Thesis on "Nurse to Patient Ratio"

Quoted Instructions for "Nurse to Patient Ratio" Assignment:

The focus of this assignment is specific to CHANGE THEORY, SYSTEMS THEORY AND BUILDING COMMUNITY PARTNERSHIPS.

Be concise, precise and write to the point of the assignment.

Address the following key issues:

Discussion Possible Points

Refine your statement to leadership to be clear and concise, providing facts and figures to support your proposed change

Identify potential allies in planning the proposed change. Who are they and how can they assist you in making this possible?



Where are key points of resistance within and outside the system? Why would there be resistance? Utilize systems theory in describing the role that groups and individuals would play in the process.

Elaborate on potential negatives that individuals or groups might bring up in discussions and how you would counteract this.



Based on change theory, how long do you anticipate that it would take to socialize the idea, propose the specific change, and initiate implementation?

Please see below information for source

Healthcare systems are stressed by limited resources and increasing demands on their services. Nurses, as the largest group of healthcare professionals, have experienced significant changes in their work life and environment as systems have tried to meet these challenges. As workloads become more substantial because of cutbacks and the number of nurses per patient diminishes, patients and healthcare workers are put increasingly at risk.

I would like the opportunity to make a statement to leadership regarding the Nurse patient ratio dilemma we are facing in our organization. According to the Massachusetts Nurses Association in a research study by federal Agency for Healthcare Research and Quality shows that patients do better with lower nurse to patient ratios. The research study found in given hospital unit the optimal workload for a nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission. A workload of 8 patients versus 4 was associated with a 31% increase in mortality. I have not been able to find any studies related to the effects of the nurse to patient ratio in a dialysis clinic.

Reducing the nurse patient ratio would set a safety net for patients and nurses. It would provide a safer environment for patients because there would be more staffing available for each patient. Patient can feel more confident that their needs are being met by the medical staff and the nurse will have fewer distractions. According to International Council of Nurses, California has set mandatory upwardly adjustable minimum nurse patient ratios. An example of this shows staffing for a medial surgical ward on day shift would be four patients for each Register Nurse. According to the International Council of Nurses improvements reported since the implementation of the ratios include more than 3000 extra nurses employed in hospitals, decreased staff turnover and absenteeism, and public approval of the State government has increased. This would also be incentives for nurses to work in the field of dialysis. It would have an impact on patient outcomes and on nurse retention and recruitment. I feel, as a nurse, that working in a safe environment for patients and staff is of the upmost importance. Nurses have dialysis technicians to rely on, but they are only able to rely on them to maintain equipment and alert her if a change in the patient occurs. The majority of responsibility for patient care falls on the Register nurse.

My strongest allies in the fight to change the nurse to patient ratio include dialysis nurses, patients, and the dialysis technicians. The majority of nurses that work in dialysis feel strongly about this issue. The nurses feel overworked and stressed due to the nurse patient ratio. The care and safety of ten patients fall upon one Register Nurse which puts a great deal of pressure on them. The register nurse is responsible for pre and post treatment physical assessments of all patients, giving all medications, supervision of the technicians, operating kidney dialysis machines, initiating, monitoring, and discontinuing dialysis treatments, assisting physicians on rounds, calling in prescriptions, making doctor*****s appointments for patients, assisting patients with transportation issues, patient education, and writing physician orders. Patients also feel the effects and some have voiced to me their concerns. They feel their lives are in jeopardy due to the nurse being over extended between patients. Dialysis technicians also experience the effects because it requires them to take on more responsibility for patient care. Many of the technicians have no formal medical training and have a limited knowledge of patient care.

Nurses, patients, and technicians can help elevate this problem by joining together in a united front to voice their concerns and demand a change be made. No one group alone can make a difference but together new policies can be implemented and enforced. Also contacting the Nurse Association and asking them for help in the situation would be a great benefit. According to their website the ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public. ANA is the voice of nursing. This voice is heard through policy development, lobbying, publications/newsletters, involvement and partnerships with other organizations, and its presence on the Internet. ANA*****s work addresses the needs of nurses in their professional settings as well as patient care. The ANA involvement in this national issue is critical.

Change is always difficult and resistance is to be expected. One of the barriers to changing the ratios is the continuing nursing shortage that we are experiencing. The Bureau

of Health Professions predicts that the current shortage of 150,000 nurses nationwide

will by 2020 grow to 800,000 nurses the area hospitals are continually recruiting for nurses. Most of the hospitals offer between $5000.00 to $10,000.00 sign on bonus for a one year commitment. Dialysis organizations would be the main opponent to the change due to the cost. Dialysis units are smaller and without the financial resources the major hospitals have. The increased cost would place a greater burden on the clinics which have a limited budget each year. It is estimated by the American Hospital Association the projected cost to change the nurse to patient ratio would be around $270 million dollars.

The organization would play a key role proposed changed. The dialysis organization would have to change their views toward nurse patient ratio. The company would also have to find money in the budget to allow for a change. This would cause an increase in cost to patients as well. I believe patients would agree to the increase if it would guarantee them higher quality of care. Nurses may also be willing to take a small decrease in pay to help facilitate the change. Dialysis nurses receive some of the best pay rates that I personally found. I make more money working in a dialysis clinic than in the hospital. In order for the change to occur I believe that all parties involve must be willing compromise. We are all part of the same system of healthcare.

The cost of such a change would be the main negative of such a proposed plan. A majority of the cost would be passed on to the patient*****s insurance company. Many of the patients receive Medicaid or Medicare which means the increase cost would fall on the tax payers. My main point to counteract this position is that patient safety must be our first and foremost priority. Although we may spend more money to begin with for more nursing staff patient outcomes would offset the expense. Patients that have better outcomes from dialysis treatments spend less time in the hospital. When patients are in the hospital we do not get paid for their treatments. Hospital stays cost the company a loss of revenue.

Unfreezing the organizations ideas on nurse patient ratio will take a great deal of time and effort. It would take at least two to three years to socialize the idea with all the dialysis organizations and put together a proposal for the specific changes. It would take another year to initiate implementation. Major changes never occur overnight and must be thought out and planned thoroughly before implementing.

References

American Hospital Association, Commission on Workforce for Hospitals and Health Systems. In our hands: how hospital leaders can build a thriving workforce. May 2007 retrieved Oct 6, 2008 from www.aha.org

The Patient Safety Act" is The Key to Protecting Your Patients and Your Nursing Practice, 2007 retrieved Oct 6, 2008 from http://www.massnurses.org,

International Council of Nurses Press Release retrieved Oct 8, 2008 from http://www.icn.ch/PR23_02.htm

The American Nurses Association retrieved Oct 9, 2008http://www.nursingworld.org/