Europe and the United States shows” (p.19). Clendon also is for lower nurse-to-patient ratios, she stated “The higher the number of patients per nurse, the greater the death rate, the higher the burnout rate, and greater the job dissatisfaction or nurses” (p.23). Jill Clendon explained all these factors, increased death rate, higher burnout rates and job...
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