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Nurse ratios have been shown to decrease burnout

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Nurse ratios have been shown to decrease burnout

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1. Less burnout means that there will be more accomplished during a shift (Liu et al. 2019).

2. Less burnout means more teamwork on units (Liu et al. 2019).

3. Burnout may lead to poor performance and alertness, leading to a decrease in the quality of patient care. ((Barker & Nussbaum, 2011).

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Review of literature: Patient mortality increase

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Review of literature: Patient mortality increase

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1. Patient mortality increases with increased patient ratios even when they are discharged. If the staff is unable to prioritize education and discharge instructions over other nursing tasks then there is an increase of mortality from .8% in hospitals with a low nurse to patient ratio to 2.5% in hospitals with a high nurse to patient ratio.  (Liu, et al. 2020)

2. During a study done by Schalski et al. (2008) between 1993 and 2001, when RN levels increased by 1.2 percent per year, they found that more RN time per patient per day were linked to lower mortality rates for patients with acute myocardial infarction.

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1. To improve patient care, not only should ratios be considered, but patient needs and acuity.
2. The workloads of nurses are often too much due to the specific needs of the patients.

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Nurse ratios equate to less patient Significant events

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Nurse ratios equate to less patient Significant events

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1. Patient mortality increases by 7% for each patient that is added to the nurses workload (Kim, et al. 2020).

2. 22.64% of shifts are understaffed according to nurse- patient ratio, while 44.64% are understaffed according to patient acuity, leading to higher incidence of multiple organ failure. (Jansson, 2020)

3. Evidence of the positive outcomes of better RN staffing can be found not only in the evaluation of nurse reports from better and  worse staffed hospitals but also in differences between these hospitals in the severity-adjusted probability that the patient treated in these hospitals will be discharged alive (Aiken et al.,2010).

4. Researchers have found that lower staffing levels are linked to poor patient outcomes. Staffing also appears to be related to occupational health issues like back pain injuries and needlestick injuries (Clarke et al., 2008).

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1. Orem's model of self care. Orem’s theory is holistic and suggests that the nursing staff is there to supplement the patient’s health related deficits, until they are able to perform these functions on their own. When the nursing staff is spread too thin, these functions do not get the support that they need and the patient suffers because of it.

2. When there is an increased number of patients per nurse, the nurse does not have much time to assist the patient with self care, thus neglecting this theory.

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1. Staff retention is a high priority for any organization, the price to train and orient a new nurse is very high. Teamwork is also important to reduce burnout and reduce missing essential nursing tasks (Senek et al. 2020).

2. While still in the middle of this pandemic, studies have been done on the nurses who were in the epicenter in New York. At times they had a mean ratio of 1 to 9.4 patients on a med surg floor (Lasater et al, 2020).  These nurses reported at a rate of 70% that they would not recommend their hospital as a place of employment (Lasater et al, 2020).

3. Many researchers have identified higher levels of adverse patient events (mortality and complications, for instance) and negative nurse job outcomes (such as burnout) under poorer staffing conditions (specifically, thinner staffing coverage or fewer nurses per unit of patient care and, somewhat less commonly in these studies, lower skill mix/education level of staff)(Largent, et al. 2017).

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1. Higher odds of reporting complaints from patients and families for nurses working in the hospitals without mandated ratio (Aiken et al., 2010).

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Across many different countries and nursing environments, there is a consistent empirical data when nurses are stretched thin between patients, there are negative consequences to the patient population. When nurses are pressed for time, the last things on the priority list are education and emotional comforting. These are the soft skills that are essential for patient survival not only in the acute setting but also in the post op discharged setting. When nurses have more time to spend with their patients, HCAP score go up, medicare reimbursement increases and therefore better quality care can be justified.

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1. Jiali Liu, Jing Zheng, Ke Liu, & Liming You. (2019). Relationship Between Work Environments, Nurse Outcomes, and Quality of Care in ICUs: Mediating Role of Nursing Care Left Undone. Journal of Nursing Care Quality, 34(3), 250–255. (Liu et al, 2019)

2. Kim, Y., Kim, H.-Y., & Cho, E. (2020). Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: a cross-sectional analysis using Korean administrative data. BMC Nursing, 19(1), 1–10. https://doi-org.ju.idm.oclc.org/10.1186/s12912-020-0410-7

3. Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Reneau, K., Alexander, M., & McHugh, M. D. (2020). Chronic hospital nurse understaffing meets COVID-19: an observational study. BMJ quality & safety, bmjqs-2020-011512. Advance online publication. https://doi.org/10.1136/bmjqs-2020-011512

4. Michaela Senek, Steve Robertson, Tony Ryan, Rachel King, Emily Wood, & Angela Tod. (2020). The association between care left undone and temporary Nursing staff ratios in acute settings: a cross- sectional survey of registered nurses. BMC Health Services Research, 20(1), 1–8. https://doi-org.ju.idm.oclc.org/10.1186/s12913-020-05493-y

5. Largent, E. A., & Fernandez Lynch, H. (2017). Paying Research Participants: Regulatory Uncertainty, Conceptual Confusion, and a Path Forward. Yale journal of health policy, law, and ethics, 17(1), 61–141.

6. Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J., & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health services research, 45(4), 904–921. https://doi.org/10.1111/j.1475-6773.2010.01114.x