But, physicians may spend only 30 to 45 minutes a day with even a critically ill hospitalized patient, whereas nurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team. Of all the members of the health care team, nurses therefore play a critically important role in ensuring patient safety by monitoring patients for clinical deterioration, detecting errors and near misses, understanding care processes and weaknesses inherent in some systems, and performing countless other tasks to ensure patients receive high-quality care. Nurse staffing and patient safety Nurses' vigilance at the bedside is essential to their ability to ensure patient safety.
Major Methodological Considerations in This Literature Staffing Staffing levels can be reported or calculated for an entire health care organization or for an operational level within an organization a specific unit, department, or division.
The formal costs of increasing the nurse–patient ratio cannot be calculated because there has been no evaluation of an intentional change in nurse staffing to improve patient outcomes. Key Summary Points. Nurse–Patient Ratios as a Patient Safety Strategy Tables and Figures. Nurses have an integral role in the health care system. State-mandated safe-staffing ratios are necessary to ensure the safety of patients and nurses. Adequate nurse staffing is key to patient care and nurse retention, while inadequate staffing endangers patients and drives nurses from their profession. A nurse-patient ratio of was associated with a higher incidence of unplanned extubation relative to a nurse-to-patient ratio of (Marcin, Rutan, Rapetti, Brown, Rahnamayi & Pretzlaff).
Specific time frames at the shift level and as a daily, weekly, or yearly average must be identified to ensure common meaning among collectors of the data, those analyzing it, and individuals attempting to interpret results of analyses.
In many cases, staffing measures are calculated for entire hospitals over a 1-year period. It is fairly common to average or aggregate staffing across all shifts, for instance, or across all day shifts in a month, quarter, or year and sometimes also across all the units of hospitals.
It is clear that nurses are best-placed to make a judgement on staffing levels. From patient complexity, to layout of the nursing unit; nurses know the provision that they and their team need. In the face of limited federal intervention, ANA supports a legislative model with nurses sanctioned to create flexible staffing plans for their unit. Not only would nurse-to-patient ratios improve, but nurses would be able to . Complete Question: What is the suggested nurse/patient ratio and the suggested CNA/patient ratio for a medical-surgical floor? I am the Unit Practice Council (UPC) chair for my medical-surgical unit, and we are tasked with manipulated our staffing grid. Improved Safety. The National Campaign for Safe RN-to-Patient Staffing Ratios is a nationwide effort to ensure safe staffing for nurses and patients across the country.. Studies have shown that appropriate nurse staffing helps achieve clinical and economic improvements in patient care, including.
However, staffing levels on different units reflect differences in patient populations and illness severity the most striking of which are seen between general care and critical care units.
Furthermore, in practice, staffing is managed on a unit-by-unit, day-by-day, and shift-by-shift basis, with budgeting obviously done on a longer time horizon. For these reasons, some researchers argue that at least some research should be conducted where staffing is measured on a shift-specific and unit-specific basis instead of on a yearly, hospitalwide basis.
A distinct, but growing, group of studies examined staffing conditions in subunits or microsystems of organizations such as nursing units within hospitals over shorter periods of time for example, monthly or quarterly. The first type divides a volume of nurses or nursing services by a quantity of patient care services.
Common examples include patient-to-nurse ratios, hours of nursing care delivered by various subtypes of personnel per patient day HPPDand full-time equivalent FTE positions worked in relation to average patient census ADC over a particular time period.
Commonly, the composition of the nursing staff employed on a unit or in a hospital in terms of unlicensed personnel, practical or vocational nurses, and registered nurses RNs is calculated.
The specific types of educational preparation held by RNs baccalaureate degrees versus associate degrees and diplomas have also begun to be studied. Additional staffing-related characteristics studied include years of experience and professional certification.
The incidence of voluntary turnover and the extent to which contract or agency staff provide care have also been studied. As will be discussed, the majority of the evidence related to hospital nurse staffing focuses on RNs rather than other types of personnel.
For the most common measures, ratios and skill-mix, determining which staff members should be included in the calculations is important, given the diversity of staffing models in hospitals.
Most researchers feel these statistics should reflect personnel who deliver direct care relevant to the patient outcomes studied.
