Nurse Staffing and Patient Safety

Subject: Nursing
Pages: 10
Words: 2713
Reading time:
10 min
Study level: College

Introduction

Nurse staffing is the most important factor in determining the quality of patient care offered in hospitals. Research has revealed that hospitals that experience low staffing levels have high rates of negative patient outcomes because of the poor quality of care offered (Patterson, 2011). Many hospitals face this problem because it is difficult to increase staffing levels due to financial constraints. Examples of factors that give rise to low levels of nurse staffing include a low number of registered nurses and a high number of patients that require care (Huber, 2013). In the United States, many hospitals have low nurse staffing. A single nurse usually serves five patients. Low nursing staffing results in reduced patient safety and low quality of care. A research study conducted by Agency for Healthcare Research and Quality (AHRQ) found out that low staffing leads to poor patient outcomes (Huber, 2013). Many patients succumb to illnesses such as cardiac arrest, pneumonia, and urinary tract infections. In many hospitals, the ratio of nurses to patients is 1:5. This has led to low nurse staffing, which affects the quality of patient care and safety (Patterson, 2011).

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Causes of low nurse staffing

In California and other states, the nurse to patient ratio is 1:5. However, this ratio has affected patient safety and the quality of care offered in hospitals. A report released by the Institute of Medicine (IOM) noted that low nurse staffing is one of the major problems that face the U.S. Health Care System (Doran, 2010). Nursing is the most important aspect in ensuring proper care and positive patient outcomes in hospitals and other medical facilities. The report also noted that inadequate staffing has negative effects on patient safety. The issue of low nurse staffing has resulted from several factors that include hospital restructuring and cost-cutting measures. One of the major sources of costs for hospitals is human resources. Nurse staffing is one of the major areas that are affected whenever hospitals implement cost-cutting measures. Workforce reduction leads to low nurse staffing in many hospitals. This increases the workload for nurses. On the other hand, the growing demand for nursing services has also contributed to the problem. Other factors that have worsened the problem include poor working conditions in hospitals and a low number of nurses that graduate from nurse training programs (Huber, 2013). Poor working conditions discourage licensed nurses from taking up jobs in hospitals. The problem is expected to deteriorate in the future because the shortage of nurses is projected to grow.

The health care system of the United States aims to improve the health of citizens. However, this has not always been the case. Many patients have contracted illnesses because of poor patient care offered in most hospitals. A report released by the Institute of Medicine (IOM) revealed that more than 98,000 people die annually in the United States because of medical errors that could be avoided (Huber, 2013). The report revealed that many of these deaths are largely due to low nurse staffing. There are insufficient nurses to care for a high number of patients admitted to hospitals every day. According to the United States Department of Health and Human Services, 5% of patients with infections acquire them during hospital care (Doran, 2010). In addition, about 25% of patients that benefit from the Medicare program are harmed from the care they receive. Nurses are responsible for these medical errors. However, little has been done to rectify the problem.

Effect of low nurse staffing on patient safety

There is a direct relationship between nurse staffing and the safety of patients. Poor patient safety results from factors such as nurse fatigue, stress, poor working condition, sleep deprivation, shift work, and poor organizational culture (Doran, 2010). Examples of errors that endanger the safety of patients include wrong medication, the performance of wrong medical procedures, procedures that encourage infections, and poor monitoring of patients. These errors have been attributed to long working hours that leave nurses stressed and fatigued (Doran, 2010). In addition, they also affect the accuracy of medication and medical procedures. In many hospitals, nursing systems do not support adequate checks and empowerment for nurses to mediate during medical operations (Finn, 2014). Nurses cannot intervene in cases where doctors make mistakes that affect the safety of patients.

Low nurse staffing increases the cost of treatment for patients. For instance, a study conducted by AHRQ found out that patients who developed pneumonia during their hospitalization period paid more for nursing care because the cost rose by 80% (Patterson, 2011). In that case, the cost of nursing care provided for the treatment of pneumonia increased by about $22,000. On the other hand, the length of hospital stays increased by approximately 5 days. The probability of succumbing to death rose by about 5%. Due to low nurse staffing, the cost of treating pressure ulcers is approximately $8.5 billion every year (Department of Professional Employees, 2014).

Workload and job dissatisfaction

Heavier workload and job dissatisfaction are two factors that suffice with regard to poor patient safety in hospitals in Pennsylvania. The main effect of low nurse staffing is increased nurse workload that leads to job dissatisfaction (Patterson, 2011). Nurses work for long hours and experience burnout that affects the quality of patient care. The percentages of patients who need high levels of nursing care have increased significantly. Hospitals have not increased the number of registered nurses to cater to the needs of an increasing number of patients. The problem has persisted because hospitals have not employed more licensed nurses due to financial constraints. Many hospitals have increased the number of nurse aides to solve the problem. Therefore, nurses have been assigned other roles that have consequently lowered the quality of nursing care offered to patients. The main reasons given by nurses for job dissatisfaction include increased patient acuity and assignment of additional responsibilities that have reduced the quality of patient care (Doran, 2010).

