Tag: Nursing practice

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Nurse to Patient Ratios

One of the major difficulties in the healthcare sector is the unbalanced nurse to patient ratios. (Cornwall, 2018)recently performed a study to better understand the changing environment and growing problems of the nursing profession. Respondents from around the country offered their thoughts on topics such as workload, the national nurse shortage, the nursing profession in general, and workplace respect.

The results showed that the growing national nursing shortage exacerbates all of the challenges confronting today’s nurses. According to the Bureau of Labor Statistics, there will be 1.2 million registered nursing openings between 2014 and 2022, with the consequences of this growing gap becoming severe. Respondents to a poll supported this perspective, with 91 percent believing their hospital was understaffed (Cornwall, 2018).

Burnout Syndrome has been a serious concern in the workplace, contributed by the nurse to patient ratios with its prevalence increasing by 60% – 70% over the last few decades (Gutsan, Patton, Willis, & Coustasse, 2018). One of the most frequent definitions of Nurse Burnout is a persistent response to work-related stress that includes three components or dimensions: emotional fatigue, depersonalization, and personal achievement. 

Burnout Syndrome has been more commonly observed in nurses due to the emotional aspect of their occupation, particularly in hospitals and psychiatric wards where common exposure to stress, inflexible policies, improper work assignments, poor training, inadequate remuneration, employee conflict, and complex or unknown patient needs occur (Gutsan, Patton, Willis, & Coustasse, 2018).

The minimum nurse-to-patient ratio in hospitals and ambulatory units has been recommended as 1:6 in medical-surgical units and behavioral units, 1:4 in step-down, telemetry, or intermediate care units and non-critical emergency rooms, 1:2 for Intensive Care Unit or trauma patients and post-anesthesia units, and 1:1 for every patient under anesthesia (Gutsan, Patton, Willis, & Coustasse, 2018).A high nurse-patient ratio has dangerous effects, including increased stress levels and mental weariness among nurses, as well as an increase in errors and accidents, which has resulted in a rise in malpractice cases.

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Most nurses don’t have a lot of spare time. According to the research, 40% of nurses said they had less free time (Cornwall, 2018). Eighty percent of respondents feel there is a nurse shortage at their facility, and 76 percent say the shortfall has directly harmed them. Because there are fewer nurses in the business, 88% of nurses’ workloads have increased (Cornwall, 2018).

Nurses believe they don’t have enough time to give enough comfort and emotional support to their patients and their family members, and 86% say they can’t devote as much time to patient education as they would want (Heath, 2018). Mandatory nurse staffing ratios would have a detrimental financial impact on hospitals while restricting patient access to treatment.

Poor resource allocation leads to more disparity in care delivery, less local access to healthcare, and fewer patient options. Furthermore, hospitals may be obliged to recruit less experienced and trained RNs, which would certainly cancel out any quality or safety improvements (Heath, 2018).

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According to study (Michaud, 2020), people in long-term care institutions with lower nurse staffing levels, worse quality scores, and larger percentages of disadvantaged individuals have higher rates of confirmed COVID-19 infections and fatalities. Data analysis revealed that long-term care facilities with a larger number of disadvantaged people, such as Medicaid recipients and racial and ethnic minorities, and lower nurse staffing levels had higher rates of confirmed COVID-19 cases and fatalities.

Higher nurse staffing ratios in the nurse to patient ratios, in particular, were substantially linked to fewer cases and fatalities (Michaud, 2020). Greater staffing numbers are consistently associated with higher levels of care quality, (Harrington & Edelman, 2018). Increased registered nurse and certified nursing assistant employment has been linked to better quality indicators such as physical restraints, catheter usage, pain management, and pressure sores.

Larger employment numbers and professional staff mix, as well as reduced turnover and usage of agency employees, were found to be linked with improved quality. Higher staffing levels have been found to have the strongest association with fewer defects (violations of rules) issued by state surveyors (Harrington & Edelman, 2018).

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Regardless of such a nurse to patient ratios situation, all nurses are expected to maintain professionalism when interacting with their patients. (Curtin, 2016) used the Gricean Maxims to elaborate on the ethics that all nurses should have with the first Gricean Conversation Supermaxim which is to attempt to make your contribution truthful, which naturally means that you do not say anything you think to be untrue or anything for which you lack proof. 

According to the following Gricean Supermaxim, everything you say must be well articulated and readily comprehended. This necessitates that all parties avoid ambiguity, confusion, and excessive verbosity, and deliver their contributions in an impassionate and organized manner (Curtin, 2016). The first rule in healthcare ethics is to do no damage. People usually take precedence over objects in ethics.

Making money, saving money, or even losing money is not an ethical justification for harming others. By virtue of who they are and what they do, health professionals and those who earn a living by employing, organizing, and facilitating their practice bear extra responsibilities (Curtin, 2016). Nurses are responsible for examining patients and choosing how to effectively share the priceless resource that is themselves or themselves.

