Impact of Nurse to Patient Ratio on Patient Outcomes: A Report

This report delves into the critical issue of nurse-to-patient ratios within the American healthcare system, highlighting the financial pressures and their impact on patient care. The introduction underscores the business-oriented nature of the healthcare industry, where insurance companies and hospital management influence treatment decisions and resource allocation. The author, a nurse in a Transitional Care Unit, shares personal experiences of being overburdened with a high patient load, leading to compromised care. The report aims to analyze existing literature on the topic and propose strategies for improvement. An annotated bibliography is included, summarizing key studies that explore the relationship between nurse staffing levels, patient outcomes, and missed care. The conclusion emphasizes that reducing nurse-to-patient ratios can potentially increase patient satisfaction, improve nurse morale, and decrease lawsuits, ultimately benefiting healthcare organizations financially. The report references several scholarly articles that support the arguments presented.

Running head:NURSE TO PATIENT RATIO
Nurse to Patient Ratio
Name of the student
Name of the university
Author’s name

1NURSE TO PATIENT RATIO
Introduction
The American healthcare system acts more as a business industry compared to any other
healthcare system in the world. In America, the insurance companies have a substantial effect on
the patient care and on the treatments, which occurs by influencing which diagnostic tests and
which treatment cost will be reimbursed (Denton, 2018). The hospital management always keeps
a track on the budget and on the duration of stay of the patient to stay in the profitable margin
and remain viable. In American healthcare system, nursing staff are the core members.
According to a literature, the nurses are the key members who are responsible for the smooth and
effectively running of the hospital (Dousay, Childers, Cole, Hill & Rogers, 2016). Though, there
are complaints of nurses that they are generally overworked and given responsibilities of more
patients than the amount they can handle and they are underpaid. This reason has led fewer
nurses taking responsibility of more patients and as a consequence the patient care gets adversely
affected (Aiken et al., 2018).
Currently I am working for a long term care in the Transitional Care Unit (TCU) of a
healthcare organization in Minnesota in United States. I have been given the responsibility of 30
patients to take care of, and among those around 5 to 8 patients belong to the TCU. It becomes
very much challenging and hard for me to alone take care of so many patients. When taking care
of so many patients I don’t get a chance to take any break and as a result I fail to take good care
of my patients. I am always working as a nursing assistant whenever I am called for by my
superiors.

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The aim of this article is to thoroughly study the current literature regarding the nurse to
patient ratio and examine different approaches in reducing the challenging healthcare issue and
incorporate them in the healthcare organization.
Annotated Bibliography:
Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D.
(2017). Are high nurse workload/staffing ratios associated with decreased survival in
critically ill patients? A cohort study. Annals of intensive care, 7(1), 46.
Despite the key role of caregivers in intensive care, there has been no clear relationship
between the workload / personnel ratio for intensive care nurses and survival. The study has
determined whether there is a threshold workload/staffing ratio above which the likelihood of
hospital survival is reduced and the study has then shaped the relationship between exposure to
poor staffing and risk-adjusted hospital survival at any stage of an ICU stay. A retrospective
study was undertaken on potential collected data from two multi-disciplinary Intensive Care
Units assigned to a group of adult patients. The care workload [ midway through the Therapeutic
Intervention Systems (TISS-76)] for each ICU patient during each day was analyzed using a net-
benefit regressive approach and logistic regression as a measure of total number of nurses each
shift (workload / nurse), seriousness of the condition and medical longevity per day. The study
has found that exposure of critically ill patients to high workload / staffing ratios indicates that
the chances of survival have been significantly reduced.
Oppel, E. M., & Young, G. J. (2018). Nurse staffing patterns and patient experience of
care: An empirical analysis of US hospitals. Health services research, 53(3), 1799-1818.

