Introduction
The nurse-to-patient ratio refers to a specified number of nurses or caregivers working in a healthcare unit concerning the number of patients they care for. The ratio is an important performance indicator as it determines whether or not a nurse is overworked. In the healthcare setting, a nurse is expected to treat patients and also have time for family, study, and personal development. A higher nurse-to-patient ratio signifies overworking the nurse, and the tendencies for burnout are higher (McHugh et al., 2021). Whenever the nurse is overworked because of an inappropriate ratio, medical errors increase as the quality of care deteriorates. Although different hospital setting has unique ratios for patient safety, the recommended ratios in the United States of America is 1:3 for the emergency room, 1:2 for maternal care, 1:4 for psychiatric care, and 1:1 for the intensive care unit (Qureshi et al., 2019). The nursing ratios must be maintained at the recommended value because it is paramount to patient safety and the quality of care.
Impact of Patient-Nurse Ratio in Nursing Practice
The quality of care in a healthcare setup depends on the emotional state of the nurse. When nurses are motivated and satisfied with their jobs, they are likely to improve the quality of care and patient outcomes. On the other hand, when nurses are overwhelmed by higher ratios, they are likely to experience burnout which is the prerequisite for medical errors and deteriorating patient safety. Further, the turnover increases as the nurses quit their jobs for safer jobs where work-life balance is guaranteed. As a result of the high number of nurses quitting their jobs, the quality of care further deteriorates (McHugh et al., 2021). The ratios also impact patient satisfaction during the delivery of care. When the ratio is higher, the waiting period for patients increases, and a patient may die before accessing care. The ratio has a direct impact on access to healthcare. The ratios impact the nurses and patients and must be maintained at a safer level for higher-quality nursing practice.
Historical Perspective on the Impacts of the Ratios
The USA specifies staffing regulations that must be followed for a hospital facility to be operationalized. Each state has different regulations on nursing ratios, and the basic principle is to have a nurse serve the least number of patients for increased quality. In 2003, numerous cases of nurse negligence were reported in California, and 12% of the patients lost their lives and more were injured courtesy of nurse burnout (Livanos, 2018). Investigation into the matter proved that the nurse-to-patient ratio in California at the time was 1:7, which was far above the recommended ratio (Van den Heede et al., 2020). Consequently, the nurses were overwhelmed and could not control the quality of care delivered to patients. In 2004, California became the first state in the USA to introduce a law on safe nursing ratios (Livanos, 2018). It conducted a massive recruitment program to increase the number of nurses and caregivers in public institutions.
Implementing laws to have a safe ratio is fundamental to improving performance. As a result of the law on mandatory ratios, the number of negligence and deaths in California reduced by 31% (Van den Heede et al., 2020). The nurse turnover rate, which was above 21% due to overwhelming, also declined to 7%, and the patient satisfaction rate increased significantly (Livanos, 2018). California’s revised safe nursing ratio is 1:4 for patients, and the quality of care has improved (Van den Heede et al., 2020). As a result of the revised ratios, the state made it to the top five best-performing states in healthcare provision after Hawaii, New Jersey, Connecticut, and Massachusetts (Livanos, 2018). States and other nations intending to improve the quality of care must work on the nursing nurse-to-patient ratio to satisfy the needs of both the nurses and the patients.
Current Impact of Ratios on Nursing and Society
The working conditions in a given field determine the number of graduates likely to choose the career path. When the nursing ratios are higher and nurses are overworked, the healthcare sector becomes less appealing and fewer people are likely to take nursing courses. Consequently, society will need additional resources to import labor from other parts. The government and other stakeholders must make the healthcare sector lucrative by passing laws that lower the ratios and allow nurses to work with fewer patients and have time for research (McHugh et al., 2021). When there is an outbreak in society, nurses working at a lower ratio will have time to analyze the situation and advice on the best containment measures. The current impact of the nursing ratios in the current healthcare setting is increased quality and safety of care. The ratios further ensure that nurses have personal time for development and family, which leads to work-life balance, a key to positive outcomes.
Role of Nurses in Addressing Patient-Nurse Ratios
Nurses are the first line of defense when fighting against any pandemic and sickness in the community. They are, however, the most affected stakeholder by the ratios and have a critical role in rectifying the nursing ratios. The core role is to lobby the hospital management and the relevant legislative platforms to have a law supporting a required nursing ratio. One of the causes of a higher nurse-patient ratio is the higher turnover of nurses without replacement (Qureshi et al., 2019). The nurse leadership must address all the turnover cases by working on the key reasons why the nurses quit. When quitting is reduced, the ratios are maintained, and the quality of care is assured. Nurses also have a role in empowering and supervising the caregivers and other technicians effectively, which leads to a reduced workload for the nurse and hence acquires high levels of efficiency.
Future Impacts of the Ratios on Nursing and Society
As nurses lobby for a safer nurse-to-patient ratio, the future implication of the ratio is to improve the quality of care and increases safety in healthcare settings. As more states and regions adopt safe ratios, medication errors are likely to reduce, and patient mortality and infection rates will decline while the waiting time reduces. When nurses treat a few patients in a day, they are more accessible and can be reached easily, unlike the waiting time when a nurse deals with a large number of patients. One of the most significant challenges in the healthcare domain is readmission caused by poor-quality medication (McHugh et al., 2021). The future impact of improved ratios is reduced readmission rates which helps society to lower its expenditure on medical expenses.
Conclusion
Nurse-patient ratios play a crucial role in hospital; safety and quality of care. Hospital leadership must ensure a low ratio, allowing the nurses time to relax and avoid burnout. Overworking medical personnel is the prerequisite for errors, increased infection, and medical negligence cases. Patient safety and improved care can only be achieved through adequate staffing to give nurses adequate time to rest and spend with family. The nurse-patient ratio is the key performance indicator that must be achieved to attain a high quality of care.
References
Livanos, N. (2018). A broadening coalition: Patient safety enters the Nurse-to-Patient ratio debate. Journal of Nursing Regulation, 9(1), 68–70.
McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-1913.
Qureshi, S. M., Purdy, N., Mohani, A., & Neumann, W. P. (2019). Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation. Journal of nursing management, 27(5), 971–980.
Van den Heede, K., Cornelis, J., Bouckaert, N., Bruyneel, L., Van de Voorde, C., & Sermeus, W. (2020). Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria and Queensland: a discussion paper. Health Policy, 124(10), 1064-1073.