Staffing Ratios

PATRICIA BEEMER
NURSING 450
2014
Objectives
To have an awareness of correlation between nurse-patient ratio and
safety.
To have a basic understanding of the Registered Nurse Safe Staffing Act
of 2013.
To be able to discuss nurse and patient satisfaction related to nurse-
patient ratio.
To have an understanding of how nurse-patient ratio may affect patient
outcomes.

Introduction
Nurse staffing ratios:
Affects multiple areas
Safety
Patient outcomes
Patient satisfaction
Nurse job satisfaction


Nurse to Patient Staffing Ratio
The number of patients assigned to a nurse.
Considerations:
Patient acuity
Unlicensed assistive personnel
Skills, education, and training within specific settings




ANA 2014
Theories
Jean Watsons Philosophy of Nursing
The Ten primary carative factors
1. The formation of a humanistic- altruistic system of values.
2. The installation of faith-hope.
3. The cultivation of sensitivity to ones self and to others.
4. The development of a helping-trust relationship
5. The promotion and acceptance of the expression of positive and negative feelings.
6. The systematic use of the scientific problem-solving method for decision making
7. The promotion of interpersonal teaching-learning.
8. The provision for a supportive, protective and /or corrective mental, physical, socio-cultural and
spiritual environment.
9. Assistance with the gratification of human needs.
10. The allowance for existential-phenomenological forces.
Nursing Theories 2013

Theories
Nursing Intellectual capital theory

Conceptualizes the sources of nursing knowledge available within an
organization and delineates its relationship to patient and organizational
outcomes.
The combination of collective knowledge of individuals and structures in
an organization or society.
Outcomes associated with intellectual capital include improved business
performance or the creation of intellectual assets such as innovative
technologies or products which create future returns for the company.

Covell, 2013


Root Cause Analysis


Understaffing
High Safety Risks
Increase Falls
Increase Medication
Errors
Poor Patient
Outcomes
Increase
Readmission Rate
Poor Patient and
Nurse Satisfaction
Increase in Nurse
Turnover
Poor Patient Referral
Safety
Patient Falls
Nurse staffing levels are predictive of patient falls
Study found that an additional RN HPPD was associated with a 3% lower fall rate in
intensive care units.
It was discovered that higher fall rates were associated with lower HPPD and lower
percentage of RNs.



Kalisch, 2012

Safety
Medication Errors
Findings from study indicated nurse staffing is an important human resource to
keep patients safe from medication errors.
As the RN HPPD increased, the medication errors decreased
The 1999 Institute of Medicine study To Err is Human estimated the total medical costs
for treating inpatient preventable adverse medication events at $2 billion annually.
Leaders in Healthcare need to consider technology capital investments as well as
human capital as a strategy to keep patients safe.

Frith, 2012



Registered Nurse Safe Staffing Act of
2013

ANA supports this Act which require Medicare-participating hospitals to establish unit
specific plans utilizing a committee, comprised of at least 55% direct care nurses, and
publicly report the staffing plans. The plans must:
Establish upwardly adjustable minimum ratios of direct care RNs to patients for each unit
and shift
Include input from direct care RNs.
Be based upon patient numbers and the variable intensity of care needed.
Take into account education, training and experience of RNs providing care; staffing levels
and services provided by other health care personnel; unit and facility-level staffing,
quality, and patient outcome data and national comparisons as available; other factors
impacting the delivery of care, including unit geography and available technology.
Consider staffing levels recommended by specialty nursing organizations.
Ensure that RNs are not forced to work in units where they are not trained or experienced.

ANA , 2014
States with Staffing Laws
Currently 13 states:
California, Connecticut, Illinois, Minnesota, Nevada, New Jersey, New York,
Ohio, Oregon, Rhode Island, Texas, Vermont, and Washington
Seven of these states require hospitals to have staffing committees responsible
for planning and safety policies
Connecticut, Illinois, Nevada, Ohio, Oregon, Texas and Washington
California is the only state that requires minimum nurse to patient ratio
Five states require public reporting or a form of disclosure
Illinois, New Jersey, New York, Rhode Island and Vermont


