Patient Outcomes and the Nurse-Patient Ratio

In medicine, the primary issue is how to maximize patient outcomes by delivering effective medical services (Aiken, 2014). This is highly dependent on the level of treatment patients receive in medical facilities, which is determined by a variety of factors ranging from the recipient’s perspective to the provider’s perspective. The majority of research has focused on patient outcomes in terms of the quality of health care offered. The PICO question in this paper is whether a 1:3 nurse-patient ratio or a 1:6 nurse-patient ratio improves patient outcomes in the long run. From the PICO question, the problem is patient outcomes, intervention increasing nurse-patient ratios, comparison not increasing the nurse-patient ratios and the outcome of interest is increased patient outcomes. The paper is based on the analysis of the results of studies done to determine the relationship between nurse-patient ratios and patient outcomes.

Background of Studies

A significant number of these studies were conducted as a result of inadequate studies done regarding the topic; most researchers generalized the quality of healthcare and hardly expounded on the role played by various nurse staffing levels on the quality of care. Its impact on the healthcare system has clearly been taken for granted when according to the results summarized below; the former influences the effectiveness of the medicine field (Minnesota Department of Health, 2015). These studies therefore, show how increasing the nurse-patient ratios affects safety outcomes and some of them also do a cost-benefit analysis to determine the impact in the long run (Penoyer, 2010). They also emphasize the fact that factors such as patient acuity and morbidity rates should be considered while designing nurse staffing models (Mark, 2011).

Methods of Studies

They mostly included quantitative data retrieved from nearby health facilities’ records and observations by researchers (Minnesota Department of Health, 2015). Quantitative data was used in some studies to compare the accuracy of the information portrayed in the medical records. This ensured that the data collected was feasible and not exaggerated/underrepresented. The timeframe was also considered by collecting records within the past years to capture changes in the nurse staffing models used.

Results of Studies

Studies show that increasing nurse-patient ratios improved patient outcomes (Kutney-Lee, 2013). This was however, dependent on nurses’ attributes and qualifications and the level of patient acuity (Aiken, 2011). The more tolerant the nurse was, the more effective the nurse staffing model was (Bradshaw, 2011). Patient acuity on the other hand was different in each patient and the nurse staffing model was more efficient if patients’ conditions were considered; increasing nurse-patient ratio is futile if nurses do not provide undivided attention to individuals suffering from chronic illnesses and other severe conditions (Anderson, 2014). This does not imply that some patients should receive special attention than others; nurses should be keen to notice patients requiring frequent follow ups and medications (Bae, 2014). Nurse staffing models are determined by administrators and other stakeholders of medical institutions. Some may decide to lower the nurse-patient ratio to cut down on costs in terms of remuneration and employee packages. This may lower costs in the long run but deteriorating patient outcomes may discourage potential investors and the medical center end up having lower or no profit margins. Increasing the nurse-patient ratio ensures that each patient’s needs are met to reduce or if possible eliminate medication errors and as a result improve patient outcomes (Shekelle, 2013).


Nurse staffing is a key concept in nursing practice since it contributes to the performance of medical practitioners if factors such as their qualifications and patients’ acuity are considered. Nurses should be educated and trained on the effective nursing skills to increase the effectiveness of improving nurse staffing models. Increasing the nurse-patient ratio in health facilities will enable the health sector to meet its goal of providing affordable and high quality health services.


Aiken, L. H., Sloane, D. M., Smith, H. L., Flynn, L. & Neff, D. F. (2011). The Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals with Different Nurse Work Environments. Med Care, 49 (12), 1047-1053.

Aiken, L. H., Sloane, D. M., Brurneel, L., Van den Heede, K., Griffiths, P., Busse, R., … & McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824-1830.

Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., Bratzler, D.W., Dellinger, E.P., Greene,L., …& Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infection Control and Hospital Epidemiology, 35(6), 605-627.

Bae, S. H., Kelly, M., Brewer, C. S. & Spencer, A. (2014). Analysis of Nurse Staffing and Patient Outcomes using Comprehensive Nurse Staffing Characteristics in Acute Care Nursing Units. Journal of Nursing Care Quality, 29(4), 318-326.

Bradshaw, A. (2011). Ethical and Compassionate Nursing. Nursing Times, 3-30.

Kutney-Lee, A., Sloane D. M., & Aiken, L. H. (2013). An Increase in the Number of Nurses with Baccalaureate Degrees is linked to Lower Rates of Post-Surgery Mortality. Health Affairs, 32(3), 579-586.

Mark, B. A., & Harless, D. W. (2011). Adjusting for Patient Acuity in Measurement of Nurse Staffing: Two Approaches. Nursing Research, 60(2), 107-114.

Minnesota Department of Health. (2015). Hospital Nurse Staffing and Patient Outcomes.

Minnesota Department of Health.

Penoyer, D. A. (2010). Nurse Staffing and Patient Outcomes in Critical Care: A Concise Review. Critical Care Medicine, 38(7), 1521-1528.

Shekelle, P. G. (2013). Nurse-Patient Ratios as a Patient Safety Strategy. A Systematic Review. Annals of Internal Medicine, 158, 404-409.

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