Nursing Issues: Nurse-Patient Ratio and Confidentiality Breach

This article discusses the nursing shortage issue and confidentiality breach in healthcare organizations. It highlights the effects of poor nurse-patient ratio on patient care, burnouts, and workplace stress. It also discusses the causes of low nurse-patient ratio and confidentiality breach and provides recommendations to overcome these issues.

Running head: NURSING ISSUES
NURSING ISSUES
Name of the student:
Name of the university:
Author note:

1
NURSING ISSUES
Introduction:
Nursing shortage can be defined as the situation where there arises a demand for the
nursing professionals to meet up the needs and requirement of service users because the number
of nurses present in the organization proves to be not sufficient to meet the service care needs
(Jacob et al., 2015). This has become one of the most severe issues that healthcare industry is
facing resulting in propounding impact on the quality service delivery to the patients by the
professionals. Confidentiality breach is another concern that is also affecting the patient
satisfaction and involving the professionals in legal consequences on breaking human rights.
This assignment will mainly be focusing in these two issues faced by the healthcare
organizations putting more light on the different aspects of them. Australia’s Future Health
Workforce – Nurses is the policy published by Commonwealth Australia discussing the nursing
shortage issue. Patient Confidentiality Policy is another policy published by Department of
health Australia discussing confidentiality issues of patients.
Discussion:
First issue: Nurse patient ratio:
The nurse patient ratio is one of the most important aspects that help in identifying the
presence of nursing shortage in the healthcare organization. The nurse-patient ratio can be
defined as the ratio of the nurses on a particular floor, ward as well as unit to the number of
patients who require the healthcare services. When the nursing professionals are lower than that
of the number of patients requiring service or when the nurse patient ratio is low, it can result in
negative consequences on the health of the patient and can lead to unsafe and poor quality
service (Whitehead & Myers, 2016). There has been a huge increase in the demand of healthcare

2
NURSING ISSUES
services particularly among the aging population in the present decade. This has been mainly due
to the advancement of the medical science as well as the technological improvements that had
helped in increasing the life expectancy of the people. However, the condition of life in the aged
population has not developed as many complex disorders affect them. Therefore, in order to meet
the increased healthcare needs of the huge number of the patients of the aged population, the
present number of nursing professionals is not sufficient. Hence, this increased number of the
aging population had created the main urge of requirement of more nurses in the nation.
Effects of poor nurse-patient ratio: poor patient care and increased suffering:
Researchers are of the opinion that low nurse patient ration remain intricately associated
with increased mortality rates in the healthcare units. Moreover, it also results in huge number of
medication errors by the nursing professionals, as they have to handle huge patients within short
time creating huge scopes of human errors (Buchan et al., 2015). Wrong infusion rates,
admission of more number of doses than the prescribed number of doses, omission of the
medications, mistaken medication as well as administering medication of one patient to another
patient are some of the types of medication errors that remain associated with low nurse-patient
ratios. About 12.76% of the different medication errors that are reported to the higher authorities
are mainly because of the poor nurse-patient ratios in the hospital organizations (Whitehead &
Myers, 2016). Studies are also of the opinion that inadequate nurse-patient ratios are associated
with higher levels of the patient falls and different type of infections that results in higher levels
of suffering for the patients (Wang et al., 2017).

