Assessing the Effectiveness of 1:1 Nurse-Patient Ratio in Achieving Positive Patient Care and Nurse Job Satisfaction

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Title: A summary of assessing the effectiveness of 1:1 nurse-patient ratio in achieving positive
patient care as well as nurse’s job satisfaction: a rapid review
Objectives
The objective of the study is to assess the effectiveness of the 1:1 nurse patient ratio, in order to
achieve a standardised and positive patient’s outcome.
Research question: What is the effectiveness of 1:1 nurse-patient ratio in achieving patient’s
health outcome and job satisfaction?
PICO element:
P: Number of nurse and patient in the health care setting
I: Strategy of maintaining the1:1 nurse-patient ratio
C: Comparing between the patient health outcome of adequate nurse-patient ratio and inadequate
nurse patient ratio.
O: Patient health outcome and job satisfaction
Keywords used: Nurse –patient ratio, nurse staffing, standardised care, systematic reviews
Significance of the study:
Nurses provides holistic care to the patient and their families 24 hour a day. Inadequate
nurse staffing in the health setting significantly effects on the quality of patient care and may

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results in negative nurse’s outcomes such as job dissatisfaction and emotional exhaustion
(Nantsupawat et al., 2015). In one hand, the nurse-to-patient ratio shows nurses outcomes, as,
one-fourth (approximately) of nurses have job dissatisfaction, about half of the nurses outcome
includes needle injury and three-fifth of nurses reported having misses in the past year
( Nantsupawat et al., 2015). On the other hand, the research study shows that proper nurse patient
ratio, as well as increase in their working hours per patient has a significant impact on patient’s
health outcomes such as lower rates of pressure ulcers, pneumonia, falls and sepsis, reduces
medication error and decrease in the mortality rate. Additionally, the research conducted in
England shows health settings with less number of patients per registered nurse had lower
mortality rate (20%) comparing to those hospitals which has higher number of patient per
registered nurses (Watson et al., 2016.). Inadequate staffing of the nurses has been found to be
dangerous for the patients and they increases the rates of infections, illness, errors and mortality.
When the nurses are assigned with too many patients, they are at a higher risk of the medical
errors that can be easily prevented, the avoidable medical errors, the falls and the injuries, the
pressure sores, increased length of the stay and readmissions.
Globally, there had been an increasing concern about the job satisfaction of the nurses, as
it plays an important role in the retention of the nurses and the care quality of the patient (Lu,
Zhao, & While, 2019). Inadequate staffing has been found to have been long working hours, lack
of personal time and lack of organisational commitment.
Other studies by Kleinpell et al., (2015), have found that understaffing in the intensive
care unit increases the risks of medical infection. Specific ratio of the nurse and patient are
maintained in an intensive care. In paediatric intensive care unit the ratio was found to be 1 to 4.

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The factors affecting the nurse practitioners and physician assistant involved severity of the
illness, the number of patients in the intensive care unit.
It is the routine of the clinical settings to respond to the nurse-patient ratio and the
legislator calls for a minimum safe nurse staffing laws with threats of staffing cuts. A study in
Twigg, Cramer & Pugh, (2016) has found that the nurse staffing for the rural health care settings
needs to be increased for managing the workload staff utilisation and greater patient outcomes. It
has been found that the nurse staffing models of care with a diversity in the workload factors
driving the nursing activity pose a major challenge for providing a safe and quality patient care.
According to the Falk and Wallin, (2016), the nurse-patient ratio affects the intensive
care unit, the most. As per the results of the study, patient care and complications in relation to
the patient/ nurse ratio had shown that unplanned extubations occurred in 3-5 % of the cases. A
difference has also been found in the length of the patient’s stay.
Hockenberry and Becker, (2016), have stated that nurse face higher level of stress and
burnout in comparison to the other health care professionals. It has been found that hospitals
with higher levels of nurse’s per bed increases patient satisfaction. According to the study, less
traned staffs are never desired for the organisation. However, if properly trained, different
staffing mixes can affect the different domains of patient satisfaction. This can be supported by a
paper by Cho et al., (2015), which studied that nurses often have to work for long hours/
overtime due to shortage of staffing. A considerable link between patient outcomes and nurse
staffing, work environment has been found. The findings of the review has suggested that nurses
working for longer hours have experienced fatigue and have poor quality of sleep that has
affected their vigilance , reaction time , alertness and the decision making ability and thus