Impact of Nurse to Patient Ratio: A PICOT Statement Analysis

This report provides a detailed analysis of the impact of nurse-to-patient ratios on patient outcomes and the quality of care in healthcare settings. The report begins with an introduction to the concept of nurse-to-patient ratios and their significance in healthcare, highlighting the importance of safe staf...Read More

Running head: PICOT STATEMENT
Nurse to patient ratio
Name of the Student
Name of the University
Author Note

1PICOT STATEMENT
Introduction
The nurse to patient ratio refers to a quantity that helps in describing the total number
of patients who have been assigned to each nurse (McHugh et al., 2016). Allocation of
patients to nurses are primarily dependent on the needs or acuity of the patients, in relation to
nursing care. This assignment will elaborate on a PICOT statement, in relation to nurse to
patient ratio.
Evidence based solution
Time and again it has been proved that a greater nurse to patient ratio advances
countless expanses of nursing, counting in the quality of care, quality of documentation, and
adverse health events. Nurses have been recognized to play an important role in the
healthcare settings, thereby calling for the need of implementation of safe-staffing ratios that
are mandated by the state (Watson et al., 2016). This in turn ensures the safety of both nurses
and patients. According to (Driscoll et al., 2018) higher nurse staffing levels are correlated
with decreased mortality, ulcers, medication errors, restraint use, pneumonia, infections, and
more patients obtaining percutaneous coronary intervention, and higher aspirin use. Higher
ratio has also been linked to poor work environment and reduced likelihood of optimum
survival rates among patients.
Nursing intervention
With budget cuts, nursing shortage, and hospital downsizing most nurses find it
difficult to spend adequate time on each patients. The major interventions should focus on
recruiting more nursing professionals and preventing overcrowding of patients, through
proper delegation of clients to healthcare personnel. Improving recruitment and retention
rates are largely associated with a drastic improvement in nurse to patient ratio (Hairr et al.,
2014). Collaboration with multidisciplinary team members, budget allocation, and proper

2PICOT STATEMENT
time management skills are also required for improving the ratio. Establishing minimum
adjustable number of nurses, including output from direct care nurses and their
representatives, taking into account the educational attainment and training of nurses, and
following mandatory staffing levels that are enforced by the state legislature are other
interventions (Arkin et al., 2014).
Patient Care
Safe staffing creates an impact on the quality and safety of patient care. Low ratio
helps in decreasing nurse fatigue, which in turn promotes safety of the patients and increases
nurse job satisfaction. Reduction of burnout, comprising of chronic fatigue, insomnia,
irritability, and depression allows the nurses to spend more time in caring for all patients,
thereby allowing them to focus properly on individual patients. Under poor work
environment when nurses have to care for more than one critically ill patient, none of the
latter get optimal care services, which in turn violates patient safety and wellbeing.
Research question
What is the consequence of a high nurse to patient ratio on the quality of care and
patient outcomes, compared to low nurse to patient ratio, in acute care settings?
PICOT components
PICOT acts as a mnemonic that helps in describing the different components of a good
research question (Abbade et al., 2016). The components of the capstone research question
are given below:
 (P)/Population- Patients admitted to ICU
 (I)/Intervention- Low nurse to patient ratio
 (C)/Comparison- High nurse to patient ratio
 (O)/Outcome- Better patient outcomes and enhanced quality of healthcare

3PICOT STATEMENT
 (T)/Time- 3 months
Health Care Agency
According to the AHRQ (2019) excessive nursing workload is a crucial safety issue
for both the healthcare personnel and the patients who are admitted to different healthcare
organizations. The AHRQ has recognized the fact that missed nursing care is a kind of error
related to omission where the much necessary care elements are not accomplished, and this is
comparatively common in the inpatient wards. Furthermore, the capstone project will also be
based on the California state law that mandates a 1:1 or 1:2 nurse to patient ratio in ICUs,
depending on patient stability (Leigh et al., 2015).
Nursing practice
Nurse staffing is a critical factor that helps in the determination of the quality of
healthcare services that are delivered in hospitals, and their subsequent impact on patient
outcomes. Proper nurse to patient ration will help in reducing rates of errors, thereby
lowering the chances of preventable health complications in at-risk clients who are admitted
to ICU (Martin, 2015). Another potential implication to practice is the fact that a low ratio
will result in positive clinical outcomes, thereby increasing the desire to care for patients, and
enhancing job satisfaction.
Conclusion
To conclude, maintaining a low ratio of nurses on a ward, to that of the patients has
been associated with an improvement in patient health and wellbeing. Therefore, the PICOT
statement for the capstone project will try to determine the impacts that low nurse to patient
ratio will have on patient health outcomes.

4PICOT STATEMENT
References
Abbade, L. P., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of
research question using the PICOT format in randomised controlled trials of venous
ulcer disease: a protocol for a systematic survey of the literature. BMJ open, 6(11),
e013175.
Agency for Healthcare Research and Quality. (2019). Nursing and Patient Safety. Retrieved
from https://psnet.ahrq.gov/primers/primer/22/Nursing-and-Patient-Safety
Arkin, N., Lee, P. H., McDonald, K., & Hernandez‐Boussard, T. (2014). The Association of
Nurse‐to‐Patient Ratio with Mortality and Preventable Complications Following
Aortic Valve Replacement. Journal of Cardiac Surgery: Including Mechanical and
Biological Support for the Heart and Lungs, 29(2), 141-148.
Driscoll, A., Grant, M.J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee,
G., Munyombwe, T. and Astin, F., 2018. The effect of nurse-to-patient ratios on
nurse-sensitive patient outcomes in acute specialist units: a systematic review and
meta-analysis. European Journal of Cardiovascular Nursing, 17(1), pp.6-22.
Hairr, D. C., Salisbury, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse staffing and
the relationship to job satisfaction and retention. Nursing Economics, 32(3), 142-147.
Leigh, J. P., Markis, C. A., Iosif, A. M., & Romano, P. S. (2015). California’s nurse-to-
patient ratio law and occupational injury. International archives of occupational and
environmental health, 88(4), 477-484.
Martin, C. J. (2015). The effects of nurse staffing on quality of care. MedSurg Nursing, 24(2),
S4-S4.

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McHugh, M. D., Rochman, M. F., Sloane, D. M., Berg, R. A., Mancini, M. E., Nadkarni, V.
M., ... & American Heart Association’s Get With The Guidelines-Resuscitation
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Watson, S. I., Arulampalam, W., Petrou, S., Marlow, N., Morgan, A. S., Draper, E. S., &
Modi, N. (2016). The effects of a one-to-one nurse-to-patient ratio on the mortality
rate in neonatal intensive care: a retrospective, longitudinal, population-based
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