Nurse-to-Patient atios in Illinois
The Facts
For many years the ongoing nursing shortage has required nurses to work longer hours and care for more patients, causing many of them to make fatal and near-fatal mistakes on the job that could have otherwise been avoided. Illinois has attempted to remedy this situation by enacting The Nurse Staffing by Patient Acuity Law on August 24, 2007 ("The Nurse Staffing by Patient Acuity Law," 2012). ather than setting hard numbers for specific nurse to patient ratios, the law instead requires hospitals to enact staffing plans recommended by a committee of their nurses that is comprised of at least 50% direct-care staff nurses. The plans created by these committees must be reevaluated semi-annually so that their effectiveness can be gauged. The nurses on staff are responsible for continually monitoring the plans that have been put in place to ensure that patient needs are properly met, as…...
mlaReferences
Aiken, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H.L. (2010). Implications of the California nursing staff mandate for other states.
Health Services Research, 45(4), 904-921.
Nurse staffing by patient acuity law. (2012). Retrieved September 16, 2012, from:
Dialysis organizations would be another opponent to the change due to the cost. aising the costs of treatment might be necessary to hire new nurses. Dialysis clinics, because of their small size, often have fewer resources than large hospitals and the increased cost of wages of new hires would place a an additional stress on the unit's already limited budget, perhaps if estimates by the American Hospital Association are correct, as much as $270 million dollars a year.
Elaborate on potential negatives that individuals or groups might bring up in discussions and how you would counteract this.
Some nurses, despite their generally strong feelings in favor of the proposal because of their workload, may fear having to take a pay cut, or have overtime hours cut, because of the increased costs and influx of new nurses. Administrators may adopt a different type of change-resistance technique, and simply assert that it cannot be…...
mlaReferences
The American Nurses Association. (2008). ANA.
Retrieved Oct 9, 2008 at http://www.nursingworld.org/
In our hands: how hospital leaders can build a thriving workforce. (May 2007).
American Hospital Association, Commission on Workforce for Hospitals and Health
Nurse-Patient atio on Care Quality
Nurse Patient atio
The Impact of Nurse to Patient atio on Healthcare Quality
The Impact of Nurse to Patient atio on Healthcare Quality
It would be hard to understate the importance of a high nurse to patient ratio (NP) for patient and staff safety, as well as quality of care. While there are a number of different nursing factors that can influence these outcomes, including nursing education, experience, skills mix, contact time, frequency of interactions, and type of inpatient unit, the NP has been the focus of considerable interest in part because it can be easily quantified (reviewed by Sidani, Manojlovich, and Covel, 2010). This review will examine the empirical evidence for the importance of NP in determining patient and staff safety, as well as quality of care. Towards this goal, research articles obtained from the Library of Medicine will be reviewed in detail and compared to the…...
mlaReferences
Aiken, Linda H., Clarke, Sean P., Sloane, Douglas M., Sochalski, Julie, and Silber, Jeffrey H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288(16), 1987-1993.
Despins, Laurel A., Scott-Cawiezell, Jill, and Rouder, Jeffrey N. (2009). Detectiion of patient risk by nurses: A theoretical framework. Journal of Advanced Nursing, 66(2), 465-474.
Duffield, Christine, Diers, Donna, O'Brien-Pallas, Linda, Aisbett, Chris, Roche, Michael, King, Madeleine et al. (2011). Nursing staffing, nursing workload, the work environment and patient outcomes. Applied Nursing Research, 24, 244-255.
Institute of Medicine. (2000). To Err is Human: Building a Safer Health System. Online: National Academy Press. Retrieved 18 Apr. 2013 from http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx.
Staffing in Nursing
Staffing and Other Nursing Issues
The main topic of this paper is staffing related to the field of nursing, here it is very important to realize a correct balance between the demand of nurses and available nurses at any medical facility. Since the duty of any medical professional like a doctor requires much assistance from a subordinate such as nurse therefore it is vital for any organization to fulfill this requirement in a way that best suits all parties involved especially the patients. This paper will focus on many different aspects related to the issues of staffing and will also shed some light on some of the difficulties of keeping a low or high number of required nurses.