ANA 2014

Patient Outcomes
Hospital Acquired Infections
Transmission of MRSA and other HAI-causing organisms has been shown to be
greater during periods of understaffing.
Success of MRSA outbreak control has been linked to staff workload.
Clements, 2008
Readmission Rates
The Affordable Care Acts Hospital Readmissions Reduction Program (HRRP)
penalizes hospitals based on excess readmission rates among Medicare
beneficiaries.
Hospitals with higher nurse staffing had 25% lower odds of being penalized compared to
otherwise similar hospitals with lower staffing.
McHugh, 2013
Patient Outcomes
Patient Mortality
Better hospital nurse staffing, more educated nurses, and improved nurse work
environments have been shown to be associated with lower hospital mortality.
Aiken, 2011

Hospitals with low nurse staffing levels tend to have higher rates of poor patient
outcomes such as pneumonia, shock, cardiac arrest, and urinary tract
infections.

Stanton, 2004

Patient Satisfaction
Patient reports of satisfaction are higher in hospitals where nurses practice
in better work environments or with more favorable patient-to-nurse ratios.
Hospitals now have financial incentive to improve their quality due to pay-
for-performance plans.


Ann, 2009
Nurse Satisfaction
Long hours of work and high work loads may cause:
High percentage of burn-out
Increase risk for musculoskeletal disorders, hypertension, cardiovascular
disease and depression.
Increase in occupational injuries
Illnesses that require a median of seven days away from work

DPE, 2014

Nurses need to report to their manager if they feel they are not able to
provide safe care to their patients due to the nurse-patient ratio.
One of our many jobs in nursing is to advocate for our patients. Making
sure we are able to provide appropriate care is extremely important for
safety, positive patient outcomes and a high level of patient satisfaction.

References
Ann, K., McHugh, M., Sloane, D., Cimiotti, J., Flynn, L., Neff, D., and Aiken, L. Nursing: A
Key To Patient Satisfaction. (2009). Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2718727/
Clements, A., Halton, K., Graves, N., Petitt, A., Morton, A., Looke, D., and Whitby, M.
Overcrowding and understaffing in modern health-care systems: key determinants in
meticillin-resistant Staphylococcus aureus transmission. (2008). Retrieved from:
http://yagamoto.server260.com/pac/PDFs/Lancet_Study_on_MRSA_Staffing%20.pdf
Covell, C., PhD, RN, Sidani, S. PhD. Nursing Intellectual Capital Theory: Implications for
Research and Practice. (2013). Retrieved from:
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/O
JIN/TableofContents/Vol-18-2013/No2-May-2013/Nursing-Intellectual-Capital-
Theory.html?css=print
DPE. Safe-Staffing Ratios: Benefiting Nurses and Patients. (2014). Retrieved from:
http://www.nursingworld.org/safestaffingfactsheet.aaspx


References
Frith, K., Anderson, E., Tseng, F., and Fong, E. Nurse Staffing Is an Important
Strategy to Prevent Medication Errors in Community Hospitals. (2012).
Retrieved from:
https://www.nursingeconomics.net/necfiles/specialissue/2012/Frith_Staffing.pd
f
Journal of Nursing Quality Care. Missed Nursing Care, Staffing, and Patient
Falls. (2012). Retrieved from:
http://journals.lww.com/jncqjournal/Fulltext/2012/01000/Missed_Nursing_Care,
_Staffing,_and_Patient_Falls.2.aspx
McHugh, M., Berez, J., and Small, D. Hospitals With Higher Nurse Staffing Had
Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing.
(2013). Retrieved from:
http://content.healthaffairs.org/content/32/10/1740.abstract

References
Nursing World. ANA. (2014). Nurse Staffing. Retrieved from:
http://www.nursingworld.org/mainMenuCategories/thePracticeofProfessional
Nursing/nurseStaffing?css=print
Nursing Theories. Jean Watsons Philosophy of Nursing. (2013). Retrieved from:
http://currentnursing.com/nursing_theory/Watson.html
Safe Staffing. ANA. (2014). Retrieved from:
http://journals.lww.com/ajnonline/Fulltext/2013/08000/Nurse_Patient_Staffing_R
atios.17.aspx
Stanton, M. Hospital Nurse Staffing and Quality of Care. (2004). Retrieved
from:
http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/inde
x.html