Nurse Staffing and Patient Safety
Typically, most patients and clinicians consider doctors as the “super heroes” of the medical field, which is justifiable. Nonetheless, physicians spend an average of 30 minutes interacting with patients, while nurses are ever present in all departments and they interact with all levels of stakeholders, including families, doctors, patients, and pharmacists. Therefore, nursing staff play the most critical role of ensuring patients are constantly safe by tracking their clinical progress, identifying errors, understanding system weaknesses, adhering to safety principles, and providing quality care (Vaismoradi et al., 2020). This paper encapsulates how nurse staffing ratios affect patient safety, while highlighting other underlying factors in the relationship. Also, it outlines a proposed solution for the problem that could help institutions overcome inconsistencies.
Staffing Ratios and Patient Safety
Nurses’ attention towards patients is integral in ensuring the latter’s safety throughout the care process. Therefore, accommodating more patients in an institution without adjusting staffing ratios would inherently overwhelm the workforce. The ability of nurses to provide quality bedside care would be significantly compromised. Over the years, studies have identified a profound connection between nurse staffing ratios and patient safety (Griffiths et al., 2018). They concluded that inconsistencies in patient safety, like increased morbidity and accidents tend to increase with a rise in patient-nurse ratios (Ball et al.,2015). Consequently, some states and jurisdictions imposed restrictions on minimum nurse-patient ratios, mainly in surgical units (Cordova et al., 2019).
The connection between nurse staffing and patient safety is relatively complex, as it’s mot just influenced by nurse-patient ratios. For instance, some studies confirm that increased patient numbers could breed high mortality rates even when staffing ratios are adequate. Determining the optimal ratio is quite challenging, as it changes across different shift times, and necessitates proper coordination between management and workforce. Each institution has to conceptualize contingency plans based on factors like patient turnover, availability of support staff, and resource availability, to name a few. Likewise, nursing training and skills can also influence patients’ outcomes, with lower cases of mortality rates being recorded in institutions that have educated practitioners (Rahman et al., 2015). Consequently, some regions mandate nurses to have at least a baccalaureate educational background supported by relevant professional training. Less experienced practitioners are also urged to seek mentorship and training to expand their understanding on complex medical cases.
Current Situation
In 2004, the National Quality Forum (NQF) proposed the National Voluntary Concession Standards for Nursing-sensitive care. The publication highlighted various outcomes that were identified as markers of quality care, including falls and bedsores. Also, it included related system-linked measures that influence patient outcomes, including nursing skills, nurse turnover, working hours, and nursing ratios (National Quality Forum, 2004). These factors help in defining quality of nursing care and efforts from institutions for supporting patient safety endeavors. The ANCC Magnet Recognition Program acknowledges institutions that provide high quality care and those that attract competent nurses. NQF’s program was proposed in a study that identified healthcare institutions that retained nursing staff for significant periods of time. It investigated the institutional traits associated with high retention, to aid the hurdle of nursing shortages. In the last decade, US states have adopted policies and regulations associated with nursing ratios to enhance patient safety and outcomes and employee satisfaction (Cordova et al,. 2019).
Proposed Solution
Nursing shortage are a significant global problem, with continents like Asia and Africa posing significantly low nursing ratios (Dewanto & Wardhani, 2018). The US has a nurse-patient ratio of approximately 10 nurses to 1000 patients, which compromises the performance of various institutions. Most importantly, the problem of nursing shortages can’t be solved by a single “magic bullet” and it’s necessary for individual organizations to grow in flexibility by streamlining various laws and regulations.
One, healthcare organizations need to implement HR policies that fit institution-specific characteristics, context, and needs. Each institution has unique traits, requirements, resources, and decision-making procedures that require distinct interventions. Second, implementing coordinated and comprehensive “bundles” of interventions will ensure organizations enjoy sustained performance improvements. The healthcare sector is relatively bureaucratic and individual efforts from individual organizations will help avoid short term focus, nurse shortages cycles, and system instability (Kuye & Akinwale, 2020). Healthcare institutions should also realize that the process of implementing identified “best practices” into sustained HR policies is relatively challenging. They should, therefore, implement a profound “take up” process to ensure the changes are integrated effectively into routine functions.
References
Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P. (2015). ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Journals, 23 , 116-125.
Cordova, P. B., Pogorzelska-Maziarz, M., McHugh, M. D., & Eckenhoff, M. E. (2019). Public Reporting of Nurse Staffing in the United States. Journal of Nursing Regulation, 10(3), 14-20.
Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nursing, 17(2) .
Griffiths, P., Recio‐Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., . . . Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487.
Kuye, O. L., & Akinwale, O. E. (2020). Conundrum of bureaucratic processes and healthcare service delivery in government hospitals in Nigeria. Journal of Humanities and Applied Social Sciences, 1-24.
NationalQualityForum. (2004). National Voluntary Consensus Standards for Nursing-Sensitive Care: An Initial Performance Measure Set. Washington D.C., United States: National Quality Forum.
Rahman, H. A., Jarrar, M., & Don, M. S. (2015). Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-Sectional Study. Global Journal of Health Science, 7(6), 331-337.
Vaismoradi, M., Tella, S., Logan, P. A., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to Patient Safety Principles: A Systematic Review. International Journal of Enviromental Research and Public Health, 17(6), 2028-2029.