3
NURSING ISSUES
Effects of poor nurse-patient ratio: burnouts and workplace stress
Attending to huge number of patients more than the capability of the professionals can
result in physical and emotional drain-outs of energy that affect the health of the professionals.
The nursing professionals are seen to suffer from burnouts and fatigue that not only affect their
personal as well as professional lives but also have severe impacts on the health of the patient.
Due to nursing shortage, many of the professionals are forced to work for more number of hours
than their stipulated hours (Maclean et al., 2014). These make them suffer from physical issues
like body-ache, shoulder-ache, headaches, fatigue, gastric disorders and many others. Moreover,
nursing job is emotionally draining as well and caring or so many patients with different needs
and requirements also create mental and emotional stress in them making them feel stressed and
burned-out. These forms of stress and fatigue affect the ways by which they provide care to the
patients. They do not get proper time and energy for developing therapeutic relationship with the
patients that are extremely important for the development of trust and bond among the patient
and the nurses (Buchan et al., 2015).
Absence of effective communication between the nurses and patients due to reduced
patient-time for the nurse’s impact patient satisfaction. The patient are seen to believe that the
nurses are not providing them enough respect and care which they require and this makes the
patients upset (Cowan et al., 2015). Patients also report longer waiting times and this is also
associated with low nurse-patient ratio. Such stress of attending more number of patients often
forces them to work beyond their stipulated hours and this affects their work life balance were
they cannot have proper personal and family lives. These affect them to a huge extent and all
these affected the morale of the nurses making them leave their jobs.

4
NURSING ISSUES
Causes of low nurse-patient ratio:
Often studies have revealed that increased aging population has created extra pressure on
the nurse population in the nation. The present nursing population is not sufficient to meet the
increasing aged care service users and therefore, this has led to the occurrence of nursing
shortage. The different healthcare services witness more number of patients than the number of
nurses can care for. Therefore, increased aged population has been one of the causes of low nurse
patient ratio in the organization (Twig et al., 2016). The second cause is that the generation is
accounting for about high number of nursing population who has reached the retiring age and
would be retiring within the year only. Studies have shown that for every 110 retiring nurses,
there are only 84 nurses who are joining the healthcare industry. This gap of 24 nurses in every
retirement phase is culminating to a huge gap resulting in huge number of nursing shortage in the
nation.
Another cause is the improper supply of funding and resources by the healthcare
departments of the organization. Many of the organizations are seen to try their best to keep up
their profit margin and therefore they tend to recruit lesser number of nurses than that which is
required in the healthcare departments (Bemoth et al., 2014). They do not want to pay to higher
number of nurses and they want to recruit only lower number of nurses to increase the profit
margin.
Their lack of proper funding is also noticed where they do not arrange for proper training
and education sessions to the nurses. Therefore, it becomes very difficult for the nurses to dream
of proceeding forward in their career and hence they tend to leave the profession. Moreover, the
healthcare organizations also do not supply requisite amount of resources required for

5
NURSING ISSUES
maintaining hygiene like gloves, sterilizing agents, sanitizers, proper equipments and many
others. Moreover, proper education and training resources are also not provided making it very
difficult for the nurses to keep up with the recent advancements in the nursing professionals
(Green et al., 2017). Moreover, they are also not provided incentives for working outside shift,
health benefit schemes and many others. Proper leadership and guidance also remain absent for
the nursing professionals. All these hamper their job satisfaction. They suffer from lower morale
and thereby all these make them leave their profession.
Recommendations: to develop nurse staffing:
The healthcare departments mainly of the governmental organization should introduce
strategies like allocation of specific funds for students who would be pursuing nursing
profession. This would be an interesting medium for encouraging many students to take up
nursing as a career. Moreover, the governmental organizations should promote the nursing
profession as a lucrative opportunity with proper amount of remuneration so that more students
take up the nursing profession in the nation (Petrova et al., 2016). This would help in increasing
the number of students undertaking the professionals and would help in bringing the gap between
the aged nurses who are retiring and the new nurses who are joining the industry. The second
recommendation that the healthcare departments can undertake is the allocation of experienced
nursing leaders and managers who would ensure that the nurse patient ratio is healthy and is not
harmful to both patient and nurses. They need to develop proper training sessions as well as
counseling sessions.
Training sessions would be helping the nursing professionals to learn new improvements
made in the nursing field and be up to date. This would make them feel that the organization care

