NURSE TO PATIENT RATIOS research project (validity, sampling, reliabity)

2

Literature Review: The Impact of Nurse-to-Patient Ratios on Healthcare Outcomes

Milena Lopez Hernandez

Professor: Orel Ramirez

West Coast University

NURS 540

7/21/2024

Literature Review: The Impact of Nurse-to-Patient Ratios on Healthcare Outcomes

Nurse staffing is a critical factor in defining the health care environment, safety of patients, patient outcomes, quality of care, and nurses’ health. This literature review focuses on several previous studies that have been conducted in an effort to determine the impact of nurse staffing on health care outcomes. This is to provide a discussion of findings by other authors in the hope of drawing attention to the effects of low levels of staffing by nurses and to present ways of improving the nurse-patient ratio in health facilities. Therefore, to contribute to the ongoing discussion on strategies for increasing nurse staffing for patient and nurse benefits, this review seeks to assess the sources and identify the knowledge gaps. Ensuring adequate numbers of nurses also has positive outcomes for the patients, but it also has important implications for the morale of the nurses and the stability of the health care workforce.

Jarrar, M., Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Asian Social Science, Volume 11, Issue 9, 2 April 2015, Pages 326-332.

Jarrar et al. (2015) conducted a cross-section study to predict the effect of the patient-to-nurse ratio on the quality of care and patient safety in private hospitals in Malaysia. Data was collected from 652 nurses from the medical and surgical wards. For those nurses that had a higher ratio of patients, a greater negative association with the quality of care and patient safety was established. The study established that a high patient-to-nurse ratio is an indication of unfavorable staffing that affects the outcomes, a finding that is consistent with the present study. This means that more patients put under one nurse implies an increasing danger to the safety of the patients. This study borrows from previous studies on the subject of the nursing shortage and, by carrying out a scientific study, creates a solid basis from which to interpret the findings. It informs greatly on the potential implication of nurse-patient ration on the quality of care.

Tencic, M., & Roche, M. A. (2023). Nurse–patient ratios and infection control practices: a cross-sectional study. Collegian, 30(6), 828-834.

Tencic & Roche (2023) carried out a study to examine the relationship between nurse-patient ratios and infection control practices. The study posits that there has been previously established link between nursing workload and patient safety, with higher nurse workload linked to missed infection control practices and healthcare-acquired infections. Through a cross-sectional study, the paper points out that nurses had the perception that nurse-patient ratios improved the implementation of infection control practices by the nurses. As result, study results from this paper are essential in understanding how the nurse-patient ratio will impact not only the health of the patient but also nurse workplace safety by looking at how they affect the implementation of infection control practices. The study results are consistent with previous studies on nursing practices around patient control. This study would help in explaining how the nursing work ratio will affect the health of the nurses as well as their safety in the hospital settings. It is highly reliable as it has borrowed from previous peer reviewed studies in addition to the cross-sectional methodology it has adopted.

Gutsan, E., Patton, J., Willis, W. K., & PH, C. D. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace.

Gutsan et al. (2018) examine the relationship between burnout syndrome and nurse-to-patient ratio in the workplace. The study has linked nurse burnout with understaffing or in areas that have improper work assignments. This has been linked to poor or higher nurse-to-patient ratios. Using a qualitative literature review, the study found increased concern about the nurse-patient ratio for some time beginning in 2015. Psychological and mental health issues were found for those nurses with higher nurse-to-patient ratios. The study established from various literature published over time that higher or imbalance in the nurse-to-patient ratio has resulted in psychological dissonance and imbalance in healthcare. The study also found out that nurse-to-patient ratio directly determines the nurse's performance and the health status of the patient. This study is, therefore, in line with the previous articles above that have linked higher nurse-to-patient ratios with poor health and safety outcomes in hospitals.

Mohamed, L. A., & Mohamed, A. S. (2022). Nurses Patients Ratio and its Effect on Patient's Safety. Assiut Scientific Nursing Journal, 10(28), 222-229.

