Nurses and Safe Staffing
Nurses are critical determinants of health, and their contributions to the healthcare system must be recognized. They play an important role in the treatment and recovery of patients, hence their presence in the hospital is essential. The state-mandated safe staffing ratio is required to protect the safety of both the nurses and the patients (Shekelle, 2013).
Staffing Problems and Nurse Managers
Inadequate nurse staffing is detrimental to nurse retention and patient care, whereas excessive staffing drives nurses away from the profession while endangering patients. With the growing demand for healthcare and baby booming, there is a high likelihood that staffing problems will intensify, making safe staffing an issue of concern across the globe. This management issue will touch directly on the nurse managers who are responsible for the operating budget (financial plan for day-to-day expenses related to daily activities) (Andel, David, & Hollander, 2012). The nurse manager is also responsible for the personnel budget, which involves budgeting for staff required to staff the unit. Regarding the research problem, although one may think that staffing less would equate to less cost for the hospital, it has been found in studies that a lower patient to nurse ratio decreased the cost due to avoided death and length of hospital stay.
The Impact of Environment on Nurses
The previous research has indicated that nurses only work effectively in safe and friendly environment. Working in a comfortable environment had presented positive results among nurses in their respective stations of work (Stanton, 2004). The findings have also contributed that nurses in the healthcare institutions where there are high patients to nurse ratio have higher chances of reporting fatigue and burnout as compared to their professional counterparts in other institutions (Stanton, 2004). Separate results also found out that when there is a high patient to nurse ratio, the nurses record dissatisfaction with their work. Therefore, the dissatisfaction and burnout among the nurses contribute to their laxity in handling patients, which ultimately may lead to the avoidable deaths (Choi & Boyle, 2013). Besides, when there is high patient to nurse ratio, there are higher chances of poor response to the symptoms that the clients show. The fact that the practicing nurse may be allocated to many patients may make it complicated to them to notice some of the changes in their patients. Failing to monitor the physical changes among patients makes the diagnosis and treatment more complicated leading to the loss of more lives than what can be controlled.
The Cost of Lower Staffing
In as much as some people might think that lower staffing would be beneficial to the healthcare institutions regarding the average expenditure, it is worth giving a critical eye on the same issue. Of course, the pay for the nurses would be less, but it will also cost the management more to take care of the patients within the hospital. Constant and close monitoring of a patient would enhance his or her recovery, which would lead to an earlier discharge as compared to if the patient is not monitored closely in institutions (Stanton, 2004). For instance, patients who have just gone through surgical operations need adequate care for their quick recovery.
The Dangers of Understaffing
However, if the ratio of nurses to patients is low, there are high chances that such patients would take longer in the hospital beds. The added days of stay in the hospital should not be assumed. If anything, it should be considered one of the greatest contributors to unnecessary expenditures in the healthcare sector. Moreover, if the available nurses are not enough to take care of patients in critical conditions such as those who have just gone through surgery, then they risk losing more lives due to infections that are resulted by failure to attend to such patients (Shekelle, 2013). It should also be noted that nurses are not happy when they lose lives, which they are expected to take care of. Instead, the death of patients only adds the nurses a lot of fatigue making them be less effective at work.
Impact on Patients and Nurses
Other studies have also shown that understaffing endangers both the patients and the nurses. Lowering the budgets that should go to nurses by reducing the nurses to patient ratio, combined with the problems presented by the increasing shortage in nursing have led to fewer nurses spending longer hours in the hospital while giving care to the sick (Rothberg et al., 2005). The situation does not only compromise the process of care but also contributes to shorting in nursing by creating an environment, which pushes nurses to the wall. Other than the inadequate and ineffective care that the patient will receive from a nurse who has worked for long hours, the nurses are also affected directly. Working without enough rest poses physical, mental and emotional challenges. For example, continuously standing and moving up and down would expose someone to some of the musculoskeletal disorders, depression, cardiovascular disease, and not limited to hypertension (Stanton, 2004). Therefore, it is clear that when managers are trying to cut down the expenditure by lowering the ratio of the nurses to the patient, they are also raising the cost indirectly by having patients stay for more days in the hospital and endangering more lives.
