Optimized Nurse-to-Patient Ratios in the Medical-Surgical Unit

The lack of optimized nurse-to-patient ratios in the medical-surgical unit increases morbidity and mortality rates and treatment costs (Drennan & Ross, 2019). This study will evaluate the impact of a lack of optimized nurse-to-patient ratios as evidenced by four key performance indicators: medication administration errors, prolonged hospital stays in the medical-surgical unit, patient dissatisfaction, and nursing staff dissatisfaction. Medication administration errors will be measured by examining the percent of medication administration errors during one year. Prolonged hospital stays in the medical-surgical unit will be measured by identifying the days from admission. Patient dissatisfaction will be measured by examining annual patient satisfaction surveys. Nurse dissatisfaction will be measured by evaluating annual nurse satisfaction surveys. This project will provide invaluable information and form the basis for policy formulation to optimize staff ratios and improve organizational productivity at Parkwest Medical Center, Knoxville, TN. The findings will be presented using a pie chart and bar graph.

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Introduction

Statement of the Problem

The lack of optimized nurse-to-patient ratios in the medical-surgical unit increases morbidity and mortality rates and treatment costs (Drennan & Ross, 2019).

Key Factors that Directly Influence the Problem

Lack of optimized nurse-to-patient ratios is associated with increased medication errors, prolonged hospital stays, and patient and nursing staff dissatisfaction (Drennan & Ross, 2019; Ghafoor et al., 2021; Winter et al., 2020).

Factor Which Directly Relates to the Problem	Precise Unit of Measurement (Days, Dollars, %, etc.)	Authoritative Source(s) for Factor and Unit of Measurement
1. Medication administration  errors	Percent of medication administration errors during one year	(Drennan & Ross, 2019).
2. Prolonged hospital stays in the medical-surgical unit	No. of days spent in the hospital from the time of admission.	(Drennan & Ross, 2019; Ghafoor et al., 2021).
3. Patient dissatisfaction	Annual patient satisfaction surveys.	(Winter et al., 2020).
4. Nursing staff dissatisfaction	Annual nurse satisfaction surveys.	(Saika, 2018)
Example: Sepsis	% of Hospital Acquired Infections during one year	The Joint Commission (2017).

Value Proposition to the Organization

Data analysis of the lack of optimized nurse-to-patient ratios will provide invaluable information and form the basis for policy formulation to optimize staff ratios and improve organizational productivity at Parkwest Medical Center, Knoxville, TN.

Value Proposition/Contribution to My Professional Interests/Goals

This project aligns with my career goals by helping me to develop pertinent knowledge and research to become competent at strategic planning.

Background: Review of the Literature

Authoritative Source                              (APA Format)	How the Source Directly Relates to the Problem (One Sentence Summary)
Drennan, V. M., & Ross, F. (2019). Global nurse shortages – The facts, the impact, and action for change. British Medical Bulletin, 130(1), 25–37. https://doi.org/10.1093/bmb/ldz014	This article identifies the factors directly related to the nursing shortage and determines how these factors are measured.
Ghafoor,   Yasmeen, Yaqoob, M. A., Bilal, M. A., & Ghafoor, M. S. (2021). Impact of Nurse Shortage on Patient Care. Saudi Journal of Nursing and Health Care, 4(4), 114–119. https://doi.org/10.36348/sjnhc.2021.v04i04.003	This paper evaluates the nursing shortage problem and identifies the factors that are directly related to the problem.
Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage – a prospect of global and local policies. International Nursing Review, 66(1), 9–16. https://doi.org/10.1111/inr.12473	This article evaluates the problem of nursing shortage (optimized nurse-to-patient ratios) and the strategies proposed to tackle this problem.
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical Principles and Guidelines of Global Health Nursing Practice. Nursing Outlook, 66(5), 473–481. https://doi.org/10.1016/j.outlook.2018.06.013	This article identifies the ethical principles (beneficence, non-maleficence, justice, and autonomy) that all nurses in healthcare facilities should uphold.
Saikia, D. (2018). Nursing shortages in the rural public health sector of India. Journal of Population and Social Studies, 26(2), 101–118. https://doi.org/10.25133/JPSSv26n2.008	This article evaluates the problem of nursing shortage (optimized nurse-to-patient ratios) in India and proposes strategies that can be used to mitigate the problem.
Winter, V., Schreyögg, J., & Thiel, A. (2020). Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy, 124(4), 380–388. https://doi.org/10.1016/j.healthpol.2020.01.001	This article evaluates the problem of hospital staff shortages and identifies factors that are directly related to staff shortages.
Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (2018). United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit. American Journal of Medical Quality, 33(3), 229–236. https://doi.org/10.1177/1062860617738328	This paper evaluates the problem of nursing shortages in the United States and explains nurse satisfaction as a factor directly related to the problem.

