Nurse-to-Patient Ratio Increase and Change Models


Although a drop in the nurse-to-patient ratio (NPR) is typically viewed as a reason for concern in the healthcare system, high NPR can also affect patient outcomes negatively (Jarrar, Rahman, & Shamsudin, 2015). With the rise in the number of nurses per patient, the threat of mismanaging patient information and, consequently, providing insufficient or unrequired services rises significantly (Jarrar et al., 2015). Furthermore, the increase in the NPR results in a significant drop in the amount of control exercised over the performance of nurses in a hospital setting (Jarrar et al., 2015). Thus, the possibility of making an error and leading to negative effects on patients’ health increases exponentially. To address high NPR, one has to consider introducing an approach based on changing the role of a registered nurse in the hospital setting.

The rationale for Evidence-Based Practice

The disproportionate concentration of nurses per patient affects the quality of care negatively since the process of information management becomes erratic and convoluted (Gomaa et al., 2015). As a result, crucial data about patients, their current health concerns, needs, and treatment processes can be easily confused, which will inevitably lead to medical errors (Shieh, Sung, Su, Tsai, & Hsieh, 2016). In addition, extraordinarily high NPR is likely to develop workplace burnouts due to the stress caused by the increased necessity to transfer essential data. Finally, the threat of depression and similar health issues rises with the increase in NPR within a hospital setting, with its inherent challenges of information management. Herein lies the necessity to introduce a coherent approach toward managing NPR within a hospital. To be more specific, a study allowing for the analysis of the connection between NPR and health issues among nurses must be conducted to define the best method of handling the issue.

Literature Review: Increasing NPR

The problem of high NPR is surprisingly common in some healthcare settings (Aiken et al., 2018). There are several indications that unreasonably high NPR affects nurses’ health and general well-being negatively. Moreover, high NPR has a deleterious effect on patient outcomes as well. Because of the loss of control over an increasingly large amount of data, and the transfer of roles and responsibilities from one nurse to another, errors are expected to occur (Jarrar et al., 2015). The specified threat will become especially high in the cases involving patient handoffs since crucial information must be transferred within a limited period of time.

The lack of control over nurses’ actions in the setting that involves high NPR also has deplorable effects on both nurses and patients (Aiken et al., 2018). Unable to receive proper instructions, nurses suffer from the inability to provide patients with appropriate services and meet quality standards. Patients, in turn, are affected significantly due to the lack of care and the increased possibility of medical errors. Negative effects of NPR can be reduced by reconsidering the role that nurses play in the hospital setting. Creating tasks, such as educating new nursing staff, enhancing patient education, and maintaining the connection between nurses and target communities, will help relieve the target population of some of the pressure. A resulting rise in positive outcomes is expected.

Kotter’s 8 Steps as a Change Theory

To introduce changes to the nursing industry, and improve the situation, one should consider using Kotter’s eight-step model. The framework suggests not only introducing changes to a particular setting but also institutionalizing them (Small et al., 2016). Thus, by controlling the execution of the proposed strategies, one will be able to prevent similar instances in the future.

The goodness of Fit: Model’s Efficacy

Using the Goodness-of-Fit Model to determine the possibility of adopting the chosen model successfully, one will see that the proposed method allows the setting of specific expectations for the change in nurses’ and patients’ well-being, as well as the identification of the outcomes of the intervention. Consequently, the difference between the expected outcomes and the ones that are to be produced can be identified successfully (Franke, Jeffries, & Svergun, 2015). Thus, Kotter’s eight-step model can be utilized to encourage change in the specified environment.


Aiken, L. H., Sloane, D. M., Ball, J., Bruyneel, L., Rafferty, A. M., & Griffiths, P. (2018). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 8(1), 1-4.

Franke, D., Jeffries, C. M., & Svergun, D. I. (2015). Correlation Map, a goodness-of-fit test for one-dimensional X-ray scattering spectra. Nature Methods, 12(5), 419-422.

Gomaa, A. E., Tapp, L. C., Luckhaupt, S. E., Vanoli, K., Sarmiento, R. F., Raudabaugh, W. M.,… Sprigg, S. M. (2015). Occupational traumatic injuries among workers in health care facilities – United States, 2012–2014. MMWR. Morbidity and Mortality Weekly Report, 64(15), 405-410.

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.

Shieh, S. H., Sung, F. C., Su, C. H., Tsai, Y., & Hsieh, V. C. R. (2016). Increased low back pain risk in nurses with high workload for patient care: A questionnaire survey. Taiwanese Journal of Obstetrics and Gynecology, 55(4), 525-529.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotter’s change model for implementing bedside handoff: A quality improvement project. Journal of Nursing Care Quality, 31(4), 304-309.