On any given shift, nurses are responsible for providing safe and effective care and maintain strict vigilance on patient's status. With increase demand in nursing units due to increased patient acuity, staffing shortages, and budget cuts, nurses frequently have to practice under unfavorable conditions andunsafe work environments, that domino effect to the nurses rushing through patient care, exposing nurses to higher probabilities of making mistakes. The Journal of Nursing published multiple research studies that address the topic of nurse-patient ratio, and as evidenced by these studies, increased ratios results in increased chances of adverse outcomes for patients.
Unfortunately, many hospitals still operate under high patient to nurse ratios, overlooking the vast evidence supporting safe nurse and staffing ratios. For hospitals administrators, nurses are an expense from which the most productivity is expected from the lowest cost possible. It won't be until government issued mandatory nurse staffing ratios are passed as law, that we will see changes being made to current practices. Until then it continue to rest with the nurse the responsibility to do everything in their power to make sure their patients remain safe, and receive adequate care despite of staffing shortage. Unsafe patient to nurse ratios are linked to higher rates of patient falls, increased hospital acquired infection rates, medication errors and deaths. When a single nurse is responsible for too many patients at one time, significant signs may be overlooked or missed completely.
With inadequate staffing ratio, patients are not the only ones being harmed. More often than not, nurses suffers as well, according to an article in American Nurse Today, nurses on average lifts 1.8 tons of cumulative weight during an 8-hour shift, exposing nurses to high risks of injury. When adding more patients to the nurse’s daily responsibilities, that cumulative weight increases. This results in nurses burning out, suffering from job related injuries and high staffing turn over relating to job dissatisfaction.
With decrease in nursing quality of care, health care facilities also lose. According to the Centers for Medicare and Medicaid Services, and it’s implementation of the value-based purchasing, which dictates hospital’s reimbursements, increased risks of adverse outcomes for patients and patient dissatisfaction with the care may cost the facilities money. Preventable complications costs are now falling back on the facilities themselves, and treatments are not being reimbursed. When the quality of care decreases, the adverse incidents rates increases and costs the hospitals money from readmissions within 30-days, additional surgeries, and treatments for preventable infections such as catheter-associated urinary tract infections. Also, as a result of nurse injuries, hospitals also lose money in increased worker's compensation costs.
Now, until there is such mandate dictating staffing ratio, nurses must deal with the shortage of staff. Also, as a result of hiring adequate staff, nurses may see cutbacks in other aspect of the care. Health care facilities may have to claim cuts elsewhere to balance the budget, which may prevent them from investing in other necessary tools for quality improvement. Upgrading computers, for example, and other tools may have to be postponed until budgets are properly set.
But, as nurses we always carry on, working together in our units operating with inssuficient staffing, and dividing the care based on patient's acuity and depending on team members to help. Working well with the charge nurses, and vice versa, to assess the demand of the unit and working together with all the resources available to provide high quality, patient-centered care, to the best of our abilities. Sharing unit specific expected duties, and delegating when appropriate.
Nurses have become overwhelmed with all the tasks at hand and unrealistic expectations not related to patient care, while managing and ensuring all patients receive the care necessary. Nurses maintain a constant need to prioritize patients needs, administration requirements and deal with the constant threat of losing their jobs. Nursing is a highly rewarding career choice, though at times challenging and demanding. Inadequate and unsafe nurse staffing ratio is a common barrier to providing optimal care, and is an issue that must be addressed by legislation, hospitals and health care facilities. Further patient education and public exposure to the proven facts will ensure a shift of focus enforcing compliance with the research evidence supporting safe patient to nurse ratio. Until then, we continue doing our best, caring for the ill and their families. We continue working together with our colleagues to improve the quality of care within each unit, and working with hospital administrators to assess the needs and implement necessary changes.
The Dude Nurse
Klaus Campos, BSN-RN