3NURSE TO PATIENT RATIO
The observational study aims to determine the connection between nursing and the
experiences of patients in hospitals with a focus on staff flexibility. The research has covered
general hospitals in the US, around 2010 and 2012. The data from the Annual Survey by the
American Hospital Association came from the health care providers and system's Medicare
Hospital Consumer Assessment. An observational design for a pooled cross-sectional series was
used in the study. Models of regression were estimated by the generalized estimating equation
(GEE) and fixed effects in hospitals. The patterns for the staff in nurses were assessed on the
basis of both the level of the staff (i.e. ratio of full-time equivalent nurses per 1,000 days of the
patient) and the level of composition. The research findings suggest that all three staff variables
were significantly linked to the patient's GEE analysis, but only employee flexibility was
important in the analysis for fixed effects. The patient experience was positively associated with
a higher proportion of part-time caregivers. The workforce factors also had numerous and
nonlinear impacts. Flexibility has been found to be the most essential compared to patient
experience among three staff variables. Unregulated hospital characteristics as well as certain
nursing staff patterns seem to form the basis of patient experience.
Griffiths, P., Recio‐Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., ... &
Missed Care Study Group. (2018). The association between nurse staffing and omissions in
nursing care: A systematic review. Journal of advanced nursing, 74(7), 1474-1487.
The systematic review aims to identify the most frequent failure to nursing care in acute
adult hospital wards and to determine evidence that missed care is associated with the nurse
staffing. Research has linked the levels of nursing staff to the results of the unfavorable patient,
including death in hospitals. However, the causality and lack of care (referred to as missed care,
care left undone) have been proposed as an indicator of the adequacy of nurse health care. The

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authors have looked for quantitative studies of the associations between staff and missed care at
the Cochrane Library, CINAHL, Embase and Medline. They have also scanned for journals,
personal libraries and publications or articles. The study suggests that a low registered nurse
personnel are associated with hospital missed care reports. A promising indicator of the
adequacy of nursing work is the lack of care. It is still necessary to investigate to what extent the
relations observed represents true failures.
Conclusion
Different literature studies have demonstrated that by decreasing the nurse ratio,
healthcare organizations can make huge financial profits, though it will have a negative outcome
where the health of the patient will keep on worsening and the duration of stay in the hospital
will keep increasing. By shortening the nurse ration will also have a negative effect on the
morale of the nurses and will have various recruitment challenges and cause malpractice suits,
that can increase the financial burden compared to the amount of recruiting more nurses. Thus,
by decreasing the nurse to patient ratio, that is, by limiting the ratio of patients, there is a slight
chance that it will boost patient satisfaction; increase morale of the nurses, there will be a
decrease in the lawsuits and all of this outcome will positively impact the healthcare organization
by reducing the hospital costs in the long-term.

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References
Aiken, L. H., Cerón, C., Simonetti, M., Lake, E. T., Galiano, A., Garbarini, A., ... & Smith, H. L.
(2018). Hospital nurse staffing and patient outcomes. Revista Médica Clínica Las Condes, 29(3),
322-327.
Denton, G. (2018). The intensive care nurse. In The Beginner's Guide to Intensive Care (pp. 49-
50). CRC Press.
Dousay, T., Childers, B., Cole, M., Hill, T., & Rogers, C. (2016). Lower Nurse-to-Patient Ratio:
Higher Patient Satisfaction.
Griffiths, P., Recio‐Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., ... & Missed
Care Study Group. (2018). The association between nurse staffing and omissions in nursing care:
A systematic review. Journal of advanced nursing, 74(7), 1474-1487.
Lee, A., Cheung, Y. S. L., Joynt, G. M., Leung, C. C. H., Wong, W. T., & Gomersall, C. D.
(2017). Are high nurse workload/staffing ratios associated with decreased survival in critically ill
patients? A cohort study. Annals of intensive care, 7(1), 46.
Oppel, E. M., & Young, G. J. (2018). Nurse staffing patterns and patient experience of care: An
empirical analysis of US hospitals. Health services research, 53(3), 1799-1818.