The Role of Nurse Managers
Whereas the nurse managers have the responsibility of managing the daily flow of cash within the institutions of care, they also have the responsibility of caring for the life of those whom they lead (Northouse, 2013). In this connection, it would only be fair when they exercise authentic style of leadership, where they become positive people who embrace openness. Authentic managers focus on building their legitimacy through having honest relationships with their followers (Northouse, 2013). Hence, when the nurse managers are confronted with tough decisions such as reducing the number of nurses in the task force, they would only make decisions that are built on ethical foundations and only those that value the input of the other nurses on board. If the nurse managers adopt the authentic leadership style, then there is no doubt that they would build trust and generate enthusiastic support from the nurses working below them. The understanding of this leadership style would not only help the nurse managers in improving their performance but also that of their team (Northouse, 2013). The adoption of this type of leadership in nursing would make the leaders stop viewing the subordinates in terms of profit and share but as human beings and ethics. The guidance from this style of leadership will make the leader explore all the available avenues for making profits instead of understaffing, which would only make things worse within a health care sector.
The Effects of High Patient-to-Nurse Ratio
Apart from the occupational hazards that might be contributed by understaffing, several studies demonstrate a positive correlation between high patient-to-nurse ratio and poor outcome among the patients (Welton, 2007). When few nurses are attending to many patients, it is highly likely that they would make errors during prescription and administration of drugs to the patients. This would increase the risk of making patients suffer even more. It would also increase the chances of accidental death, something that would have been avoided if there were no understaffing. Finally, yet importantly, it is also worth adding to the account that safe staffing ratio may not only enhance the quality of life of the patients and the nurses but also keep the nurses in the profession (Rothberg et al., 2005). When nurses have a friendly environment at work, the probability stands high that they would want to continue serving humanity even after their retirement (Choi & Boyle, 2013). Retired nurses would only reconsider being employed in another hospital if he or she enjoyed the working conditions. Besides, a friendly patient-to-nurse ratio would also attract the graduates to work as nurses. Thus an improvement in the quality of life for both patients and the nurses.
Cost-Effective Measures and Safe Staffing
Concisely, while the proponents of safe staffing believe that mandatory nurse-to-patient ratios bring burdens to hospitals with a high cost of operations, the bulk of the research indicates that lower patient to nurse ratio decreased the cost due to avoided death and length of hospital stay, making it more cost effective. The high levels of temporary nurse staffing and the high rates of turnover increase the overall operating costs and the average costs per discharge (Andel, David, & Hollander, 2012).
References
Andel, C. David, S.L, & Hollander, M. (2012). The economics of health care quality and medical errors, Journal of health care finance 39(1) 1078-6767. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/23155743
Choi, J. & Boyle, D.K. (2013). RN work group Job satisfaction and patient falls in acute care
hospital units. The Journal of Nursing Administration, 43, 587-591 DOI: 10.1097/01.NNA.0000434509.66749.7c
Northouse, P. G. (2013). Leadership: Theory and Practice. Los Angeles [u.a.: SAGE.
Rothberg, M. B., Abraham, I., Peter, K., Lindenauer, R., & David N. (2005). Improving nurse to-patient staffing ratios as a cost-effective safety intervention, Medical Care. 43(8):785 791 DOI: 10.1097/01.mlr.0000170408.35854.fa. Retrieved from: http://journals.lww.com/lww medicalcare/Abstract/2005/08000/Improving_Nurse_to_Patient_Staffing_Ratios_as_a.6.aspx
Shekelle, P. G. (2013). Effect of Nurse-to-patient staffing ratios on patient morbidity and mortality. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); Mar. (Evidence Reports/Technology Assessments, No. 211.) Chapter 34. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK133362/
Stanton, M.W. (2004) Hospital nurse staffing and quality care. Research In Action.
Agency for Healthcare Research and Quality. 14, 4-29
Welton, J.M. (2007) Mandatory Nurse to patient staffing ratio: time to take a different
approach. The Online Journal of Issues in Nursing, 12, 12-35
Annotated Bibliography
Andel, C. David, S.L, & Hollander, M. (2012). The economics of health care quality and medical errors, Journal of health care finance 39(1) 1078-6767. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/23155743
The research conducted by Andel, David, & Hollander (2012) concerning the economics of health care quality and medical errors indicated that hospitals have taken approximately three decades looking into how to improve the efficiency of operations and quality in the healthcare sector. The authors of The Journal of Healthcare Finance estimate that the cost needed to enhance the quality of care and eliminate the medical errors would be much higher than the previous interventions. The article also touches on the existing gap in healthcare delivery in the United States.
