Literature Review: Nurse-to-Patient Ratio and Quality of Care

This assignment is a literature evaluation table focusing on the global nursing shortage. The student begins by summarizing the clinical issue, highlighting the shortage's impact on patient care, nurse burnout, and adverse outcomes like medication errors and reduced quality of care. A PICOT question is formulated to investigate the effect of high versus low nurse-to-patient ratios on patient outcomes and nursing errors over a 10-week timeframe. The evaluation includes six peer-reviewed research articles, analyzing their citations, relevance to the PICOT question, research methods, key findings, and recommendations. The articles explore the relationship between nurse staffing levels and outcomes such as mortality, medication errors, and omissions in nursing care, providing insights into the need for adequate staffing ratios to improve patient safety and the overall quality of care. The student also discusses the implications of the research and suggests recommendations for practice.

Literature Evaluation Table
Student Name:
Summary of Clinical Issue (200-250 words):
Nursing shortage is a global problem that faces the nursing profession. In the U.S, recent evidence reveals that more than 1 million
nurses are needed to feel the gap in nurses and to adequately cater for the needs of all patients. There are myriad numbers of reasons
that are associated with nursing shortages. Lack of potential educators and high turnover are the key reasons why nursing shortage is
prevalent. Various researches have also indicated that increase in aging population, aging workforce and most importantly nurse
burnout could worsen the situation. With increased need for care and limited supply of nurses, the working nurses experience
exhaustion and burnout factors which are strongly associated with job dissatisfaction and willingness to leave the profession. The
nursing turnover has in turn increased from 8.8% to 37% over the last five years (Gaffney et al, 2016).
Staffing shortages and increased burnouts also imply the ratio of patient-to-nurses is high. Other adverse effects
including poor quality of care, increased nurses’ slipups and lack of patient satisfaction are also associated with shortage in nurses
(Frith et al, 2012). Thus, the issue of nursing shortage should be addressed at its root level by increasing the staffing ratios in relation
to the number of patients demanding care. This notion is backed by the fact that evidence reveals increasing these ratios will in turn
improve quality of care and reduce medical errors.
PICOT Question:

When caring for acute care patients, does high nurse-to-patient ratio compared to low nurse-to-patient ratio decrease
or increase quality of care and nursing errors over a 10-week time-frame?
Criteria Article 1 Article 2 Article 3
APA-
Formatted
Article
Citation
with
Permalink
Driscoll, A., Grant, M. J., Carroll, D.,
Dalton, S., Deaton, C., Jones, I., &
Astin, F. (2017). 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), 6-22.
Retrieved from
https://journals.sagepub.com/doi/full/10.
1177/1474515117721561
You, M. E., Choe, M. H. Park, G.
K., Kim, S. H., & Song Y. J.
(2015). Perceptions Regarding
Medication Administration Errors
among Hospital Staff Nurses in
South Korea. International Journal
of Quality in Health Care, 27(4),
276-283. Retrieved from
https://academic.oup.com/intqhc/art
icle/27/4/276/2357294
Mark, B. A., & Belyea, M. (2009).
Nurse Staffing and Medication
Errors: Cross Sectional or
Longitudinal Relationships?
Research on Nursing and Health,
32(1), 18-30. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC2628558/
How Does
the Article
Relate to
the PICOT
Question?
Shows the relationship between nurse
staffing and patient outcomes.
The paper seeks to understand
whether nursing staffing is
associated with reduced medication
errors.
Illustrates the relationship between
nurse staffing and medication errors
in acute care settings.
Quantitati
ve,
Qualitative
(How do
you
know?)
Quantitative study. A systematic review
and meta-analysis.
Quantitative study involving a
cross-sectional survey with more
than 300 participants.
Quantitative study. Uses primary
data from medical surgical units.
Purpose
Statement
To examine the relationship between
nurse staffing levels and nurse sensitive
To identify reasons for medication
administration errors and why they
To examine the relationship
between change in nurse staffing
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patient outcomes in acute specialists
units.
are underreported. and change in medication errors
over 6 months in 284 general
medical-surgical nursing units.
Research
Question
What is the relationship between nurse
staffing levels and nurse sensitive patient
outcomes in acute specialists units?
What are reasons for medication
administration errors?
What is the relationship between
change in nurse staffing and change
in medication errors?
Outcome Reduced mortality and medication
errors.
Medication administration errors. Increased nurse staffing and patient
safety outcomes.
Setting
(Where did
the study
take
place?)
Conducted an online search in nine
electronic databases.
Three university hospitals in three
South Korean provinces.
Acute care hospitals with at least 99
licensed beds that were accredited
by The Joint Commission.
Sample 35 articles from 3429 articles met
inclusion criteria. 175,755 patients from
six studies were used in the meta
analysis.
312 hospital nurses 284 general medical-surgical
nursing units in 145 hospitals.
Method Systematic review and meta-analysis. A cross-sectional survey design. Experimental, longitudinal, causal
modeling design.
Key
Findings of
the Study
Higher staffing levels were associated
with reduced mortality, medication
errors, infections and better patient
recovery.
Inadequate number of nurses in
each working shift was the main
reason for the occurrence of
medication administration errors.
Increase in nurse staffing was
associated with reduced rates of
medication errors.
Recommen
dations of
the
Researcher
More evidence is required to substantiate
optimal nurse-to-patient ratios.
Nurse-staffing adequacy could be
helpful to prevent medical errors
among nurses.
Staffing-medication errors ought to
be examined within a larger
organizational context than in
isolation.
Criteria Article 4 Article 5 Article 6
APA-
Formatt
Griffiths, P., Saucedo, A.
R., Chiara, D., Briggs, J.,
Gaffney, T. A., Hatcher, B. J., Milligan, R., &
Trickey, A. (2016). Enhancing Patient Safety:
Frith, K. H., Anderson, E. F., Tseng,
F., & Fong, E. A. (2012). Nurse
3