The emphasis here would also be on many different aspects related to staffing such as the economical perspective, the quality perspective of any medical organization and so on. The paper is divided…...
mlaReferences
Aiken, L.H., Clarke, P.S., Sloane, D.M., Sochalski, J. Silber, J.H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction. Original Contribution, Vol 288, 16.
Cook, A., Gaynor, M., Stephens, M., Taylor, L. (2010). The effect of hospital nurse staffing on patient health outcomes. National bureau of economic research, 31.
Cimiotti, J., Aiken, L., Sloane, D., Evans, S. (2012).
Nurse staffing, burnout and healthcare-associated infection.
Inpatient atio and Morale
E: INPATIENT ATIO AND MOALE
Emergency oom: Nurse to Patient atio and Morale
Nurse to patient ratios in health institutions is one of the most influential factors in health providence, in any country's health sector. Two states of the aforementioned aspect would comprise of either high or low ratios. The former demonstrates poor patient outcomes that would imply high mortality rates and dissatisfied clientele. On the contrary, the latter would ensure quality patient outcome and positive feedback from patients. The ratio has an impact on cost effectiveness and also nurse turnover rates were highly influenced by the ratios that sometimes dictated the working conditions of these nurses. A recommendation to increase the number of nurses by various implementations needed to be taken sequential would be the ultimate solution. This would be despite the cost that these procedures would reflect, meaning that the budget need to be compromised to endow…...
mlaRelated to the above is the workload at the job-level. Here the type of job is an important consideration in morale. Job-level workloads are linked to stress and low morale in nurses in multiple units (Freedman and O'Brien-Pallas, 1998). Often this comparison is made on the basis of unit, for example and ICU unit verses an ER unit, but there are probably various contextual factors within the ER unit that are related to differing perceptions of workload. The research has not looked strongly at the contextual factors with a unit that can affect morale and this would be an interesting question to address. Of course one of the factors that of concern at the patient level is the clinical condition of the patient. There is actually good research that has developed measures of workload based on the patient's clinical condition such as the Therapeutic Intervention Scoring System (Cullen, Civetta, Briggs, & Ferrara, 1974). Such measures could be employed for the current proposed question.
Nurses report that one of the biggest issues for them in an ER setting is the issue of patient centered care. Certainly, the modern healthcare professional's role is not limited to only assisting the doctor in procedures, however. Instead, the contemporary professional takes on a partnership role with both the doctor and patient as advocate caregiver, teacher, researcher, counselor, and case manager. The caregiver role includes those activities that assist the client physically, mentally, and emotionally, while still preserving the client's dignity. In order for one to be an effective caregiver, the patient must be treated in a holistic manner. Proper communication and advocacy is another role that the modern caregiver assumes when providing quality care. For the purposes of our essay, the two terms, advocacy and communication, are often interchangeable, since one is the result of the other, and vice versa (Kozier, Erb, & Blais, 1997). Therefore, it is extremely important to ascertain how the ER setting can be improved to decrease stress levels of ER Nurses and, at the same time, increase morale. The study could be targeted as finding the optimal balance of the above factors that would reduce stress and help to keep morale among the nurses at its peak.
Getting back to previously stated
cute care facilities try to maintain low costs and employ quality nurses. Within this statement is a double standard. How can we have quality nurses and cut costs at the same time? This is where the skill mix comes into play. In the skill mix, there are Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. If the lesser skilled staff free RNs they can be better able to perform their nursing duties and assessments. If acute care facilities can agree on an appropriate number of each type of staff member within the facility, they might be better able to accomplish safe patient outcomes while keeping costs down.
Determining nurse-to-patient ratios is a complex issue where one solution is not sufficient to cover all circumstances. The merican Nurses ssociation assembled a panel of nursing and health professionals to research appropriate staffing levels. The panel developed the following Matrix for Staffing…...
mlaAiken and colleagues have been pioneers in studying nurse patient ratios and their relationship to patient outcomes.