6
NURSING ISSUES
for their career and this would help them to remain dedicated to the organization. On the other
hand, counseling would be mainly helping the nursing professionals to release their mental and
emotional pressures and accordingly would give those suggestions about how to overcome their
mental instabilities effectively (Mannix et al., 2017). Thirdly, the HR department has to take up
the initiatives for the recruitment of professional nurses in order to meet the nursing staff needs
in the organization. Moreover, they should also arrange for proper resources allocation according
to the needs of the nurses so that they can practice effectively, provide safe care to the patients,
and take care of their own selves.
The fourth strategy would be that the nursing leaders should take up transformational
leaders where they would follow individualized consideration. Here they would individually
learn about the concerns of the nurses and give the effective ways of overcoming the issues.
They would also motivate the employees to work beyond their potential and not to leave the
profession (Scruth et al., 2015). These would k the employees feel that their dedication is
respected and that they are cared for by the organization. These would reduce the turnover rates
helping to manage the nurse staffing in the organization.
Second issue: confidentiality issue:
Confidentiality is one of the most important bioethical principles that every healthcare
professional needs to maintain in order to ensure proper relationship between the patient and the
professionals, to ensure safety and security of the patient and to protect human rights. This
bioethical principle advises nurses to keep any personal information about the patient private and
secured until the patient gives consent in sharing this information with others. Studies have
supported this view and had confirmed that it is not only a matter of the moral respect but is also

7
NURSING ISSUES
important in the retaining of the important bond of trust between the professional and the
individual service users (Hao & Gao, 2017). However, often many of the nurses are seen to
breach this bioethical principle intentionally as well as unintentionally which result in various
kinds of negative impact on the patient affecting his quality of life. This is discussed in the
following paragraph.
Effects of breaching the confidentiality of the patient:
Breaching of confidentiality and revealing of information by the healthcare professionals
might have severe negative impact on the patient. The patient might be seriously harassed
mentally as well as physically and emotionally by the leak of the information to dishonest
people. The spreading of the information might affect the self-esteem or the self-respect of the
person in front of family members, acquaintances, friends and others which might have severe
impact on his health (Shuckling et al., 2016). The patient might face threatening situations or
might be abused by perpetrators who gain the valuable information over might might blackmail
them. The patient may also feel embarrassed or shameful because of the spreading of valuable
information. Moreover, it also results in breaking of the bond of trust between the professionals
and the patients affecting the therapeutic relationship (Forrester, 2017). Hence, it is important for
the nursing professionals to maintain confidentiality and respect patient rights.
Causes of confidentiality breach:
Often nurses find themselves in tenuous position when they are constantly asked for the
information of the service users by the family of the patients and other well-wishers. Often they
become overtly emotional which creates a situation where the nurses fail to self-regulate their
emotions and tend to reveal the information being blown away with feelings. This is completely

8
NURSING ISSUES
a breach in the professional conduct where they are seen to break the privacy of the patient and
reveal confidential information (Johnstone, 2016). Secondly, casual behaviors of the
professionals also tend to be one of the reasons that results in breaching of the privacy of
patients. Often healthcare professionals are seen to talk casually about the patients in the public
patients, elevators as well as in the cafeterias, during telephonic conversations, during the
accessing of the electronic data as well as on the social media. Such careless behaviors become
one of the main causes of the breaching of the confidentiality of patients.
Recommendations: to overcome the issue of confidentiality breach:
Lack of education, skill and knowledge are mainly found to be the reason that results in
such behaviors of the professionals. Nurses might not have proper knowledge or that they are not
educate enough to understand the importance of emotional intelligence. Self-regulation as well
as self-awareness is two important components that help them to handle situations like constant
emotional coaxing of family members of patients effectively. They should be educated about
ways to develop such skills effectively. Once they master these skills, they will be able to
critically analyze the situation, develop effective plan to handle the situations and control the
situation by managing the emotions of family members and not revealing information as well
(Ryan, 2016). Again, lack of education about the importance of professional conduct and
bioethical principle management make them portray casual behaviors or discussing valuable
information anywhere. Such information should be also instilled making them aware of the
consequences and helping them to identify their mistakes. Therefore, proper trainings should be
given to them, encouraging them to attend workshops and go through evidence based articles.
Conclusion:

9
NURSING ISSUES
From the above discussion, it becomes clear that poor nurse-patient ratio and
confidentiality breach are two of the most important concerns that healthcare organizations face
in the present day. Both of them have propounding impact not only on the physical, mental and
emotional health of the patient but can also disrupt the therapeutic relationship of the patient and
the nurse. It can break the trust between them affecting the patient satisfaction. While aging
population, lack of funding and resource are the main causes for the first issue, lack of education,
casual behavior and low emotional intelligence are the causes of the second issue. Therefore,
strategies need to be developed by the concerned authorities so that they both the issues can be
overcome successfully and patient satisfaction along with better quality life of the patients can be
ensured.

