Term Paper on "Nurse to Patient Ratios Is it Important"

Term Paper 5 pages (1450 words) Sources: 20 Style: APA

[EXCERPT] . . . .

Nurse-to-Patient Ratios: Is it Important?

The climate and role of the acute care nurse has drastically changed over the last three decades. The rising costs of healthcare and diminishing coverage and reimbursements from health insurance carriers have prompted acute care facilities to cut costs and modify procedures to remain profitable and competitive. The largest expense of any for-profit organization is payroll. Unfortunately, staff reductions are typically included in cost cutting efforts by management. Nursing staff levels are often impacted the most in hospitals trying to decrease costs. Hospitals have reduced inpatient admissions to the most critical patients. Shorter lengths of stay and fewer complications after surgeries are attributable to improvements in surgical procedures and technology. These factors lead to higher concentrations of patients requiring acute care.

Introduction:

Nurse-to-patient ratios refers to the number of patients each nurse has to care for. A history of nurse staffing and patient outcomes dates as far back as a study by Moses and Mosteller (1968).

They found nurse staffing among the significant determinants of mortality (as cited in Aiken, 2005). Later, publicly available Medicare data for U.S. hospitals generated more studies on the factors related to mortality. (Shortell & Hughes, 1988; Hartz, Krakauer, & Kuhn 1989; Silber, Kennedy, & Even-Shoshan, 2000). Authors of these studies reported that nurse staffing was significantly related to mortality (as cited in Aiken, 2005). Aiken, Clarke, Sloane, Sochalski, and Silber (2002b) produced the first study to specifically quantify the impact of nurse-to-patient ratios on death rates.

Minimum staffing ratios represent the minimal amount of nurses required to care for the maximum number of patients, without compromising patient or nurse safety. Both the public and physicians rank nurse understaffing of hospitals as one of the most serious threats to patient safety (Blendon, DesRoches & Brodie, 2002). Patient safety experts are concerned whether or not inappropriate ratios lead to higher mortality rates and a variety of complications and adverse effects as well as higher patient stays at hospitals. Nurse safety advocates are beginning to question if there is an appropriate number of each type of staff member within a healthcare facility, and, if there isn't how does it impact job satisfaction and the ability of nursing staff to have adequate multidisciplinary interaction to improve quality of care.

One suggested solution to ensure safe and effective nurse staffing has been to mandate nurse staffing ratios. Currently, California has minimum nurse-to-patient ratios resulting from the passage of AB 394 in the states legislator which went into effect in 2004 (Spetz, 2004). However, California is the only state to do so, calling to question whether other states or the federal government ought to follow suit.

Quality of Care / Patient Safety

More than one-third of practicing physicians and 40% of the public say either they or a family member have experienced a medical error and 53% of the physicians and 65% of the public believe nurse understaffing is a factor in these errors (Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard School of Public Health, 2004). Results of a Harris Poll revealed that more than half ofAmericans believe the quality of health care that people receive is affected "a great deal" by a shortage of nurses (Harris Poll, 1999).

Aiken, Clarke, Sloane, Sochalski, and Silber (2002b) estimated that 20,000 people die each year because they have checked into a hospital with overworked nurses. They reported that patients scheduled for routine surgeries run a 31% greater risk of dying if they are admitted to a hospital with a severe shortage of nurses. The risk of death increased by 7% for each additional patient cared for over four patients at a time.

According to Beth Piknick, president of the Massachusetts Nurses Association, "Make no mistake about it, every day in Massachusetts patients are suffering in pain; patients are being neglected; patients are falling; patients are experiencing preventable and costly complications simply because their nurse is not there when they need them to be there because he or she is struggling to meet the needs of too many other patients." (as cited in MNA, 2006)

Nurse Staffing / Skill Mix

According to Cahill (1995), skill mix is, "the proportion of staff qualifications, levels of confidence, abilities, knowledge, and experience that are necessary to achieve an agreed standard of care for a given level of demand" (as cited in Currie, Harvey, West, McKenna,… READ MORE

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