I was an ICU nurse for 18 years and I decided to leave bedside nursing in 1999 when I found myself standing in the doorway between two patient's rooms, which both had alarms going off. I was being forced to care for three critical patients that night. I left nursing because as I stood in that doorway I realized that in choosing which room I was going to enter, the patient in the other room might very well have died (Massachusetts Nursing Association, 2004).
The nursing shortage and lack of staffing ratios have created long standing ethical dilemmas as they relate to patient care. Nurses are accountable and responsible for their own morals, decisions and behaviors. Nurses are accountable for judgments made and actions taken in the course of nursing practice, irrespective of healthcare organizations policies or providers' directives which may not always be in the best interest of the patient.
It is the legal and moral obligation of healthcare institutions to provide safe staffing levels so that nurses do not find themselves in unsafe conditions. The nurse code of ethics clearly identifies nurses as being morally bound to refuse unsafe assignments and working conditions. However, couple this with nurses who feel obligated to care for patients in their community and nurses who are fearful of making waves because of repercussions and you have set the stage for moral compromise.
Recent studies of those states and countries that have implemented these ratio practice standards have shown less nurse turnover, lower burnout, higher job satisfaction, higher quality of care [implicated by lower mortality rates], less complications and adverse events. In addition, it has been shown that fewer patients per nurse are associated with shorter length of stay and lower overall costs per discharge (Michigan Nurses Association).
The ethical issues implicating increased nurse-patient ratios more than out-ways the