How Nurse Staffing Affects Patient Outcomes

The nurse staffing ratio is a controversial issue in the health sector, as hospitals reduce nurse levels to slash costs and boost profit margins. However, nurses are now fighting back, saying that sharply increased work levels affects the quality of caregiving. Let’s take a closer look at the relationship between nurse-patient ratios and patient outcomes.

Some voices are calling for mandated nurse to patient ratios to tackle this problem.

Danny Chun, the spokesman for the Illinois Health and Hospital Association, says mandated ratios are a bad idea.

“It’s a deeply flawed, inflexible, rigid approach to setting staffing levels that does not improve quality, safety or outcomes, but in fact would adversely affect patients,” he claims.

Others insist that such ratios are necessary to provide a baseline figure and bring all healthcare organizations on the same level.

Patient Outcomes and Nurse Staffing Ratios

American federal regulation 42CFR 482.23(b) states that healthcare organizations should have an “adequate number of nurses” to provide patients with the care they need. There is no established figure in this law, which is why it’s been such a hot topic lately.

The American Nurses Association (ANA) has been pushing for a legislative model where nurses are allowed to make staffing plans for each specific unit. The association says it will help hospitals achieve desirable staffing levels that are flexible with patient needs and factors, like the number of daily admissions.

How nurse staffing ratios & engagement affect patient outcomes

1 Better nurse-patient ratios reduce infections and shorten the length of stay

A study examining the relationship between nurse-patient ratio and patient outcomes found that a better ratio prevented poor aftermaths in both general and intensive care units. The hospital safety net status and nurse working conditions were also found to have an impact on patient care.

Researchers analyzed the direct impact of nursing care per inpatient day by looking at data from several university hospitals. The results showed that more nurse staffing hours led to reduced rates of congestive heart failure (CHF).

The researchers recommended that hospitals should increase nurse staffing hours per inpatient day in all units to reduce infections and shorten hospital stays.

2 Reduction of errors in prescription and process

When nurses are in charge of a large number of patients, they run the risk of buckling under pressure. This can result in medication errors that may worsen patient outcomes and increase the chances of readmission. The Massachusetts Nurses Association conducted a survey in 2018, which found that 3 out of 4 registered nurses say they are given too many patients at the same time.

90% of the nurses surveyed lamented not having enough time to provide the right comfort and emotional support to patients and families. A significant number of them also said they didn’t have enough time to spend on patient education.

Studies on nurse engagement and patient outcomes show a direct link between nurse fatigue and medication errors, charting errors and reduced patient satisfaction.

A work life imbalance from long working hours also leads to compassion fatigue. This impairs the nurses’ ability to focus, creates anxiety, and subsequently impacts the patient experience and quality of care.

Fatigue is also the reason nurses are leaving their institutions quicker than they are being replaced. There is a direct connection between nurse retention and patient outcomes. Improving nurse staffing can, therefore, help with both nurses’ job satisfaction and the quality of patient care.

Photo: Pixabay

3 Improved patient safety

Patient safety and care provision can be hard to achieve if individual nurses are in charge of too many patients at the same time.

A study done in 2017 by the Annals of Intensive Care showed that a higher nurse staffing ratio (fewer nurses attending to more patients) decreased the likelihood of patient survival.  The researchers analyzed 845 patients and found that there were 95% chances of survival whenever nursing hours increased per patient.

Hence, effective nurse vigilance is critical for patient safety. The findings show that increasing the number of patients per nurse compromises their capacity to provide lasting care, which can heighten patient mortality rates.

4 Reduced patient care costs 

Nurse to patient ratios and patient outcomes are interdependent factors. For the patient, a better ratio means reduced treatment costs and reduced risk of readmission. The ways nurses can help reduce patient readmissions include:

  • Conducting post-discharge telephone follow-ups
  • Providing patient education to help them manage their condition
  • Educating them on the need for proper medication scheduling
  • Identifying whether they need further care to prevent the risk of readmission

5 Mandatory nurse staffing hours could negatively affect patient access

The American Nurses Association is pushing for nurses to be empowered to make flexible staffing plans for each unit. A study by Mass Insight in collaboration with the Massachusetts Health and Hospital Association (MHA) revealed that working with a mandatory nurse staffing ratio not only has negative consequences on hospital turnover costs but also reduces patient care access.

Sustainable employee engagement is needed to find an efficient approach that works for your set up. If you adopt a one-size-fits-all approach, the results would be inequity in caregiving and “reduced patient choice” according to the Mass Insight research.

The time is now for hospital managers to prioritize patient care over profits. The evidence is overwhelming; higher nurse staffing levels improve patient outcomes and reduce hospital liability – It’s also crucial for achieving operating room efficiency.