In another study , Mohamed & Mohamed (2022) sought to understand the effect of the nurse-patient ratio on the safety of the patients at Assiut Fever Hospital in Assiut City. In particular, the study found that the shortage of nurses in the dialysis unit led to increased injuries. In particular, the study has associated a higher nurse-patient ratio with the failure of nurses to apply the needed safety and standards needed to ensure higher patient safety. The study finds that in shifts that had different nurse-patient rations, then the safety of the patients differed significantly. This study is particularly relevant to the current research question because it not only establishes a cause-and-effect relationship between patient ratio and safety but also proposes strategies to mitigate potential injuries. It establishes that various strategies could be used to bring about a better patient-nurse ratio and, as a result, improve patient safety in health facilities.

Huang, G. (2021). How does the patient to nurse ratio relate to the quality of patient care and nurse burnout in the hospital?. https://doi.org/10.33015/dominican.edu/2021.NURS.ST.04

For this study, a literature review was carried out on the topic of patient-to-nurse ratio. To establish the credibility of the findings, this particular study involved various countries, including Canada, the United Kingdom, and the united states, as well as Chile. In particular, the study indicated that when the ratio was higher, people were highly motivated to leave their jobs. For instance, in the case of California, a lot of negative factors were associated with a higher nurse-patient ratio. The study establishes a theoretical basis where there are understaffed hospitals. Factors like verbal abuse and burn out, among others, have been linked to poor performance for the nurses and hence highly affecting the nurses. The more patients the nurses have to handle beyond their capacity, the poor services such patients get. Failure to rescue is increased as well as such cases lead to higher mortality among the patients going into the long run. This article, therefore, adds to the study by informing more of the effects of higher nurse-patient rations.

Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International journal of nursing studies, 120, 103950.

In this longitudinal study, Musy et al. (2021) examined how the nurse-patient ratio affects inpatient mortality. It builds to previous studies that had indicated that higher levels of registered levels had been associated with increased mortality among the patients. In particular, the study established a high quality of care and less mortality in countries that had a higher number of nursing staff as compared to those that had lower levels of staff. The study included 4 longitudinal studies , finding out that the quality of care as impacted by the number of staff has a major effect on the quality of care received or advanced to the patients. This study is consistent with the articles discussed above that show the impact of the disparities in nurse staff on the health of the patients going into the future. Hence, it brings in significant insights on ways in which patient care can be improved by having in place the right number of nurse staff.

Conclusion

The reviewed literature consistently demonstrates that high nurse-to-patient ratios negatively impact patient safety, quality of care, and nurse well-being. To address these issues, healthcare facilities must prioritize maintaining optimal staffing levels. Future research should focus on developing and implementing strategies to achieve and sustain appropriate nurse-patient ratios, thereby enhancing healthcare outcomes for both patients and nurses. Additionally, healthcare policymakers must consider legislating minimum staffing ratios to ensure standardized care across various settings. Investing in workforce development and retention strategies is crucial to mitigate the challenges posed by nurse shortages. By addressing the identified gaps and challenges, the healthcare industry can move towards a more effective and sustainable staffing model.

References

Gutsan, E., Patton, J., Willis, W. K., & PH, C. D. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. Journal of Nursing Management, 26(1), 86-92. https://doi.org/10.1111/jonm.12526

Huang, G. (2021). How does the patient to nurse ratio relate to the quality of patient care and nurse burnout in the hospital?. https://doi.org/10.33015/dominican.edu/2021.NURS.ST.04

Jarrar, M., Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Asian Social Science, 11(9), 326-332. https://doi.org/10.5539/ass.v11n9p326

Mohamed, L. A., & Mohamed, A. S. (2022). Nurses Patients Ratio and its Effect on Patient's Safety. Assiut Scientific Nursing Journal, 10(28), 222-229.

Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International Journal of Nursing Studies, 120, 103950. https://doi.org/10.1016/j.ijnurstu.2021.103950

Tencic, M., & Roche, M. A. (2023). Nurse–patient ratios and infection control practices: a cross-sectional study. Collegian, 30(6), 828-834. https://doi.org/10.1016/j.colegn.2023.05.001

2

Literature Review: The Impact of Nurse-to-Patient Ratios on Healthcare Outcomes

Milena Lopez Hernandez

Professor: Orel Ramirez

West Coast University

NURS 540

7/21/2024

Literature Review: The Impact of Nurse-to-Patient Ratios on Healthcare Outcomes

Nurse staffing is a critical factor in defining the health care environment, safety of patients, patient outcomes, quality of care, and nurses’ health. This literature review focuses on several previous studies that have been conducted in an effort to determine the impact of nurse staffing on health care outcomes. This is to provide a discussion of findings by other authors in the hope of drawing attention to the effects of low levels of staffing by nurses and to present ways of improving the nurse-patient ratio in health facilities. Therefore, to contribute to the ongoing discussion on strategies for increasing nurse staffing for patient and nurse benefits, this review seeks to assess the sources and identify the knowledge gaps. Ensuring adequate numbers of nurses also has positive outcomes for the patients, but it also has important implications for the morale of the nurses and the stability of the health care workforce.

Jarrar, M., Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Asian Social Science, Volume 11, Issue 9, 2 April 2015, Pages 326-332.

Jarrar et al. (2015) conducted a cross-section study to predict the effect of the patient-to-nurse ratio on the quality of care and patient safety in private hospitals in Malaysia. Data was collected from 652 nurses from the medical and surgical wards. For those nurses that had a higher ratio of patients, a greater negative association with the quality of care and patient safety was established. The study established that a high patient-to-nurse ratio is an indication of unfavorable staffing that affects the outcomes, a finding that is consistent with the present study. This means that more patients put under one nurse implies an increasing danger to the safety of the patients. This study borrows from previous studies on the subject of the nursing shortage and, by carrying out a scientific study, creates a solid basis from which to interpret the findings. It informs greatly on the potential implication of nurse-patient ration on the quality of care.

Tencic, M., & Roche, M. A. (2023). Nurse–patient ratios and infection control practices: a cross-sectional study. Collegian, 30(6), 828-834.

Tencic & Roche (2023) carried out a study to examine the relationship between nurse-patient ratios and infection control practices. The study posits that there has been previously established link between nursing workload and patient safety, with higher nurse workload linked to missed infection control practices and healthcare-acquired infections. Through a cross-sectional study, the paper points out that nurses had the perception that nurse-patient ratios improved the implementation of infection control practices by the nurses. As result, study results from this paper are essential in understanding how the nurse-patient ratio will impact not only the health of the patient but also nurse workplace safety by looking at how they affect the implementation of infection control practices. The study results are consistent with previous studies on nursing practices around patient control. This study would help in explaining how the nursing work ratio will affect the health of the nurses as well as their safety in the hospital settings. It is highly reliable as it has borrowed from previous peer reviewed studies in addition to the cross-sectional methodology it has adopted.

Gutsan, E., Patton, J., Willis, W. K., & PH, C. D. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace.

Gutsan et al. (2018) examine the relationship between burnout syndrome and nurse-to-patient ratio in the workplace. The study has linked nurse burnout with understaffing or in areas that have improper work assignments. This has been linked to poor or higher nurse-to-patient ratios. Using a qualitative literature review, the study found increased concern about the nurse-patient ratio for some time beginning in 2015. Psychological and mental health issues were found for those nurses with higher nurse-to-patient ratios. The study established from various literature published over time that higher or imbalance in the nurse-to-patient ratio has resulted in psychological dissonance and imbalance in healthcare. The study also found out that nurse-to-patient ratio directly determines the nurse's performance and the health status of the patient. This study is, therefore, in line with the previous articles above that have linked higher nurse-to-patient ratios with poor health and safety outcomes in hospitals.

Mohamed, L. A., & Mohamed, A. S. (2022). Nurses Patients Ratio and its Effect on Patient's Safety. Assiut Scientific Nursing Journal, 10(28), 222-229.