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In terms of relationship quality, it appears to be a component that affects the professional to support patient-centered care. This relationship quality has a direct impact on the quality of care delivered and is critical for the efficacy of nursing practice (Molina & Estrada, 2020). The health-care system has devised initiatives aimed at humanizing care and enhancing care quality. A positive nurse-patient connection shortens hospital stays and enhances the quality and happiness of both parties.

In contrast, while the patient’s involvement in choices is higher, the positive relationship is conditioned by the patient’s subservient role (Molina & Estrada, 2020). A poor or negative nurse-patient relationship reduces the quality of treatment and the patient’s autonomy. A poor patient is one who demands a lot of information, who wants to make his or her own decisions, often against those suggested by specialists, and who does not maintain a good connection with professionals (Molina & Estrada, 2020).

Nursing leadership has an influence on the whole health system as well as on the nurses’ direct life (Little, Wagner, & Boal, 2018). A nurse manager is in charge of the day-to-day operations of the workplace. This involves, among other things, personnel recruitment, employment, orientation, staff development and assessment, resource allocation and management, risk management, patient safety, and financial responsibility (Little, Wagner, & Boal, 2018).

Nurse managers are also required to offer nurses and other health care professionals with inspiration, advice, and direction and especially in a situation where the nurse-to-patient ratio is imbalanced. As a result, nurse supervisors have the best chance to establish professional nursing standards in the nursing staff. The connection between nurses and their leaders is important because it contributes to Magnet status, which results in better nurse satisfaction and high-performing work environments with excellent patient outcomes (Little, Wagner, & Boal, 2018). 

Nurse managers are skilled knowledge brokers as well. They transform organizational policy instructions into action at the frontline of health care while also providing information to top management about health care delivery and practice requirements to shape organizational policy. Nurse managers have an important intermediate function in this position (Little, Wagner, & Boal, 2018). The knowledge translation of organizational directions would not be possible without nurse managers.

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In a situation where the nurse-to-patient ratio is imbalanced, nursing leaders should employ autocratic leadership.Concentrating decision-making power at the top of the chain of command can be an effective method for completing simple tasks; rather than becoming bogged down by competing viewpoints, autocratic leaders can ensure that quality care is delivered safely and efficiently, with little time wasted on deliberation (Norwich University, 2017).

Autocratic leaders are effective at making important choices in time-sensitive situations when soliciting employee opinion may only help to confuse issues and hence represent a risk to the patient. As a result, autocratic clinical nurse leaders must be precise, succinct, and direct while organizing staff and ensuring that they follow the established protocols of their particular hospitals (Norwich University, 2017). 

In health-care environments with tight procedures, authoritarian leadership is quite successful. It can also be useful in typical medical institutions with high patient numbers. Because an unbalanced ratio of patients to health care professionals restricts how many resources may be committed, such institutions thrive when an authoritarian leader supplies them with commands broken down into fundamental stages (Norwich University, 2017).

Autocratic leadership in nursing does not foster trust or communication among team members, but rather promotes a culture in which team members’ important thoughts and knowledge go untapped. This type of leader discourages collaborative decision-making and transparency, both of which impede an organization’s journey to high reliability (Cornell, 2020).

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References

Cornwall, L. (2018, December 12). RNnetwork 2018 Portrait of a Modern Nurse Survey. From RNnetwork : https://rnnetwork.com/blog/rnnetwork-2018-portrait-of-a-modern-nurse-survey/

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

Michaud, M. (2020, June 18). COVID-19 Toll in Nursing Homes Linked to Staffing Levels and Quality. From University of Rochester Medical Center : https://www.urmc.rochester.edu/news/story/covid-19-toll-in-nursing-homes-linked-to-staffing-levels-and-quality

Harrington, C., & Edelman, T. S. (2018, July 20). Failure to Meet Nurse Staffing Standards: A Litigation Case Study of a Large US Nursing Home Chain. From NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055099/#bibr19-0046958018788686

Gutsan, E., Patton, J., Willis, W. K., & Coustasse, A. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. Chicago: Marshall University.

Curtin, L. (2016, April 7). A conversation about the ethics of staffing. From AMERICAN NURSE: https://www.myamericannurse.com/conversation-ethics-staffing/

Molina, M. J., & Estrada, J. G. (2020). Impact of Nurse-Patient Relationship on Quality of Care and Patient Autonomy in Decision-Making. International Journal of Environmental Research and Public Health, 2-3.

Little, L., Wagner, J., & Boal, A. S. (2018). Responsibility and Authority of Nurse Leaders. From Pressbooks: https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-12-responsibility-and-authority-of-nurse-leaders/

Norwich University. (2017, December 4). 5 Leadership Styles for Clinical Nurse Leaders. From Norwich University: https://online.norwich.edu/academic-programs/resources/5-leadership-styles-for-clinical-nurse-leaders

Cornell, A. (2020, April 13). 5 LEADERSHIP STYLES IN NURSING. From Relias LLC: https://www.relias.com/blog/5-leadership-styles-in-nursing

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