ed
Article
Citation
with
Permali
nk
Maruotti, Meredith, P., &
Smith, G. B. (2018). The
Association between
Nurse Staffing and
Omissions in Nursing
Care: A Systematic
Review, Journal of
Advanced Nursing, 74(7),
1474-1487. Retrieved
from
https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC603
3178/
Factors Influencing Medical Error Recovery among
Medical-Surgical Nurses. The Online Journal of
Issues in Nursing, 21(3). Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/A
NAMarketplace/ANAPeriodicals/OJIN/
TableofContents/Vol-21-2016/No3-Sept-2016/
Enhancing-Patient-Safety.html
Staffing is an Important Strategy to
Prevent Medication Errors in
Community Hospitals. Nursing
Economics, 30(5), 288-293.
Retrieved from
https://www.nursingeconomics.net/n
ecfiles/specialissue/2012/Frith_Staff
ing.pdf
How
Does
the
Article
Relate
to the
PICOT
Questio
n?
Indicates nurse staffing
levels and related patient
outcomes.
Describes the relation between education, expertise
and staffing levels on medical error recovery.
Reveals the relation between
medication errors and nurse staffing.
Quantit
ative,
Qualitat
ive
(How
do you
know?)
Qualitative study. Used
secondary data.
A descriptive qualitative study. Qualitative study. Secondary sources
from online administrative databases
were analyzed.
Purpose
Stateme
nt
To identify nursing care
most frequently missed in
acute adult inpatient wards
and to determine evidence
To examine relationships between nurse
characteristics, organizational factors, and recovery
of medical errors among medical-surgical nurses in
hospitals
To examined the relationship
between nurse staffing and the
occurrence of medication errors
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for the association of
missed care with nurse
staffing.
Researc
h
Questio
n
What is the relationship
between nurse staffing
levels and adverse patient
outcomes?
What is the relationships between nurse
characteristics, organizational factors, and recovery
of medical errors?
What is the relationship between
nurse staffing and the occurrence of
medication errors?
Outcom
e
Adverse patient outcomes. Recovery of medical errors. Prevalence of medication
administration errors.
Setting
(Where
did the
study
take
place?)
Online search in
CINAHL, Cochrane
Library and Medline.
Researchers collected data online from October
2014 to January 2015 using Qualtrics® web-based
software and a self-report survey tool.
Medication error records were
collected from24 medical-surgical
units in 8 hospitals.
Sample 127 studies were
identified and 40 were
excluded.
A sample of 184 nurses. Documents contained 801 weekly
staffing intervals and 31,080 patient
observations.
Method Systematic review Descriptive cross-sectional, correlational study Retrospective, cross-sectional
design.
Key
Finding
s of the
Study
Eighteen of the reviewed
sources revealed that 75%
or more nurses reported
omitting some care. Also,
another 14 of the reviewed
studies showed that nurse
low staffing levels were
considerably associated
with higher reports of
missed care.
Medical-surgical nurses recovered on average 22
medical errors and error recovery was positively
associated with education and expertise and,
increase in nurse staffing.
The findings indicated that
increasing the number of RN hours
and eliminating or decreasing LPN
hours was an effective strategy in
reducing medication errors.
Recom
mendati
ons of
The authors suggest that
missed care can be used as
a key indicator of nurse
The authors therefore, recommend that in order to
create a safer healthcare system, there is need to
increase number of nurses who can be able to fully
There is need for future research to
consider the cost of an error against
the RN hours lost.
5

the
Researc
her
staffing adequacy. utilize their education and expertise.
References
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., & Astin, F. (2017). 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), 6-22. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1474515117721561
Frith, K. H., Anderson, E. F., Tseng, F., & Fong, E. A. (2012). Nurse Staffing is an Important Strategy to Prevent Medication Errors in
Community Hospitals. Nursing Economics, 30(5), 288-293. Retrieved from
https://www.nursingeconomics.net/necfiles/specialissue/2012/Frith_Staffing.pdf
Gaffney, T. A., Hatcher, B. J., Milligan, R., & Trickey, A. (2016). Enhancing Patient Safety: Factors Influencing Medical Error
Recovery among Medical-Surgical Nurses. The Online Journal of Issues in Nursing, 21(3). Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/
No3-Sept-2016/Enhancing-Patient-Safety.html
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