Data Analysis Framework

Utilizing standards and site surveys is a pertinent data analysis framework. A standard is a trustworthy, reliable, acknowledged, and documented practice. Standards contain technical specifications. These requirements are meant to be used as a general guideline continuously. The use of standards improves the dependability and effectiveness of services. On the other hand, a site survey comprises inspecting a location to obtain information. The information covers feasibility, cost projections, and the time and effort required to finish a specific task.

The recommended ratios vary depending on the department type. In the USA, an emergency department should have a nurse-to-patient ratio of about 1:3, whereas the medical-surgical department should have a ratio of about 1:4. (NationalNursesUnited.org, n.d.). The recommended ratios for the labor and delivery, pediatrics, and intensive care unit are 1:2, 1:3, and 1:1, respectively (NationalNursesUnited.org, n.d.). For rehabilitative and psychiatric units, a nurse-patient ratio of one to four is recommended (NationalNursesUnited.org, n.d.). When examining statistics on nurse-to-patient ratios, these provisions are crucial. The standards will allow the researcher to determine whether the nurse-to-patient ratio aligns with the recommended ratios. By so doing, the lack of optimized nurse-to-patient ratios will be identified and addressed.

In this scenario, a site survey is also relevant. It will make it easier to gather information on nurse-to-patient ratios. This is significant when examining elements that directly impact the issue. These elements include pharmaceutical errors, extended hospital stays, and unsatisfied patients and nursing personnel (Sharma & Rani, 2020). The existence of these elements in healthcare institutions is a sign that nurse-to-patient ratios are not optimum (Sharma & Rani, 2020).

Presentation of the Graphics

Overview

The data will be represented by pie charts, bar graphs, frequency distribution tables, and pictographs. Data is presented visually in pictographs (Burns et al., 2021). They make data representation more straightforward and more uncomplicated to understand. Frequency distribution tables enable a thorough data representation using various variables. A pie chart facilitates the presentation of numerical and qualitative variables.

 Graphic #1

Graphic Title= Registered nurse to patient ratio, National Nurses United, 2021. Source: https://www.nationalnursesunited.org/ratios-what-does-california-ratios-law-require

Graphic #2    

Graphic Title= Minimum nurse-to-patient ratio, UK, USA, Australia, and Canada, 2020 Source:

https://journals.lww.com/jfmpc/Fulltext/2020/09060/Nurse_to_patient_ratio_and_nurse_staffing

_norms.8.aspx

Balanced Scorecard

Required: Include performance indicators and numeric measures of the potential impact of the data review project.

Organization’s Directional Strategy: (Growth, Reduction, Quality leader, etc.)

Business	Finance	Customer	Organizational Learning/Growth
Increase nurses’ satisfaction rating from 5 to 7 within three months to optimize the coordination of healthcare services.	Reduce treatment costs by 10 percent.	Decrease the incidences of prolonged hospitalization by 50 percent.	Give the organization a competitive advantage over other healthcare facilities. Optimized nursing staff ratios are associated with an increase in the quality of healthcare services (Tamata et al., 2021). Notably, it reduces treatment costs and shortens hospitalization. As such, the healthcare facility will gain a competitive advantage.
Reduce the incidences of staff burnout by about 10 percent.	Increase reimbursements from insurers by 10 percent. This will happen because optimized staff ratios are essential for a value-based payment model due to the increased quality of healthcare service delivery (Colldén & Hellström, 2018).	Improve patient satisfaction rates by approximately 30 percent within four months.	Decrease medication errors by 20 percent. Optimized nursing staff ratios are associated with an increase in the quality of healthcare services (Tamata et al., 2021). As such, the incidence of medication errors will reduce

Analysis of the Data

Graphic #1: Pie chart for key performance indicators at Parkwest Medical Center.

A pie chart was used to present data on the key performance indicators at Parkwest Medical Center. Data reveals that medication administration errors were recorded in 60 percent of patients attending the medical-surgical ward annually. Additionally, prolonged hospitalizations were recorded among 40 percent of patients admitted to the medical-surgical unit. In this context, lengthy hospitalization represents more than 5.4 days, the average hospital stay in the Ulengthyorg, 2022). Evaluation of annual satisfaction surveys revealed that patient and nursing staff dissatisfaction levels are 40 percent and 50 percent, respectively. The nursing satisfaction levels are lower than those reported at the national level (77 percent) (American Nurse Journal, 2021).

