Literature Review: Nurse to Patient Ratio and Quality of Care

This assignment provides a literature review focusing on the nurse to patient ratio and its impact on healthcare quality. It highlights the importance of optimal nurse staffing levels for improved patient outcomes, reduced medical errors, and enhanced job satisfaction among nurses. The review references studies that correlate higher nurse staffing with decreased mortality rates and fewer complications. It also touches upon the role of adequate nurse-patient ratios in efficient decision-making and workload distribution. Furthermore, the assignment introduces the PICOT framework to structure a research study aimed at evaluating the effects of different nurse to patient ratios on patient care within an intensive care unit, using volunteer nurses to address staff shortages. The research considers key indicators such as mortality rates, medical record accuracy, and nurse satisfaction to assess the relationship between nurse staffing levels and the quality of healthcare delivery. Desklib offers a wealth of similar solved assignments and study resources for students.

Running Head: NURSE TO PATIENT RATIO 1
Nurse to Patient Ratio
Name
Institution

NURSE TO PATIENT RATION 2
Background
Nurse to patient ratio is a quantitative description of the number of patients in a health
care facility who are under the care of a single nurse. In most cases, the patient’s allocation to the
nurses is guided by the acuity or individual need s of the patients (Arkin, Lee, McDonald &
Hernandez, 2014). Studies have indicated that nurse to patients ratio has some impacts on
nursing in general. It does affect not only the quality of documentation but also the quality of
health care made available to the patients in general. Taking into consideration the critical role
that the nurses play in the field of health care, there is a need for safe staffing ratios in the health
facilities. Every health facility in the world has one primary aim which is to improve the quality
of life for its patients (Driscoll, Grant, Carroll, Dalton, Deaton, Jones, Astin, 2018). However,
high nurse to patients ratios has constantly threatened this objective. Safe staffing is not only for
the safety of the patients and the quality of the health care delivered but also for the safety of the
nurses as they discharge their duties. Garretson (2004) points out that higher staffing levels is
directly correlated with the decrease in mortality rates, medical errors, pneumonia, restraint use,
ulcers, and the number of patients who obtain percutaneous coronary intervention. In general, if
a nurse has a few patients to handle, the focus on the patient is higher, and they can meet the
needs of the patients which results to better health care for the patients. On the flipside, if the
nurses have a higher number of patients to take care of, the focus on individual patients is
reduced, and the probability of medical errors is increased.
Problem Statement
Medical care aims at improving the quality of life of the patients. The goal of health
facilities, therefore, is to see the patients walk out in a better state of health than they walked into

NURSE TO PATIENT RATION 3
the facility. To ensure that the patients get the best medical care possible, trained and qualified
nurses are assigned to the medical facilities and even to some home medical care environments.
Like any other profession, the quality of the work delivered depends on how much load the
nurses have to bear in their line of duty (Calio, 2018). Recent studies indicate that the nurse to
patient ratio is high and is still on the rise. Over the past few years, the global population has
risen steadily.
The increase in the worldwide population is directly correlated to the increase in need of
health care throughout the world. The health awareness programs across the globe have also
resulted in increases in the number of people seeking medical attention thought the word.
However, this high number is met by the challenge of a few nurses at the health care facilities.
The existing high nurse to patient ratio has lowered the quality of health care offered in the
health facilities as well as the quality of medical record kept (Arkin, Lee, McDonald, &
Hernandez, 2014). Additionally, the safety of the nurses in their line of duties is also
compromised as they strive to go an extra mile to discharge their responsibilities. To increase
efficiency and effectiveness in the delivery of health care services, there is a need to reduce the
nurse to patients ratio.
PICOT
This paper takes into consideration the different components of PICOT to help in the
description of the various elements of the research. The different components of the research are
as follows:

NURSE TO PATIENT RATION 4
Population
The population for this study will be the number of patients admitted to the Intensive Care Unit
of the health facility.
Intervention
The intervention that the study will monitor is the implementation of a low nurse to patient ratio
in the health care facility.
Comparison
The intervention will be compared to a high nurse to patient ratio within the same facility.
Expected Outcome
The expected results from the intervention include improved and better patient outcomes as a
result of the enhanced quality of health care.
Time/ Duration of the study
The study will be conducted for three months during which both the low nurse to patient ratio
and high nurse to patient ration will be monitored and observations recorded for comparison at
the end of the study.
Strategy Employed
The study will make use of more volunteer nurses at the facility for the research. The
volunteer nurses will include recent nursing graduates and experienced nurses without jobs. The
additional number of nurses at the facility is aimed at reducing the nurse-patient ratio at the