Choi, J. & Boyle, D.K. (2013). RN work group Job satisfaction and patient falls in acute care hospital units. The Journal of Nursing Administration, 43, 587-591 DOI: 10.1097/01.NNA.0000434509.66749.7c
Choi & Boy (2013) explores the RN workgroup job satisfaction and patient falls in acute care hospital units where the two scholars seek to establish the relationship between a registered nurse satisfaction of their workgroup and patient falls of acute care hospital units. The authors address the lack of adequate research that has been conducted regarding the same health issue. They use Random-intercept negative binomial regression to analyze their findings. In their research, they conclude that there is a significant correlation between RN workgroup job satisfaction and fewer patient falls on acute hospital units.
Northouse, P. G. (2013). Leadership: Theory and Practice. Los Angeles [u.a.: SAGE.
Used by over one thousand universities and colleges across the world, this text presents a unique way of combining academically huge accounts of the major models and theories of leadership with practical exercise and accessible style that aid learners in applying the leadership theories that they learn in class. The book also allows the students to contrast the theories and give them an overview of servant leadership.
Rothberg, M. B., Abraham, I., Peter, K., Lindenauer, R., & David N. (2005). Improving nurse to-patient staffing ratios as a cost-effective safety intervention, Medical Care. 43(8):785 791 DOI: 10.1097/01.mlr.0000170408.35854.fa. Retrieved from: http://journals.lww.com/lww medicalcare/Abstract/2005/08000/Improving_Nurse_to_Patient_Staffing_Ratios_as_a.6.aspx
The article explores and compares the cost having a 8:1 vs 4:1 patient to nurse ratio using medical literature and Bureau of labor and statistics. The data collected were based on length of stay and patient mortality. The authors used the Bureau of Labor Statistics and the Medical Literature to conduct a cost-effectiveness Analysis from the perspective of the institutions. The article realized that eight patients per nurse were the cheapest though they linked to the highest patient mortality. As an intervention dealing with the safety of the patient, the authors concluded that the ratio of four patients to one nurse is reasonably cost effective and acceptable.
Shekelle, P. G. (2013). Effect of Nurse-to-patient staffing ratios on patient morbidity and mortality. In: Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville (MD): Agency for Healthcare Research and Quality (US); Mar. (Evidence Reports/Technology Assessments, No. 211.) Chapter 34. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK133362/
Shekel, in his research states that a small percentage of patients hospitalized die during hospitalization or shortly upon their admission. The article examines what constitutes the Patient Safety Practice where the author looks into the causal factors with connection to nursing care and reductions in hospital mortality. Concisely, Dr. Shekelle explores the effects of the staffing ratio on the rates of preventable medical errors a leading to patient death and injury. He also explores the cost savings of each avoided deaths due to medical errors.
Stanton, M.W. (2004) Hospital nurse staffing and quality care. Research In Action.
Agency for Healthcare Research and Quality. 14, 4-29
Stanton’s article looks into the rate of poor patient outcomes in hospitals with low staffing. It discusses the gap that still exists in increasing the level of staffing in the healthcare fields. The articles gives a summarized report of the findings of the Agency for Healthcare Research and Quality (AHRQ) as well as other research touching on the relationship of nurse staffing levels to the outcome of the patients. In a nutshell, the study shows that there is a clear negative correlation between poor patient outcomes and a low nurse staffing in hospitals.
Welton, J.M. (2007) Mandatory Nurse to patient staffing ratio: time to take a different
approach. The Online Journal of Issues in Nursing, 12, 12-35
Welton’s journal article examines the cost and benefit of having a national mandatory nurse ratio. It also offers a solution to high cost with “nursing intensity billing.” The author suggests that the high levels of temporary nurse staffing and the high rates of turnover increases the overall operating costs and the average costs per discharge. He sums by identifying the advantages and the need for a regulated plan for nurse-to-patient ratio.