A study conducted among 13, 471 nurses in Pennsylvanian hospitals found out that 40% of nurses were dissatisfied with their jobs. This percentage is very high considering that the level of dissatisfaction by professionals in other careers is between 10 and 15 percent. 83% of nurses stated that in past years, the number of patients assigned to them has been on the increase (Doran, 2010). Therefore, they have more workload. 44.8 percent of the nurses said that the quality of care offered in hospitals has deteriorated significantly (Department of Professional Employees, 2014). 66.6% said that there are insufficient nurses to provide high-quality care to patients. The quality of patient care offered is low because of the high nurse workload that interferes with the provision of quality care (Doran, 2010). Nurses offer low-quality care because they are assigned additional responsibilities that are not related to patient care. For instance, nurses are assigned tasks such as transporting patients, housekeeping, and executing ancillary services.

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A study conducted in 2010 on levels of staffing in several hospitals in the U.S. found out that nurses have a higher workload than necessary. The study revealed that 29% of nurses in Californian hospitals experienced burnout that affected their work. In New Jersey, 34% of nurses experienced burnout while in Pennsylvania, 36% of nurses experienced burnout. Job dissatisfaction was reported among 20% of the nurse in California, 26% in New Jersey, and 29% in Pennsylvania (Department of Professional Employees, 2014). The study established that the rate of patients succumbing to complications was lower in California than in other states. Low nurse staffing forces the few available nurses to work long shifts. This affects their cardiovascular health and the quality of patient care offered. Poor health of nurses, burnout, and stress leads to an increase in the number of medical errors, patient infections, and accidental deaths that are avoidable (Patterson, 2011). Research has revealed that every additional patient assigned to a nurse increases the possibility of mortality by 7% (Department of Professional Employees, 2014). Low staffing mainly affects long-term patients. These patients require more nursing care than short-term patients. However, due to the unavailability of nurses, they get little attention from nursing practitioners. Therefore, the risk of developing respiratory infections, heart failure, sepsis, and pressure ulcers increases.

A study conducted in hospitals in California revealed that there is a relationship between low nurse staffing and the prevalence of pneumonia. According to the study, offering an additional hour of nursing care to patients reduces the prevalence of pneumonia among patients who have undergone surgery by 4% (Doran, 2010). On the other hand, the study found out that the probability of contracting pneumonia decreased by 8 percent among patients who received an additional hour of nursing care. The increased risk of contracting pneumonia among survival patients is due to low nurse staffing. Patients who undergo surgery require more respiratory care than other patients (Doran, 2010). However, due to low nurse staffing, they receive inadequate care and thus suffer the risk of contracting pneumonia during surgery.

Causes and effects of high workload

Low nurse staffing increases the workload of nurses and thus reduces the quality of patient care. Poor patient care affects the safety of patients. There are four main reasons why nurses have heavier workloads than in past years. These reasons include increased overtime, high demand for nursing services, low supply of registered nurses, and reduced hospital stay for patients (Middleton, 2011). Population aging is one of the reasons for the increased demand for nursing services. By the year 2020, the population of people over the age of 65 is projected to increase by about 20 million. This population has more health care needs than the population comprising people under the age of 65. Therefore, more nursing services will be required. The number of available nurses is inadequate to meet the rising demand. On the other hand, the shortage of licensed nurses is projected to increase in the coming years (Middleton, 2011). Many nursing schools are unable to meet the requirements of the nursing profession.

A decrease in the number of nurses has an effect on the quality of care offered. In the last decade, the cost of health care has increased. In order to cut costs, hospitals have trimmed their workforce. On the other hand, they have enacted mandatory overtime policies that aim at meeting the needs of the rising number of patients. This resulted in a heavier workload for nurses. High costs of health care have forced hospital administrations to reduce the length of hospital stay for patients, which has resulted in more work for nurses because patients are readmitted to hospitals with more nursing needs (Middleton, 2011). Therefore, the responsibilities of nurses are more intensive and demanding. Research has shown that a high nursing workload has negative effects on patient safety. In addition, it results in high turnover and a shortage of nurses.