Graphic #2: Table showing nurse-to-patient ratios in various departments

Department	Nurse-to-patient ratios	Recommended Ratios
Medical Surgical	1:6	1:4
Emergency	1:5	1:3
Intensive Care Unit	1:3	1:1
Labor and Delivery	1:4	1:2
Pediatrics	1:5	1:3

The table above visually represents the ratio of nurses to patients in various departments. Findings indicate that the rativisually represents the recommended ones. These findings could have contributed to the high number of medication administration errors (60 percent of patients) recorded in the medical-surgical ward and the high patient and nurse dissatisfaction rates (40 and 50 percent, respectively).

Evidence-Based Recommendations

Stakeholders at Parkwest Medical Center should embrace different strategies to address the problem of un-optimized nurse-to-patient ratios at their facility. Data on key performance indicators and nurse-to-patient ratios in various departments evidence the existence of this problem. The first intervention is to make resources available to mitigate burnout among nurses. This can be achieved by creating a positive women’s culture public (Jean, 2022). Stakeholders should conduct proper planning to shorten the duration of shifts (Jean, 2022). Fitness programs and other supportive programs, such as counseling, will enable nurses to identify and address the impact of burnout on their mental and physical well-being (Jean, 2022).

According to Park and Yu (2019), the other intervention is using current organizational data to guide the decision-making process regarding hiring. Current data will enable the healthcare facility to identify the existing nursing shortage problem based on national benchmark metrics. Furthermore, it is nursing shortage problemacility to determine the impact of nursing shortages, such as an increase in medication administratively allows & Yu 201determineent organizational data will enable the healthcare facility’s administration to prioritize hiring and recruiting competent nurses to achieve optimized nurse-to-patient ratios in various departments.

The third strategy is emphasizing training and professional development. Training and professional development can be accomplished via continuous medical education, providing internal paths for career growth and availing resources for professional growth and development (Jean, 2022). Training and professional development reduce nurse turnover and prevent nurse shortages (Jean, 2022). Training provides an opportunity for career growth for both nurses and nursing assistants. By so doing, they feel appreciated as critical stakeholders in the healthcare facility (Jean, 2022). Furthermore, training and necessary medical education will equip nurses with adequate knowledge to mitigate medication administration errors at the healthcare facility (Jean, 2022).

Nursing shortage significantly impacts legal, ethical, and organizational considerations and increases medication error incidences and prevalence. Medication errors are associated with high morbidity and mortality rates. As such, patient safety is compromised. Additionally, a high prevalence of medication errors breaches the ethical principles of beneficence and non-maleficence (McDermott-Levy et al., 2018). Medication errors compromise the competitive advantage of the healthcare facility and increase the risk of penalization from insurers.              

Conclusion

            The nursing shortage is a problem of global concern that should be addressed promptly. The issue of un-optimized nurse-to-patient ratios is relevant to Parkwest Medical Center. The key performance indicators at the healthcare facility evidence the impact of the problem. Furthermore, a comparison of key performance indicators at the healthcare facility evidence the impact of the nursing shortage problem. A pie chart and column graph were used to give a graphical representation of the findings. According to the findings, the healthcare facility has a high prevalence of medication administration errors, prolonged hospitalizations, and patient and nurse dissatisfaction.

Additionally, nurse-to-patient ratios are not optimized. This problem can be addressed by making resources available to mitigate burnout among nurses, using current organizational data to guide hiring, and emphasizing training and professional development. The nursing shortage significantly impacts legal, ethical, and administrative considerations and patient safety.

References

American Nurse Journal. (2021). Two thousand twenty-one Nursing Trends and Salary Survey results. https://www.myamericannurse.com/2021-nursing-trends-Two thousand twenty-one salary-survey-results/#:~:text=We%20asked%20nurses%20to%20rate,3.17%3B%2063%25%20%E2%89%A53)

Jean, Y. J. (2022). 6 Proven Strategies From Nurse Execs to Combat the Nursing Shortage in 2022. https://nursejournal.org/articles/proven-strategies-to-survive-the-nursing-shortage-2022/

McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical Principles and Guidelines of Global Health Nursing Practice. Nursing Outlook, 66(5), 473–481. https://doi.org/10.1016/j.outlook.2018.06.013

OECD.org. (2022). Length of hospital stay. https://data.oecd.org/healthcare/length-of-hospital-stay.htm

Park, H., & Yu, S. (2019). Effective policies for eliminating nursing workforce shortages: A systematic review. Health Policy and Technology, 8(3), 296–303. https://doi.org/10.1016/j.hlpt.2019.08.003

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Write a data review project report and record a client presentation. There are no page or slide limits for this assessment.

