The role of nurses in patient care and safety cannot be overstated. While doctors may spend limited time each day with their patients, nurses are responsible for providing continuous care and monitoring their health. Nurses are often the ones who first notice changes in a patient’s condition. They are knowledgeable about protocols and current weaknesses in the system, and they communicate with all the members of the healthcare team. At the bedside, nurses must keep a close eye on the patient’s condition and safety. However, when nurses are overworked and responsible for too many patients, the quality of care suffers.
Studies have shown a direct correlation between nurse staffing ratios and patient safety. In order to protect patient safety, some states have put laws in place to regulate nurse staffing ratios. However, many states still lack any standard regulations. The American Nurses Association reports that only 14 states currently have legislation in place (Carthon et al., 2019). Factors such as the skill mix and competence of staff, the physical layout of the nursing unit, and the availability of technology and resources all play a role in determining nurse staffing levels. The quality of nursing care is determined by many factors, including nurse staffing levels, nurse experience and education, human factors such as fatigue, and systems of care, all of which must be taken into account to ensure patient safety and quality of care.
Nurse Staffing Levels
Unsafe nurse-patient ratios can have a serious impact on patient safety. When there are fewer Registered Nurses (RNs) available, it is essential to assess the ratio of nurses to patients or residents in nursing facilities to ensure the safety of everyone involved. In 2020, the national average of hours per resident day (hprd) was 0.75, which is equivalent to 45 minutes or three-quarters of an hour (Carthon et al., 2019). Having the right number of nurses on staff can lead to fewer pressure ulcers and UTIs, reduced risk of hospitalizations, and fewer deaths. The Patient Safety Act enforces nurse ratios and places the responsibility of allocating time among fewer patients on the nurses. However, this may not be the best approach in all cases. For instance, in intensive care units a one-to-one nurse-to-patient ratio is mandated, while a one-to-three nurse-to-patient balance is required in the emergency room. A one-size-fits-all statewide implementation of nurse staffing ratios may be expensive and ineffective, leading to decreased access to treatment and fewer patient options.
Cross-sectional studies have indicated that increased nurse staffing may be linked to better patient outcomes. However, this must be taken into account alongside the financial strain that hospitals are facing. If resources are diverted from other important uses or access to care is limited due to mandated nurse staffing ratios, this can have a detrimental effect on the patient (Carthon et al., 2019). It is important to consider the implications of nurse staffing levels in order to ensure the safety of patients, nurses, and other healthcare professionals. It is essential that hospitals, nursing facilities, and other healthcare organizations assess the ratio of nurses to patients and implement the necessary measures to ensure that everyone is safe. This includes an appropriate number of nurses on staff, access to the necessary resources, and patient-centered care. By taking these steps, healthcare organizations can ensure the safety of their patients and staff.
Nurse Experience and Education
Nursing experience and education can have a profound effect on the safety of a nurse-patient ratio. Inadequate staffing of experienced nurses can lead to an unsafe nurse-patient ratio, which has a direct impact on patient safety. The American Nurses Association (ANA) recognizes the need for nurses to have experience and education in order to provide safe and effective care for patients (Mosheva et al., 2021). Nursing experience is a key factor in the safety of a nurse-patient ratio. Experienced nurses are able to recognize subtle changes in a patient’s condition, which can help to prevent medical errors and ensure that patients receive the best care possible.
Experienced nurses also have a better understanding of the complexities of caring for a patient, which is beneficial when managing a nurse-patient ratio. Experienced nurses are also more likely to be able to provide effective communication with patients, which can lead to better patient outcomes. Education is also an important factor in the safety of a nurse-patient ratio. Nurses with higher levels of education are more likely to have a better understanding of the complexities of patient care, as well as the latest evidence-based practices (Mosheva et al., 2021). This knowledge can help nurses to provide safe and effective care and ensure that they are able to properly assess a patient’s condition. Nurses with higher levels of education are also more likely to have better communication skills, which can help to ensure that patients understand their diagnosis and treatment plan.