Effects of nursing workload on patient safety

Research has revealed that there is a direct relationship between heavy nursing workload and poor patient care and reduced patient safety. With regard to patient safety and mortality, low staffing has adverse effects. Heavy nursing workload affects the amount of time a nurse can spend on assigned tasks and responsibilities (Doran, 2010). For instance, a nurse might not have sufficient time to perform important procedures, communicate with physicians regarding the condition of a patient, and communicate with a patient. Poor nurse-physician communication and interaction can lead to the deterioration of a patient’s health condition (Department of Professional Employees, 2014). On the other hand, insufficient time might lead to poor communication between nurses and patients. Poor working conditions affect the motivation of nurses at their workplaces. Low motivation leads to absenteeism, high turnover, low morale, poor performance, and low-quality care that affects the safety of patients (Doran, 2010). High job satisfaction leads to high performance and high quality of patient care (Middleton, 2011). The main effect of a high workload is fatigue, stress, and burnout. Stressed and fatigued nurses are inefficient and ineffective. This results in poor performance that threatens the safety of patients. On the other hand, fatigue, burnout, and stress contribute to nursing errors that threaten the safety of patients.

Examples of these errors include execution errors, knowledge errors, and lapse errors. These errors happen because nurses dedicate little time to tasks that are important for the enhancement of patients’ safety (Finn, 2014). This increases the probability of errors and precarious patient care. Another consequence of nursing workload is the violation of protocols that affect the safety of patients. Many nurses violate protocols because of stress and burnout. Nurses usually make errors that affect patient safety through their failure to match medication to the patients’ medication administration records (Finn, 2014). Wrong administration of medication affects the safety of patients because it causes death in many cases. Other nurses administer wrong drugs to patients and thus endanger their safety. It is difficult for nurses to concentrate when they are fatigued and stressed. In addition, many nurses fail to follow procedures and guidelines because of the unavailability of adequate time. For instance, certain procedures require additional time for handwashing and disinfection. However, nurses might decide to ignore these steps. Failure to follow such a procedural undertaking leads to infections that threaten the safety of patients (Doran, 2010). Offering nursing care to five patients is very difficult. Therefore, medical errors occur regularly. Other violations and errors occur when nurses work under strict deadlines because of the unavailability of adequate time to care for patients. Finally, a high workload affects the health systems of hospitals that are important for the maintenance of patient safety. Low nurse staffing reduces the time that nurses have to assist each other (Doran, 2010). Therefore, recruits do not get adequate guidance from experienced nurses. Poor training and inadequate guidance result in poor quality patient care that affects the safety of patients.

Another consequence of low nurse staffing is an increased rate of patient mortality. Research has revealed that hospitals with low staffing have mortality rates of between 29 and 29 percent in cases where the services of nurses are required to save the lives of patients (Department of Professional Employees, 2014). Cases have been reported in many hospitals in the U.S. where patients die because of the unavailability of nurses to attend to them (Finn, 2014). Other patients fall from their beds due to a lack of monitoring by nurses. Many patients succumb to complications within hospital settings. In many hospitals, nurses monitor patients regularly to detect the development of complications and deterioration of patients’ conditions (Doran, 2010). However, the problem of low nurse staffing has affected the surveillance systems of hospitals. The effectiveness of patient surveillance by nurses depends on the availability of registered nurses to conduct regular patient surveillance. Therefore, many patients die because of a lack of nursing care when they develop complications or when their conditions deteriorate.

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Conclusion

Patient safety is the most important factor to consider in the nursing profession. In order to enhance patient safety, patients should receive adequate care from nurses. However, low nurse staffing has led to poor patient outcomes that threaten the safety of patients in hospitals and nursing homes. In many states, the nurse-to-patient ratio is 1:5. Every nurse is assigned to five patients. This ratio has resulted in a high nursing workload. Nurses experience fatigue, stress, and burnout. Nurse burnout threatens the safety of patients because there is inadequate time to follow guidelines about the execution of medical procedures and medication. In many hospitals, nurses monitor patients regularly to detect the development of complications and deterioration of patients’ conditions Causes of low staffing include poor working conditions, a low number of graduates from nursing schools, and a growing population of people over the age of 65. The rising demand for nursing services does not match the number of nurses in hospitals. Studies have revealed that low nurse staffing threatens patient safety due to low quality of nursing care and medical errors. Many patients succumb to illnesses such as cardiac arrest, pneumonia, and urinary tract infections. In many hospitals, the ratio of nurses to patients is 1:5. This has led to low nurse staffing, which affects the quality of patient care and safety. Research has revealed that there is a direct relationship between heavy nursing workload and poor patient care and reduced patient safety.

References

Department of Professional Employees: Safe Staffing Ratio s Benefiting Nurses and Patients. (2014). Web.

Doran, D. M. (2010). Nursing Outcomes. New York: Jones & Bartlett Publishers.

Finn, C. (2014). Patients More Likely to Die When Cared for by Nurse with Heavy Workload. Web.

Huber, D. (2013). Leadership and Nursing Care Management. New York: Elsevier Health Science.

Middleton, J. (2011). The Effects of Nurse to Patient Ratios. Web.

Patterson, J. (2011). The Effects of Nurse to Patient Ratios. Nursing Times, 107(2), 22-25.

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