NURSE TO PATIENTS RATIOS AND THE EFFECT ON PATIENT OUTCOMES.

Nurse to patients ratios and the effect on patient outcomes



Abstract

Proposed minimum, nurse-to-patient staffing ratios, such as those enacted by California, are intended to address a growing concern that patients are being harmed by inadequate staffing related to increasing severity of illness and complexity of care. However, mandatory ratios, if imposed nationally, may result in increased overall costs of care with no guarantees for improvement in quality or positive outcomes of hospitalization.

Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing.

TABLE OF CONTENTS

Abstract2

Chapter I5

Purpose/ goal of the sutdy5

Statement of the problem5

Significance of the study5

Introduction6

Chapter II9

Literature review9

Chapter III15

Methods15

Population and Samples15

Instrumentation16

Analysis plan17

Validity and reliability18

Expected Results19

Chapter IV20

Discussion20

The Argument For and Against Mandatory Nurse-to-Patient Staffing Ratios23

Limitations26

Conclusion27

References29

Chapter I

Purpose/ goal of the sutdy

To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.

Statement of the problem

Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.

Significance of the study

Recently published results from the US component of the International Hospital Outcomes Study documented a strong association between nurse staffing and mortality following common surgical procedures, and also showed that job dissatisfaction and burnout will be associated with low staffing levels.

Introduction

In the US study, every one patient added to the average hospital-wide nurse workload increased the risk of death following common surgical procedures by 7% (Aiken et al., 2002a and Aiken et al., 2002b). There was a 31% difference in mortality between hospitals in which registered nurses cared for 8 patients each and those in which nurses cared for 4 patients each after taking into account patients' severity of illness and co-morbid conditions, and the size, technology level, and teaching status of the treating hospitals. Findings from the Canadian arm of the international study mirror those in the US, most notably, a staffing skill mix with a higher proportion of registered nurses was associated with significantly lower mortality (Estabrooks et al., 2005).

Hospital nurse shortages and recent California legislation that mandates specific patient-to-nurse ratios stimulated this complex study of the relation between patient outcomes in orthopedic, vascular, and general surgery wards and patient-to-nurse ratios in 168 nonfederal Pennsylvania hospitals. Surveys of nurses in the same hospitals were completed concurrently. Within the 168 hospitals, researchers assessed 232,342 patient outcomes and the job satisfaction and burnout rates among 10,184 nurses.

Eighty percent of hospitals had patient-to-nurse ratios from 5:1 to 7:1. Most patients and nurses came from high-tech hospitals (as defined by open-heart surgery capability); 23% of surveyed patient records showed major complications, and 2% of patients died within 30 days after admission. (Aiken et al a ...