10
NURSING ISSUES
References:
Bernoth, M., Dietsch, E., Burmeister, O. K., & Schwartz, M. (2014). Information management in
aged care: cases of confidentiality and elder abuse. Journal of business ethics, 122(3),
453-460.
Buchan, J., Duffield, C., & Jordan, A. (2015). ‘Solving’nursing shortages: do we need a New
Agenda?. Journal of nursing management, 23(5), 543-545.
Buchan, J., Twigg, D., Dussault, G., Duffield, C., & Stone, P. W. (2015). Policies to sustain the
nursing workforce: an international perspective. International Nursing Review, 62(2),
162-170.
Cowan, D., Brunero, S., Lamont, S., & Joyce, M. (2015). Direct care activities for assistants in
nursing in inpatient mental health settings in Australia: A modified Delphi
study. Collegian, 22(1), 53-60.
Forrester, K. (2017). An Introduction To Legal Aspects Of Nursing Practice. Contexts of
Nursing: An Introduction, 153.
Green, J. (2017). Nurses’ online behaviour: lessons for the nursing profession. Contemporary
nurse, 53(3), 355-367.
Hao, J., & Gao, B. (2017). Advantages and Disadvantages for Nurses of Using Social
Media. of, 3, 2.

11
NURSING ISSUES
Jacob, E. R., McKenna, L., & D'amore, A. (2015). The changing skill mix in nursing:
considerations for and against different levels of nurse. Journal of Nursing
Management, 23(4), 421-426.
Johnstone, M. J. (2016). Privacy, professionalism and social media. Australian Nursing and
Midwifery Journal, 23(7), 23.
MacLean, L., Hassmiller, S., Shaffer, F., Rohrbaugh, K., Collier, T., & Fairman, J. (2014). Scale,
causes, and implications of the primary care nursing shortage. Annual Review of Public
Health, 35, 443-457.
Mannix, T., Parry, Y., & Roderick, A. (2017). Improving clinical handover in a paediatric ward:
implications for nursing management. Journal of nursing management, 25(3), 215-222.
Petrova, E., Dewing, J., & Camilleri, M. (2016). Confidentiality in participatory research:
Challenges from one study. Nursing Ethics, 23(4), 442-454.
Ryan, G. S. (2016). International perspectives on social media guidance for nurses: a content
analysis. Nursing Management.
Scruth, E. A., Pugh, D. M., Adams, C. L., & Foss-Durant, A. M. (2015). Electronic and social
media: The legal and ethical issues for healthcare. Clinical Nurse Specialist, 29(1), 8-11.
Suckling, R., Shickle, D., & Wallace, S. (2016). 16 Public and Patient Attitudes Toward the Use
of Their Health Information: A Review of the Literature. GIS in Public Health Practice,
265.

12
NURSING ISSUES
Twigg, D. E., Pugh, J. D., Gelder, L., & Myers, H. (2016). Foundations of a nursing-sensitive
outcome indicator suite for monitoring public patient safety in Western
Australia. Collegian, 23(2), 167-181.
Wang, C. C., Whitehead, L., & Bayes, S. (2017). The real ‘cost’of study in Australia and the
ramifications for China, Australia, and the Chinese nursing students: what do these three
players want? A narrative review. Globalisation, Societies and Education, 15(5), 590-
606.
Whitehead, L., & Myers, H. (2016). The effect of hospital nurse staffing models on patient and
staff‐related outcomes. International journal of nursing practice, 22(4), 330-332.