Exploring Nurse to Patient Ratios: A Comprehensive Literature Review

This literature review examines the impact of nurse-to-patient ratios on healthcare quality and patient outcomes by comparing various scholarly sources. The review analyzes quantitative studies that explore the relationship between nurse staffing levels, work environment, and adverse medical events, highlighting that lower patient assignments per nurse correlate with reduced adverse events. The review also discusses research indicating that higher nurse staffing can significantly reduce patient mortality rates and improve job satisfaction among nurses by alleviating heavy workloads. The conclusion emphasizes the importance of maintaining optimal nurse staffing ratios to promote positive patient outcomes, prevent adverse events, and enhance job satisfaction, advocating for healthcare policymakers to prioritize optimal nurse staffing as a mandatory criterion.

Running head: LITERATURE REVIEW
LITERATURE REVIEW
Name of the Student:
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1LITERATURE REVIEW
Introduction:
The quality of effective care delivery within a healthcare setting is largely determined by
the optimum nurse to patient ratio. It should be noted in this context that the ability of a nursing
professional to deliver effective care to the patients is dependent on the number of patients the
RN has been assigned to attend for the day. An optimum nurse to patient ratio within a care unit
helps in the smooth distribution of workload and also renders effective decision making (Gnanlet
& Gilland, 2014). It can be stated in this context, that a care environment that is not equipped
with ample care professionals but has a huge patient load is bound to cultivate poor job
satisfaction and excessive workload among the existing workforce. Further, as mentioned by
Knudson (2013), stretched shift hours, excessive workload and poor job satisfaction serve as the
major reasons that lead to nurses burnout. Also, according to Watson et al. (2016), maintenance
of an optimum nurse to patient ratio can help in rendering quality care services within the elderly
and the neonatal care unit. It has further been stated in this regard, that effective nurse to patient
ratio can play an integral role in the prevention of the high rates of morbidity and mortality
among a specific care setting. This paper intends to compare and contrast the available literatures
that are relatable to the research question and establish a discussion based on the findings.
Discussion:
A number of researchers have laid emphasis upon the fact that maintenance of an optimal
nurse to patient ratio within a care setting can help in improving patient outcome. This paper
intends to evaluate a number of scholarly sources to compare and contrast between the impact of
a high nurse to patient ratio on the quality of care and a low nurse to patient ratio on the quality
of care within a care environment.

2LITERATURE REVIEW
Eunhee et al. (2016) conducted a quantitative cross sectional study in order to examine
the relationship between the work environment and nurse staffing level to the incidence of
medical adverse events. The researchers used a combination of the patient discharge data, facility
data as well as the nurse survey data to conduct the research. The sample size considered by the
researchers for the study included a total of 4864 nurses and 113426 patients and the data was
collected from 58 hospitals of South Korea (Eunhee et al., 2016). The collected data was
analyzed using the descriptive statistics and the elements of Nurse staffing level, work
environment and adverse events and characteristics of the patients and nurses was also evaluated.
The results showed that less patients allotted to each nurse reduced the frequency of adverse
events. Therefore, it can be mentioned that the research study included a huge sample size and
therefore the findings can be generalized. According to Driscoll et al . (2018), a higher nurse
staffing could help in reducing the mortality rate of the patients within the care environment by
14%. The researchers conducted a systematic review and included a total of 35 articles (Driscoll
et al., 2018). The collected data was analyzed using the meta-analysis. Therefore, it can be said
that the research offers a multiple range of data from different care settings, but the number of
articles included in the study is considerably minimal to generalize the results. Another research
study conducted by Debra et al. (2014), investigated the relationship between nurse staffing and
job satisfaction. The researchers conducted a quantitative co-relational study and included nurses
who had been working for at least a period of 6 months. The sample size included 70 nurses and
a combination of NWI-R (Reversed nursing work index) and Survey was used to understand the
job experience of the nurses (Debra et al., 2014). The collected responses were evaluated using
statistical analysis. The findings critically evaluated that the nurses experienced low level of job
satisfaction due to heavy workload and were unhappy with the extensive patient load. The

3LITERATURE REVIEW
researchers conducted a primary study and validated the finding aligned to the research question.
However, the does not shed light on the ethical considerations or the biases that could have
influenced nurses opinion. Jeong et al. (2016) conducted a quantitative study to evaluate the
relationship between workload and adverse patient outcome. A sample size of 1816 nurses was
considered from 23 hospitals in South Korea. The collected data was evaluated using the logistic
regression model and the findings suggested that workload was increased by non-nursing tasks
and that led to adverse medical events. The study considered a sufficiently large sample size and
hence the findings can be generalized. However, the study did not mention recommendation to
improve practice. Leigh et al. (2015), conducted a quantitative differential research study to
investigate the impact of state ordered minimum nurse staffing on occupational health hazards.
The findings suggested that post implementation of the nurse staffing law in California, the
occupational injury dropped o a significant 55.7 per 10,000 RN. Staplers et al. (2015), conducted
a systematic review to evaluate the impact of nurse staffing on work environment and nurse
outcomes. A total of 29 articles were included, which were analyzed through meta-analysis and
the findings revealed a positive relationship between work environment and nurse outcomes in
association to appropriate staffing. Watson et al. (2016), conducted a quantitative longitudinal
study to estimate the impact of one on one nurse and patient ratio within the neonatal care unit.
The data of 43 neonatal tertiary units were observed and the data was analyzed through logistic
regression model. The findings revealed that mortality rates decreased with one to one nursing
care in neonatal units. West et al. (2014) conducted a quantitative-observational study and
considered the secondary data of 36,168 patients. The collected data was evaluated by logistic
regression model. The findings critically established that higher nursing staff prevented mortality
rate within ICU setting.

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Conclusion:
Therefore, to conclude, it can be said that the studies included in the paper have shed
light on the importance of maintaining an appropriate nurse staffing ratio so as to promote
positive patient outcome. Therefore, healthcare policy makers must make optimal nurse staffing
a mandatory criterion so as to prevent the incidence of adverse events within care setting and at
the same time induce higher level of job satisfaction among nurses.

5LITERATURE REVIEW
References:
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., ... & 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), 6-22.
Gnanlet, A., & Gilland, W. G. (2014). Impact of productivity on cross-training configurations
and optimal staffing decisions in hospitals. European Journal of Operational
Research, 238(1), 254-269.
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), 142-148.
Kang, J. H., Kim, C. W., & Lee, S. Y. (2016). Nurse-perceived patient adverse events depend on
nursing workload. Osong public health and research perspectives, 7(1), 56-62.
Knudson, L. (2013). Nurse staffing levels linked to patient outcomes, nurse retention. Nurse
Staffing Levels linked Patient Outcomes Nurse Retent, 97(1), C1.
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.
Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations
between characteristics of the nurse work environment and five nurse-sensitive patient
outcomes in hospitals: a systematic review of literature. International Journal of Nursing
Studies, 52(4), 817-835.

6LITERATURE REVIEW
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 study. Archives of
Disease in Childhood-Fetal and Neonatal Edition, 101(3), F195-F200.
West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014).
Nurse staffing, medical staffing and mortality in intensive care: an observational study.
International journal of nursing studies, 51(5), 781-794.