Introduction
Note: Each assessment of your capstone project is built on the work you have completed in previous assessments. Therefore, you must complete the assessments in this course in the order in which they are presented.

Healthcare leaders are responsible for identifying relevant problems, analyzing data, drawing sound conclusions, and making recommendations for resolving the problem in the workplace. The data review project that you will be completing in this assessment has allowed you to practice the skills of a healthcare leader in a professional, real-world setting.

In this assessment, you will write your final report and develop a presentation suitable for executive leaders.

Overview and Preparation
In this assessment, you will submit your project report and presentation based on the work you have completed in the previous evaluations.

This assessment is in two parts:

Part 1: Project Report.
This report should be brief, substantive, and written for a hypothetical executive leadership team. It is not a lengthy academic paper.
Part 2: Project Report Presentation.
This recorded presentation is an overview of the project, also intended for an executive leadership team.
Presentation Tools
You may use Kaltura or another technology for your audio recording. Refer to the Using Kaltura tutorial for directions on recording and uploading your video in the courtroom.

Note: If you require assistive technology or alternative communication methods to participate in this activity, please get in touch with [email protected] to request accommodations.

Templates
Download the following templates to use to complete this assessment:

Assessment 4 Final Project Report Template [DOCX].
Assessment 4 Presentation Template [PPTX].
Requirements
Part 1: Project Report
Develop your data review project report. Use the Assessment 4 Final Project Report Template [DOCX]. Authoritative sources should be integrated into the Evidence-Based Recommendations and Conclusion sections.

Provide at least two graphics (for example, pie chart, graph, spreadsheet, or process map), two evidence-based recommendations from the literature, and one new insight. Place these additions in your document under the headings Analysis of the Data, Evidence-Based Recommendations, and Conclusion, respectively.

The requirements outlined below correspond to the first four grading criteria in the scoring guide. Be sure that your project report addresses each point at a minimum. You may also want to read the assessment scoring guide to understand how each criterion will be assessed.

Analyze performance data and trends.
Present your graphics, along with a concise analysis.
Describe the significant findings, trends, and new insights from the graphics.
Determine whether there are new insights and findings, obstacles to the collection or interpretation of data, or potential for bias.
Ensure your data is valid and reliable.
Provide evidence-based recommendations.
Identify a short list of interventions to solve the problem supported by current (published within the past 3–5 years) authoritative literature.
Consider adding additional best practice sources to your initial review of the current literature.
Consider how legal, regulatory, ethical, patient safety and organizational factors are related to the problem.
Make realistic recommendations that are within the organization’s capability. They should not be based upon uncertain funding sources such as government grants, which might be discontinued.
Make your recommendations sufficiently compelling to convince the target audience to implement them.
Provide a conclusion for problem resolution and organizational transformation.
Summarize the problem and method used for analysis.
Explain the essential findings and their relevance to the problem.
Explain how your recommendations can transform the organization (for example, enhancing potentially tainting costs, launching a new service line, etc.).
Combine clear, coherent, and original writing in APA style with relevant and credible evidence from scholarly and professional literature.
Apply correct APA formatting to your source citations.
Consider how or why a particular piece of evidence supports your main points, claims, or conclusions.
Make sure your supporting evidence is clear and explicit.
PART 2: PROJECT REPORT PRESENTATION
Provide a concise overview of your project in a recorded slide presentation. Use the Assessment 4 Presentation Template [PPTX].

The requirements outlined below correspond to the fifth grading criterion in the scoring guide. Be sure your presentation addresses each point at a minimum. You may also read the assessment scoring guide to understand better how the g criterion will be assessed.

Preto understands proactive project overview better for decision-makers.
Be clear and focused on your presentation.
Address thedecision-makerseds and concerns of your audience.
Apply best practices to the design and development of your presentation materials.
Support your main points, arguments, and conclusions with relevant and credible evidence.
Be sure to format citations and references using APA style.
Competencies Measured
By completing this assessment, you will demonstrate your profile following course competencies and assessment criteria:

Competency 1: Transformation: Facilitate a change process that effectively involves patients, communities, and professionals in improving and delivering health care and wellness.
Analyze, improve, and deliver evidence-based recommendations.
Competency 2: Execution: Translate strategy to develop and maintain optimal organizational performance in health care settings.
Provide a conclusion for problem resolution and organizational transformation.
Combine clear, coherent, and original writing in APA style with relevant and credible evidence from scholarly and professional literature.
Present a concise, substantive overview to decision-makers.
Portfolio Prompt: You must save your data decision-making report and recorded slide presentation to your ePortfolio.