Nurse Staffing Essay

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

Nurse-Patient staffing ratios have created debate among health care professionals for years. Who determines where, when and how many patients a nurse can handle on any given shift? Who determines the acuity of the patients handled by the nurse? Does the floor nurse have a say in what she or he can feasibly handle during their shift? At what point does patient care begin to suffer? These questions and many others have led to federal and state legislation coming to light to better serve the care of a patient. “The varied agendas and the inability of nurses, hospital administrators, and financial experts to communicate toward a single purpose, as well as the complexity of meeting staffing needs, have moved the issue into the political arena (Hertel, 2012, p. 1)”. Several states have already instituted mandatory nurse-patient ratios. While you can debate for or against political involvement, I will look at many factors regarding care and safety of patients.

One of the most serious issues in nursing, that can affect a nurses career is nursing burn- out. According to the article “Where have all the nurses gone”, current nurses that are practicing, report high rates of job dissatisfaction (which is part of burn out) and 1 of 5 nurses may quit nursing in the next 5 years (Dworkin, 2002). Burnout is associated with nurses not coming in to work, not feeling satisfied when doing their job, high turnover rates and a lack of commitment to the work (Katisfaraki, 2013). If a nurse becomes burned- out, they may not take care of their patients as well and could make mistakes with medication administration. A study performed in the United States by Dr. Jeannie Cimiottti, shows that hospitals with

The debate to find the perfect balance of nurse to patient ratio continues between healthcare workers and legislators. According to an article in Modern Healthcare magazine, “Got enough nurses?” Nurse groups cite a Kentucky case to support push for staffing ratio laws,” nurses attending to a dozen or more patients at a time is “physically impossible” (Rice, 2015). Rice reports statements made by Gerard Brogan, lead nursing practice representative for the California Nurses Association, Pamela Cipriano, president of the American Nurses Association, American Organization of Nurse Executives, a subsidiary of the American Hospital Association, Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Doctor Christine Cassel, CEO of the National Quality Forum, Bonnie Castillo, director of the Registered Nurse Response Network for National Nurses United union, Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, discussing research and other insights into the hardships of large nurse to patient ratios. As nurses continue to research and present data to contest the high patient to nurse ratios, hospitals push back with confronting data and research; both unable to reach an agreement.

Nursing shortages in the United States have left practicing registered nurses (RNs) with strenuous workloads. Such heavy workloads can lead to poor patient outcomes, decreased satisfaction among both patients and nurses, and questionable quality of care, among other things (Cimiotti, Akien, Sloane, & Wu, 2012; Department for Professional Employees, 2014; Duffield et al., 2011). Realizing the potential for error that accompanies such circumstances, efforts are being made to decrease the workload of nurses in hopes of improving quality of care. One such effort, and the focus of this paper, is the implementation of mandated nursing staff ratios. Mandated nursing staff ratios would restrict the number of patients a nurse is allowed to care for at one time (Tevington, 2011). While this idea seems to be a fitting solution, there has been much debate about the effectiveness of mandated nursing staff ratios. This paper will discuss arguments for mandated nursing staff ratios, arguments against mandated nursing staff ratios, and the impact of mandated nursing staff ratios on the profession of nursing as a whole.

Studies have shown that increase RN client ratios results in a reduction of 5.7% in patient days spent in hospital. The trend toward higher RN staffing levels has been shown to decrease avoidable never events such as inpatient falls and hospital acquired pressure ulcers. He, J. (2013).Too much burden on nurses tends to negatively affect productivity which compromises patient’s safety and quality of healthcare. In California, the mandatory nurse patient ratio was implemented at the time of severe registered nurse shortage and worsening of financial position of many hospitals. This legislature has been found to improve the health care system in many ways.

Nursing is the powerhouse in the delivery of safe, quality patient-centered care in the healthcare industry. To ensure continued safety of the patient and nursing staff, the issue of inadequate staffing must be addressed. Consequently, patient’s mortality rate has been linked to the level of nursing staff utilized in ensuring an utmost outcome (Aiken, 2011). This paper will outline the issue associated with inadequate nurse to patient staffing ratios in the hospital setting; essential factors such as economic, social, ethical and political and legal affecting the issue will be established; current legislature and stakeholders will be ascertained and policy option, evaluation of bill and the results of analysis will be reviewed.