NURSE TO PATIENT RATION 5
facility for the study. The volunteer vacancy will be advertised and the applications received will
be shortlisted and the shortlisted candidate invited for an interview one month before the
commencement of the study. The successful applicants will then undergo through orientation one
week before the start of the study and then deployed to the Intensive care unit of the health
facility to add to the already existing nursing workforce in the facility. The response of the
patients to medical intervention and the accuracy of the medical records will then be monitored
throughout the study. Additionally, views of the nurses will also be collected with regards to the
ease and comfort of discharging their duties. Furthermore, other indicators such as mortality
rates and the number of medical complications experienced during this period will also be
recorded. All the data collected within the period of study will then be compared to the existing
data before the duration of the study to establish the relationship between nurse to patient ratio
and quality of health care.
Evaluation of Literature
Some scholars who have studied the relationship between nurse to patient ratio and the
quality of health care delivery have concluded that adequate nurse to patient ratio is a
prerequisite of quality health care delivery. According to Gnanlet & Gilland, (2014),
optimization of the nurse to patient ratio contributes heavily to the efficient decision making at
the health facility and effortless distribution of work. It therefore right to say that high nurse to
patient ratio leads to poor work distribution which is accompanied by job dissatisfaction among
the existing nurses. Konudson (2013) further confirms that stretched nursing shifts and excess
workload are among the key factors that contribute to job poor job satisfaction among nurses.
Poor job satisfaction impacts negatively on health care delivery by the nursing workforce.

NURSE TO PATIENT RATION 6
Optimization of the nurse-patient ration is vital in ensuring the delivery of high-quality health
care services (Watson et al., 2016). A cross-sectional study on the relationship between work
environment and nurse stuffing by Hairr et al. (2014) found out that lees patients allocated to
each nurse resulted in frequency of adverse effect. Given that the sample size of the study was
large, the results of the study can be generalized. Driscoll, Grant, Carroll, Dalton, Deaton, Jones,
Lehwaldt, McKee, Munyombwe, & Astin (2018) also pointed out that higher nurse staffing can
reduce mortality rates by 14%. In general, the majority of the existing literature on the
relationship between nurse to patient ratio and the quality of health care delivery advocate for an
adequate nurse to patient ratio.
Nursing Theory Utilized
This study makes use of two nursing theories. The first theory is the theory of quality
care. The theory is also referred to as quality care model. The model suggests that the quality of
heal care offered to patients should be optimum. However, we have to note that poor nurse to
patient ration is one of the major factors that hinder delivery of optimum quality health care. This
study agrees with the theory and aims at improving the quality of health care delivery. The
second theory is the need theory. The approach requires nursing professionals to have full focus
on the patient and address their needs other than focusing on the doctor. The theory is only
practical if there is an adequate nurse to patient ratio. In the absence of adequate nurse to patient
ratio, the nurses will have many patients to hand which hinders them from meeting each patient’s
needs (Humphrey & LeBreton, 2019).

NURSE TO PATIENT RATION 7
Proposed implementation plan and outcome measures
Some of the reasons given by the management of health care facilities for not having
more nurses to handle the increasing number of patients at the medical facilities are monitory
constraints. There are always limited monetary resources to spend on hiring more nurses.
However, the management of medical institutions should consider prioritizing the hiring of an
adequate number of nurses at their facilities to ensure quality medical care delivery. The
outcome will be measured using the critical indicators of the quality of health care delivery. This
will include the mortality rates at the health care facility, job satisfaction among the nurses and
feedback from the patients and the accuracy of the medical records.

NURSE TO PATIENT RATION 8
References
Arkin, N., Lee, P. H. U., McDonald, K., & Hernandez, B. T. (2014). The Association of Nurse-
to-Patient Ratio with Mortality and Preventable Complications Following Aortic Valve
Replacement. Journal of Cardiac Surgery, 29(2), 141–148.
https://doi.org/10.1111/jocs.12284
Arkin, N., Lee, P. H. U., McDonald, K., & Hernandez, B. T. (2014). The Association of Nurse-
to-Patient Ratio with Mortality and Preventable Complications Following Aortic Valve
Replacement. Journal of Cardiac Surgery, 29(2), 141–148.
https://doi.org/10.1111/jocs.12284
CALIO, V. (2018). Battle lines drawn in debate over nurse-to-patient ratios. Njbiz, 31(29), 2.
Retrieved from http://search.ebscohost.com/login.aspx?
direct=true&db=bwh&AN=130856555&site=ehost-live
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. https://doi.org/10.1177/1474515117721561
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.

NURSE TO PATIENT RATION 9
Garretson, S. (2004). Nurse to patient ratios in American health care. Nursing Standard, 19(14–
16), 33–37. https://doi.org/10.7748/ns2004.12.19.14.33.c3776
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.
Humphrey, S. E., & LeBreton, J. M. (2019). The handbook of multilevel theory, measurement,
and analysis. (S. E. Humphrey & J. M. LeBreton, Eds.). Washington, DC: American
Psychological Association. https://doi.org/10.1037/0000115-000
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.

NURSE TO PATIENT RATION
10
Appendix

NURSE TO PATIENT RATION
11