In another study , Mohamed & Mohamed (2022) sought to understand the effect of the nurse-patient ratio on the safety of the patients at Assiut Fever Hospital in Assiut City. In particular, the study found that the shortage of nurses in the dialysis unit led to increased injuries. In particular, the study has associated a higher nurse-patient ratio with the failure of nurses to apply the needed safety and standards needed to ensure higher patient safety. The study finds that in shifts that had different nurse-patient rations, then the safety of the patients differed significantly. This study is particularly relevant to the current research question because it not only establishes a cause-and-effect relationship between patient ratio and safety but also proposes strategies to mitigate potential injuries. It establishes that various strategies could be used to bring about a better patient-nurse ratio and, as a result, improve patient safety in health facilities.

Huang, G. (2021). How does the patient to nurse ratio relate to the quality of patient care and nurse burnout in the hospital?. https://doi.org/10.33015/dominican.edu/2021.NURS.ST.04

For this study, a literature review was carried out on the topic of patient-to-nurse ratio. To establish the credibility of the findings, this particular study involved various countries, including Canada, the United Kingdom, and the united states, as well as Chile. In particular, the study indicated that when the ratio was higher, people were highly motivated to leave their jobs. For instance, in the case of California, a lot of negative factors were associated with a higher nurse-patient ratio. The study establishes a theoretical basis where there are understaffed hospitals. Factors like verbal abuse and burn out, among others, have been linked to poor performance for the nurses and hence highly affecting the nurses. The more patients the nurses have to handle beyond their capacity, the poor services such patients get. Failure to rescue is increased as well as such cases lead to higher mortality among the patients going into the long run. This article, therefore, adds to the study by informing more of the effects of higher nurse-patient rations.

Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International journal of nursing studies, 120, 103950.

In this longitudinal study, Musy et al. (2021) examined how the nurse-patient ratio affects inpatient mortality. It builds to previous studies that had indicated that higher levels of registered levels had been associated with increased mortality among the patients. In particular, the study established a high quality of care and less mortality in countries that had a higher number of nursing staff as compared to those that had lower levels of staff. The study included 4 longitudinal studies , finding out that the quality of care as impacted by the number of staff has a major effect on the quality of care received or advanced to the patients. This study is consistent with the articles discussed above that show the impact of the disparities in nurse staff on the health of the patients going into the future. Hence, it brings in significant insights on ways in which patient care can be improved by having in place the right number of nurse staff.

Conclusion

The reviewed literature consistently demonstrates that high nurse-to-patient ratios negatively impact patient safety, quality of care, and nurse well-being. To address these issues, healthcare facilities must prioritize maintaining optimal staffing levels. Future research should focus on developing and implementing strategies to achieve and sustain appropriate nurse-patient ratios, thereby enhancing healthcare outcomes for both patients and nurses. Additionally, healthcare policymakers must consider legislating minimum staffing ratios to ensure standardized care across various settings. Investing in workforce development and retention strategies is crucial to mitigate the challenges posed by nurse shortages. By addressing the identified gaps and challenges, the healthcare industry can move towards a more effective and sustainable staffing model.

References

Gutsan, E., Patton, J., Willis, W. K., & PH, C. D. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace. Journal of Nursing Management, 26(1), 86-92. https://doi.org/10.1111/jonm.12526

Huang, G. (2021). How does the patient to nurse ratio relate to the quality of patient care and nurse burnout in the hospital?. https://doi.org/10.33015/dominican.edu/2021.NURS.ST.04

Jarrar, M., Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: A cross-sectional study. Asian Social Science, 11(9), 326-332. https://doi.org/10.5539/ass.v11n9p326

Mohamed, L. A., & Mohamed, A. S. (2022). Nurses Patients Ratio and its Effect on Patient's Safety. Assiut Scientific Nursing Journal, 10(28), 222-229.

Musy, S. N., Endrich, O., Leichtle, A. B., Griffiths, P., Nakas, C. T., & Simon, M. (2021). The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study. International Journal of Nursing Studies, 120, 103950. https://doi.org/10.1016/j.ijnurstu.2021.103950

Tencic, M., & Roche, M. A. (2023). Nurse–patient ratios and infection control practices: a cross-sectional study. Collegian, 30(6), 828-834. https://doi.org/10.1016/j.colegn.2023.05.001