Theories for burnout in the nursing profession are presented in the jobs-demands resources model. “This study uses the job-demands resources model to clarify the role of burnout among nursing staff in the relationship between stress factors and intention to leave the profession”

Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.

Michael B. Rothberg, I. A. (2005). Improving Nurse-to-Patient Staffing Ratios as a Cost-Effective Safety Intervention. Medical Care. Retrieved 2016, from Medical

Hospitals nationwide are experiencing nurse shortage and increased workloads because of shorter hospital stays, fewer support resources and higher acuity in patients (Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D., 2004). Higher nurse workloads are directly associated with job burnout and job dissatisfaction which in turn causes more voluntary nurse turnover and relates to the increased nursing shortage. According to the Missouri Hospital Association the turnover rate of nurses has increased by fourteen percent in the last five years (Browning M., 2012). Nursing shortage is a real threat to the patient population. According to the Quality Health Outcomes Model by the American Academy of Nursing by Donabedian, effects of the healthcare interventions are characterized by the environment the staff works in (Vahey et al., 2004). Donabedian describes that quality metrics can be divided into three broad categories, structural, process, and clinical.

Nursing is a career full of stressors. Every day nurses deal with some type of stress and they can become emotionally drained. Nurses are the support system for the patients and their families, they watch patients suffer, and sometimes they even care for patients who are terminally ill and dying. The modern world of health care and tightening budgets are resulting in additional work-related stressors such as barriers to providing optimal care, increasingly complex needs of patients, short acute care lengths of stays, the need for increased knowledge of ever-changing technology, nursing shortages, poor staffing, long work hours, limited resources, and feelings of lack of control (Smith, 2014, p. 119). The above stressors can put nurses at

The world and life change daily, what is good today may not be the answer for tomorrow. The ideal nurse-to-patient ratio will depend on various factors. As nurses’ workload increases mortality following common surgeries, nurse burnout and job dissatisfaction, and voluntary turnover increased significantly (Aiken et al., 2010). A nurses’ workload was associated with a seven percent increase with each added patient (Aiken et al., 2010). Patient and nurse satisfaction and quality of care provided to patients have been linked to adequate nurse staffing (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). There is a Federal regulation in place, 42 Code of Federal Regulations (42CFR 482.23(b) which requires hospitals certified. To participate

The focus of this paper centers on the stress and burnout in relation to patient safety amongst sub-acute nurses in my workplace. The term burnout describes workers’ reactions to the chronic stress common in occupations involving numerous direct interactions with people. “Burnout is typically conceptualized as a syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment” (Jenning, 2008, p.1). Moreover work related stress has significantly affected the nursing profession for ages and nothing seems to be effective organization and professional wise. Though, some states that are unionized have a cap regarding nurse-patient ratio per specialty. For example, this is effective in the state of California.

Burnout occurs more frequently in nurses who work in particularly stressful areas of nursing, such as critical care, oncology, burn units, emergency departments and also in general units, where staffing is inadequate or interpersonal relationship are strained (Ellis & Hartley, 2008). However, work stress and burnout is always a significant concerns in nursing affecting individual, patient and organization. In the health care organization, work stress may contribute to absenteeism and turnover, as a result of excessive workload continue to impact patient care outcomes at considerable cost to the system. This cost is even higher when replacing for turnover on specialized nursing units. According to research conducted by Canadian federation nurses’ union (CFNU), on average, one in five Canadian hospital nurses leaves his or her job every year, at a per capita cost to the institution of $25,000 (O’Brien-Pallas, Tomblin Murphy, Shamian, Li & Hayes, 2010). American studies cited even higher turnover costs of up to $67,000 per capita (Tschannen, Kalisch & Lee, 2010). Moreover, a study conducted among 309 new nurses in Quebec, reported that 43% experienced a high level of psychological distress, 62% intended to quit their present jobs for other jobs in nursing, and 13%