The Impact of Nurse Staffing Levels on Healthcare

The Impact of Nurse Staffing Levels on Healthcare

Nursing is an important factor in determining the nature of patient outcomes as well as the quality of care provided in hospitals. Nurse staffing is equally an essential health policy issue and is associated with various benefits such as increased patient safety and quality of care as well as a competitive advantage to hospitals, which could enhance the financial performance of hospitals (Clarke & Donaldson, 2008; Everhart et al., 2013). Additional research shows that increased nursing staffing is linked to reduced hospital-related mortality, failure to rescue, hospital-acquired pneumonia, healthcare-associated infections, and cardiac arrest, among other adverse events (Kane et al., 2007; Mitchell et al., 2018; Haegdorens et al., 2019). Most hospitals strive to reduce nurse staffing to reduce costs, but the truth is that they end up spending even more due to increased medical errors, among other things (Aiken et al., 2018). It is important to maintain a nurse staffing ratio sufficient to ensure quality care is provided to patients and enhance the flexibility of nurses while reducing the probability of burnout.

In my organization, the ratio of nurse staff to patients is about one to seven in the emergency room, whereas, in intensive care units, it is one to two. This ratio is relatively high given that the required minimum nurse-to-patient ratio is mostly one to five in the general medical-surgical ward, one to two in critical care units, and one to five in emergency units (Sharma & Rani, 2020). Adhering to this standard ratio has been linked to various benefits for both nurses and patients. Nurses in charge of several patients usually run the risk of burning out and stressing, which could increase the probability of making medical mistakes.

Generally, research shows that about three-quarters of registered nurses believe that they are assigned too many patients at ago; 90 percent claim that they are incapable of providing adequate emotional support and comfort to their patients and their families, and 86 percent of the nurses claim to spend less time on patient education (Heath, 2018). A low nurse staffing ratio has impacted my organization, including increased patient and nurse dissatisfaction, longer lengths of stay for most patients, and higher readmissions. All these factors are linked to a reduced quality of care offered to the patients. The probability of making medical errors that have endangered the well-being of patients has also been high, and about 80 percent of the nurses complain of burnout. In fact, there has been a high turnover rate of about 20 percent over the past year, and this could be partly attributed to the coronavirus pandemic, which has put more pressure on healthcare services, but it has also revealed the importance of increasing the nurse staffing ratio in the organization.

Aiken et al.’s (2018) article on “Hospital nurse staffing and patient outcomes” highlights that medical errors are among the major causes of death in the US, hence the need to reduce patient harm worldwide to lessen the burden. In the article, the authors reviewed the key findings from a program of international research undertaken by the Center for Health Outcomes and Policy Research to determine whether variation in registered nurse staffing in hospitals contributed to poor patient outcomes (Aiken et al., 2018). The authors discovered that there was a strong link between better nurse staffing and reduced mortality. For hospitals with a higher ratio of patients to nurses, there was a double probability of death rates among patients with acute medical conditions like heart failure, pneumonia, and after-surgery procedures (Aiken et al., 2018). Every patient increase in the workload of a nurse was linked to a 7 percent increase in risk-adjusted mortality, particularly after surgery. The authors suggest the need to reduce the ratio of patients to nurses to increase the quality of care and reduce the risk of infections and burnout for nurses.

Haegdorens et al. (2019) researched the impact of nurse education and nurse staffing levels on patient mortality in surgical and medical wards. The authors state that insufficient nurse staffing in acute care hospitals is linked to adverse events like medication errors, healthcare-related infections, patient falls, and in-hospital mortality. Sufficient nurse staffing has a major impact on the quality of patient surveillance since it enables nurses to spend more time in direct care for the patients, whereas insufficient staffing results in rationing of time to care (Haegdorens et al., 2019). It would be ideal to have sufficient numbers of nurses caring for a small number of patients to enhance efficacy and quality of care.

Whereas various studies link sufficient nurse staffing with better patient outcomes, very few staffing guidelines exist to date. California is the only state in the US with a mandatory nurse staffing level of one nurse for every four patients and one nurse for every two patients in the emergency and intensive care rooms, respectively (Haegdorens et al., 2019). It is quite difficult to assign a specific ratio given other factors like nurses’ education level, experience, patient outcomes, acuity, financial factors, and workflow are at play. Other organizations deal with the issue of nurse staffing by creating staffing plans specific to every unit (Kluwer, 2016). This method allows hospitals to establish flexible staffing levels and account for any changes, including the number of admissions, unit layout, level of nursing staff experience, and transfers and discharges during shifts.

The best strategy used to address the issue of nurse staffing from the articles is creating staffing plans that are specific to every unit. This means assigning a reasonable ratio for units based on the urgency and seriousness of needs as well as nurses’ experience. For instance, hospitals should consider a nurse-to-patient ratio of 1:2 and 1:1 in intensive care and operating rooms. On the other hand, in other units like the emergency room and postpartum women, a ratio of 1:4 and 1:6 could be most appropriate. Making use of these strategies could have major positive changes in my organization. For instance, by applying the suggested ratio in the emergency room, the probability of in-hospital patient mortality, nurse burnout, and high nurse turnover would be reduced. This will, in turn, save the hospital a great deal of money in hiring and retaining nurses and also increase the quality of care given to patients. However, it would also imply channelling more costs towards hiring more qualified and experienced nurses in order to effectively apply the strategies in every unit. The expenses will be worth it, given that there will be increased quality of care and patient outcomes and increased nurse and patient satisfaction.

References

Aiken, L. H., Cerón, C., Simonetti, M., Lake, E. T., Galiano, A., Garbarini, A & Smith, H. L. (2018). Hospital nurse staffing and patient outcomes. Revista Médica Clínica Las Condes, 29(3), 322-327.

Clarke, S. P., & Donaldson, N. E. (2008). Nurse staffing and patient care quality and safety. Patient safety and quality: An evidence-based handbook for nurses.

Everhart, D., Neff, D., Al-Amin, M., Nogle, J., & Weech-Maldonado, R. (2013). The effects of nurse staffing on hospital financial performance: Competitive versus less competitive markets. Health care management review, 38(2), 146.

Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: an observational multicentre study. BMC health services research, 19(1), 1-9.

Heath, S. (August 14, 2018). How Nurse Staffing Ratios Impact Patient Safety, Access to Care. Patient Engagement Hit. Retrieved from https://patientengagementhit.com/news/how-nurse-staffing-ratios-impact-patient-safety-access-to-care

Kane, R. L., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. J. (2007). Nurse staffing and quality of patient care. Evidence report/technology assessment, (151), 1-115.

Kluwer, W. (November 11, 2016). The Importance of the Optimal Nurse-To-Patient Ratio. Retrieved from https://www.wolterskluwer.com/en/expert-insights/the-importance-of-the-optimal-nursetopatient-ratio

Mitchell, B. G., Gardner, A., Stone, P. W., Hall, L., & Pogorzelska-Maziarz, M. (2018). Hospital staffing and healthcare-associated infections: a systematic review of the literature. The joint commission journal on quality and patient safety, 44(10), 613-622.

Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks. Journal of Family Medicine and Primary Care, 9(6), 2631-2637.

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The Impact of Nurse Staffing Levels on Healthcare

The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

• Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
• Reflect on the feedback you received from your colleagues on your discussion post about the national healthcare issue/stressor you selected.
• Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.