The Importance of Nurse Staffing Ratio and the Role of Nurse Leaders

This article discusses the importance of nurse staffing ratio in healthcare settings and the role of nurse leaders in shaping up the ratio while improving the overall quality of care. It explores the impact of nurse staffing on patient outcomes and the professional standards and guidelines related to nurse staffing. The article also highlights the role of nurse managers and leaders in determining the staffing levels and the importance of transformational leadership style in promoting proper nurse staffing ratio.

Running head: NURSING
Nursing
Name of the Student
Name of University
Author’s note

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Introduction
Nurses are regarded as one of the principle component of comprehensive healthcare.
Proper nurse staffing helps to impact the ability of the nursing professionals to delivery safe and
quality care under any practice settings. However, the delivery of the nursing care is
multifaceted, the proper determination of the nurse staffing is a complex work and the solution is
not simple (American Nurses Association, 2012). The following paper aims to focus on the
importance of the nurse staffing ratio under the healthcare settings and the role of a nurse leader
in shaping up the nurse staffing ratio while improving the overall quality of care.
Nursing staffing ratios
According to Rogowski et al. (2015), a national survey conducted on the perspective of
the American healthcare system found that the nurse understaffing is one of the greatest threat to
patients’ safety. As per the reports published by the American Nurses Association (ANA) when
the healthcare professionals fail to understand the relationship with the registered nurse (RN)
staffing and patients’ health related outcome, the legislations and rules becomes mandatory
(Rogowski et al., 2015). During 2003, California mandated the minimum RN: patient ratio for
hospitals and subsequently 12 other states also imposed the same law. Following the imposition
on the Medicare and Medicaid Service and subsequent quality improvement initiatives in the
domain of hospital acquired conditions, the nurse staffing ratio in the hospitals of US increased
substantially. During the tenure of 2004 to 2011 the total nursing hours per day in comparison to
the patient population in the general care units of the US hospitals increased by 11.5% and that
of RN per patient day, increased by 22.9% (Rogowski et al., 2015).

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Nursing staffing and quality of patients’ care
The study conducted by Griffithset al. (2016)over 10 years under California healthcare
setup stated that it may be intuitive that increased nurse staffing can improve the patients’ care
outcome however, the association between staffing of nurses and associated patients’ health
related outcome is inconclusive. A mate-analysis conducted by McHugh and Ma (2014) showed
that there is a consistent relationship between the high nurse staffing and lower patient mortality
rate of the patient in the ICU. However, the findings in the domain of establishing relationship
between the nurse staffing and other patients’ outcome like accidental fall, pressure ulcers and
urinary tract infections were inconclusive. The quantitative study conducted by He et al. (2016)
showed that there is a prominent association between staffing of nurse and patients’ health
related outcome both in the trend and in the seasonal levels. Kouatlyet al. (2018)showed in their
prospective study that increased nurse staffing ratio was effective in improving certain nurse-
sensitive outcomes but not others in the emergency units.
Professional standards and nurse staffing
According to the ANA (2019), it is the duty of the RN to think critically wile accessing
and analyzing the best available evidences in order to improve the safety and quality of care. The
study conducted by Twigg andMcCullough (2014) showed that increase in the nurse staffing
increases the provision for critical thinking of the nursing professionals by giving scope for
reflective practice. Reflective practice helps to refining the understanding of the clinical priority
of the patients and thereby helping to improve the patients’ health related outcomes. Conducting
comprehensive assessment also falls under ANA professional code of conduct. Increase in the
nurse staffing helps to conduct comprehensive patients’ assessment by reducing the workload
over individual nurse.

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Nurse leaders Vs Nurse managers in nurse staffing
Papathanasiou et al. (2014) are of the opinion that in order to retain the nurse staffing at a
standard level, it is the duty of the nurse leaders to keep the nursing professionals motivated.
Increase in motivation helps to increase the level of job satisfaction and thereby helping to
decrease the nurse turnover, burnout and adding to the nurse staffing ratio of professional yet
trained nurses. It is the duty of the nurse manager for plan the motivation of nursing
professionals. Motivation must come in the form of financial rewards or incentives along with
positional recognition. The positional recognition and financial rewards for the nurses working in
critical units like ICU and emergency units helps to promote nurse motivation and satisfaction
(Papathanasiou et al., 2014). While planning financial motivation, the nurse manager must
consult with the finance department of the hospital in order to estimate the range of the financial
reward.
The ANA (2012) principal of nurse staffing is organized into five different sets. The first
principal includes consideration and characterization of the healthcare consumer this will be
done by nurse managers. The second consideration includes inter-professional aspect of team
members and staffs. This aspect must be taken care of by nurse leader. The third and fourth
aspect covers the organizational environment and practice environment for care delivery. The
fifth aspect includes evaluation of the staffing plans. The staffing plan will be solely done by
nurse manager while role of the nurse leader is to maintain positive work environment in order to
keep the nursing professionals motivated.

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Additional aspect of nurse managers in nurse staffing
According to the American Nurses Association (ANA) (2019), nurse managers or leaders
are the best person to make the final judgment on the nurse staffing levels. Starting from the
complexity level of the patients, layout of the nursing unit, the nurse managers known the exact
provision that his or her team needs. In the face of the proposed federal interventions, the ANA
supports legislative model with nurse managers designated to create proper staffing plans for
their unit. These staffing plans must depend on patient’s complication, physical space, number of
admissions and skill level of the nurse (ANA, 2019).
Nursing leadership style
Transformational leadership is the nest suited nursing leadership style in order to promote
proper nurse staffing ratio under different hospital units. Transformational leaders transfer their
enthusiasm and power to their team mates by a way of modeling. This helps to promote work
engagement among the team. It also helps to lead a positive vision while establishing the zeal to
work with optimism in order to excel in work. The work engagement and positive work
environment promote by transformational leaders help to promote proper nurse staffing
ratio(Hayati, Charkhabi & Naami, 2014).
Conclusion
Thus from the above discussion it can be stated that nurse staffing plays an important role
in improving the health-related outcome of the patient. In order to maintain the proper nurse
staffing level the principles and the regulations published by the ANA must be followed for
fetching better outcomes. Apart from this, proper leadership style also plays an important role in
regulating proper nurse staffing under different hospital unit. Among other leadership style,

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transformational leadership holds prime importance in shaping up proper nurse staffing ratio by
motivating the nurses.

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References
American Nurses Association. (2012). Nurse Staffing Principle. Access date: 29th July 2019.
Retrieved from: https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/
principles-of-nurse--staffing--2nd-edition.pdf
American Nurses Association. (2019). Nurse Staffing. Access date: 29th July 2019. Retrieved
from: https://www.nursingworld.org/practice-policy/work-environment/nurse-staffing/
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