The combination of nursing experience and education can help to ensure that nurses are able to provide safe and effective care to patients. This can help to reduce the risk of medical errors and ensure that patients receive the best care possible. In addition, nurses with experience and education are more likely to be able to recognize subtle changes in a patient’s condition and respond quickly and appropriately (Hummel et al., 2021). This can help to reduce the risk of a nurse-patient ratio becoming unsafe. For example, an experienced nurse may recognize subtle changes in a patient’s condition, such as increased heart rate, and quickly act to provide appropriate care. This can help to ensure that a patient is receiving the best care possible and help to avoid a situation where an unsafe nurse-patient ratio is created. In addition, a nurse with higher levels of education may be able to recognize the signs and symptoms of a medical condition earlier than a nurse with less education, which can help to prevent a medical error and ensure that the patient receives the best care possible.
Human Factors and Systems of Care
Human factors, such as fatigue, can play a major role in unsafe nurse-patient ratios. Fatigue can lead to a decrease in focus, a decrease in quality of care, and an increase in medical errors. Fatigue is a common issue among nurses due to long shifts, overtime, and high workloads (Hummel et al., 2021). This can lead to a decrease in concentration and an increase in medical errors. Studies have found that nurses who are tired are more likely to make mistakes and have decreased performance in their work. For example, when nurses are tired, they may be more likely to forget to document important information, forget to administer medications, or miss important signs or symptoms. This can increase the likelihood of medical errors and adverse events.
In addition to fatigue, the systems of care can also have a major effect on unsafe nurse-patient ratios. Poorly designed systems can lead to higher workloads and higher nurse-patient ratios, which can lead to decreased quality of care and increased risk of medical errors. For example, if the system is not optimized for efficient workflow, nurses may be unable to complete their tasks in a timely manner, resulting in a decrease in quality of care. Additionally, if staffing levels are inadequate, nurses may be unable to provide the necessary care and attention to patients, resulting in an increased risk of medical errors. Another issue related to systems of care is the lack of access to support services (Carthon et al., 2019). When nurses are unable to access support services, such as social work and nutrition services, they are unable to provide the necessary care and attention to their patients, resulting in an increased risk of medical errors. Additionally, if the system does not allow for the timely response to patients’ needs, nurses may be unable to respond to changes in their condition, leading to an increased risk of adverse events.
Nurse staffing ratios are essential for ensuring patient safety and providing quality care. Nurses must monitor patients for clinical deterioration, identify errors and near-misses, understand care protocols and weaknesses in systems, recognize and communicate changes in patient condition, and perform many other tasks. Setting minimum nurse to patient ratios is important in order to reduce the risk of patient safety problems, morbidity, and even fatality. However, mandating nurse staffing ratios can be costly and ineffective in financially strapped hospitals, as it can limit access to patient treatment and services. Moreover, the effectiveness of mandated nurse staffing ratios can be affected by individual nurse traits, such as education and experience, as well as factors such as exhaustion and the physical setting, systems for cooperation and communication, and information systems. In order to ensure optimal patient safety and quality of care, it is essential to take into account all of these factors when setting nurse staffing ratios.
Carthon, J. M. B., Davis, L., Dierkes, A., Hatfield, L., Hedgeland, T., Holland, S., … & Aiken, L. H. (2019). Association of nurse engagement and nurse staffing on patient safety. Journal of nursing care quality, 34(1), 40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263830/
Hummel, S., Oetjen, N., Du, J., Posenato, E., De Almeida, R. M. R., Losada, R., … & Schultz, J. H. (2021). Mental health among medical professionals during the COVID-19 pandemic in eight European countries: a cross-sectional survey study. Journal of medical Internet research, 23(1), e24983. https://www.jmir.org/2021/1/e24983/
Mosheva, M., Gross, R., Hertz‐Palmor, N., Hasson‐Ohayon, I., Kaplan, R., Cleper, R., … & Pessach, I. M. (2021). The association between witnessing patient death and mental health outcomes in frontline COVID‐19 healthcare workers. Depression and anxiety, 38(4), 468-479. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014064/