Whether or not to count charge nurses, nurse educators involved in bedside care, and nurses not assigned a patient load but who nevertheless deliver important clinical services can present problems, if not in principle, then in the reality of data that institutions actually collect.
Outcomes research examining the use of advanced practice nurses in acute care—for instance, nurse practitioners and nurse anesthetists—to provide types of care traditionally delivered by medical staff and medical trainees has been done in a different tradition analyzing the experiences of individual patients cared for by specific providers and does not tend to focus on outcomes relevant to staff nurse practice; therefore these studies are not reviewed here.
No studies were found that examined advanced practice nurse-to-patient ratios or skill mix in predicting acute care patient outcomes.
There have been calls to examine advanced practice nurses supporting frontline nurses in resource roles for instance, clinical nurse specialists who consult and assist in daily nursing care, staff development, and quality assurance and their potential impact on patient outcomes.
No empirical evidence of this type was found. Outcomes Clearly, capturing data about patient outcomes prospectively i. This approach is the most challenging because of practical, ethical, and financial considerations. However, researchers can sometimes capitalize on prospective data collections already in progress.
For instance, hospital-associated pressure ulcer prevalence surveys and patient falls incidence are commonly collected as part of standard patient care quality and safety activities at the level of individual nursing units in many institutions.
Patients are not all at equal risk of experiencing negative outcomes. Elderly, chronically ill, and physiologically unstable patients, as well as those undergoing lengthy or complex treatment, are at much greater risk of experiencing various types of adverse events in care.
For instance, data on falls may be consistently collected for all hospitalized patients but may not be particularly meaningful for obstetrical patients. Accurately interpreting differences in rates across health care settings or over time requires understanding the baseline risks patients have for various negative outcomes that are beyond the control of the health care providers.
Ultimately this understanding is incorporated into research and evaluation efforts through risk adjustment methods, usually in two phases: Without sound risk adjustment, any associations between staffing and outcomes may be spurious; what may appear to be favorable or unfavorable rates of outcomes in different institutions may no longer seem so once the complexity or frailty of the patients being treated is considered.
However, as was noted earlier, quality of care and clinical outcomes and by extension, the larger domain of nursing-sensitive outcomes include not only processes and outcomes related to avoiding negative health states, but also a broad category of positive impacts of sound nursing care.
Knowledge about positive outcomes of care that are less likely to occur under low staffing conditions or are more likely under higher levels is extremely limited. The findings linking functional status, psychosocial adaptation to illness, and self-care capacities in acute care patients are at a very early stage 37 but eventually will become an important part of this literature and the business case for investments in nurse staffing and care environments.
Linkage In staffing-outcomes studies, researchers must match information from data sources about the conditions under which patients were cared for with clinical outcomes data on a patient-by-patient basis or in the form of an event rate for an organization or organizational subunit during a specific period of time.The nurse-to-patient ratio is only one aspect of the relationship between nursing workload and patient safety.
Overall nursing workload is likely linked to patient outcomes as well. The formal costs of increasing the nurse–patient ratio cannot be calculated because there has been no evaluation of an intentional change in nurse staffing to improve patient outcomes.
Key Summary Points. Nurse–Patient Ratios as a Patient Safety Strategy Tables and Figures. The California Nurses Association (CNA) noted that patients were being transferred quickly out of critical care units. Patients in transitional units and medical-surgical wards were often as sick as those receiving their nursing care in critical units, although the nurse-to-patient ratios were far lower.
A nurse-patient ratio of was associated with a higher incidence of unplanned extubation relative to a nurse-to-patient ratio of (Marcin, Rutan, Rapetti, Brown, Rahnamayi & Pretzlaff).
Increased nurse staffing is a more cost-effective tactic to improve patient care when compared to other interventions (Nursing Administration Quarterly, ). Safe nurse staffing reduces turnover in hospitals.
When ratios are blown out of proportion, there is an increase in nursing turnover and a decrease in patient satisfaction. Nurses' working conditions and patient safety. The causal relationship between nurse-to-patient ratios and patient outcomes likely is accounted for by both increased workload and increased stress and risk of burnout for nurses.