Aiken, Sochalski, and Lake (1997) demonstrated that nursing presence, whether measured as RN ratios or as RN hours relative to other nursing personnel hours, is significantly correlated to mortality. When studying patient outcomes in specialized AIDS units,
Aiken, Sloan, Lake, Sochalski, and Weber (1999) found that at 30 days post admission, mortality rates were 60% lower in magnet hospitals, and 40% lower in dedicated AIDS units than in conventional scattered bed units. The researchers concluded that higher nurse patient ratios were a major factor in these lower
Evidence of this can be corroborated with a study conducted by the California Nurses Association, which found similar positive effects. At the same time, researchers found that reducing these ratios in various specialty environments inside the hospital (such as the ICU), improves the underlying amounts of care being provided dramatically. This is important, because it is verifying the positive effects that nurse to patient ratios are having on the industry. ("Does Mandating Nurse Patient Ratios Improve Care," 2010)
Clearly, the study that was conducted by article titled, Nursing Staff and Patient Mortality, highlights how various nurse to patient ratios, improves the quality of care being provided. The study is useful, because it examines the underlying affects of having various nurse to patient ratios at a facility or the lack of these regulations. As a result, the information that was collected and analyzed helps to highlight how hospitals can avoid the…...
mlaBibliography
Does Mandating Nurse Patient Ratios Improve Care. (2010). Health Leaders Media. Retrieved from:http://www.healthleadersmedia.com/content/NRS-245408/Does-Mandating-NursePatient-Ratios-Improve-Care
Aiken, L. (2002).Hospital Nursing Staff and Patient Mortality. Journal of American Medial Association, 288 (16), 240 -- 247.
Clarke, S. (2003). Failure to Rescue. American Journal of Nursing, 103 (1), 42 -- 47.
Nurse Patient atios and Quality of Care
This study reviews the broad level of issues that surround the nurse/patient ratio: a critical shortage of trained and experienced nurses; increased political and fiscal demands from all sectors of society; rising costs internally and externally combined with a rising number of under-insured; and the conundrum of nursing ethics and the ability to foster excellence in care and patient advocacy. We note that there remains an issue about hiring more nurses -- where will these nurses come from if the nursing schools do not increase their recruitment efforts and broaden their curriculum. In addition, we note that the large majority of patients and stakeholders primarily want two things when admitted to a healthcare facility: better paid nurses and more highly-trained professionals who are satisfied with their vocation.
Introduction
Modern nursing is, by necessity, a mixture of complex balance: patient care vs. staffing; procedures vs. patient load;…...
mlaREFERENCES
More Nurses Make the Difference. (February 2012). The Lamp. 69 (1): Retrieved from: http://search.informit.com/au/documentSummary;dn=045435426132502;res=IELHEA
Safe Nurse Staffing: Looking Beyond the Numbers. (2009). Vantage Point, CNA. Retrieved from: -_Looking_Beyond_the_Raw_Numbers_2009-pdf&folder=pdfs/db/newslettershttps://www.nso.com/pdfs/db/newsletters/Safe_Nurse_Staffing_-_Looking_Beyond_the_Raw_Numbers_20094.pdf?fileName=Safe_Nurse_Staffing_
Aiken, L. (2001). The Hospital Nurse Workforce: Problems and Prospects."Draft
For the Council on the Economic Impact of Health System Change. Retrieved from: / Council-Dec-14-2001-Aiken-paper.pdfhttp://council.brandeis.edu/pubs/hospstruct
They also need to research how much increasing the staffing levels will increase costs, and where funding will come from to cover those costs.
There is another aspect of the argument that must be addressed, as well. There is a nursing shortage, and even if staffing levels are increased, there may not be enough nurses to bring the staff up to the mandated levels, and then health care facilities would be in non-compliance. The union proposal to adopt mandated staffing levels should also address implementing new training and recruiting techniques to help health care entities meet the staffing challenges that a mandate would bring. Without the nurses and other trained professionals to work in these areas, staffing mandates do not do much good, and if the union wants to be successful, they must recognize that.
eferences
Atkins, Siegel & Slutsky. (2005). Making policy when the evidence is in dispute. Health Affairs, 24(1),…...
mlaReferences
Atkins, Siegel & Slutsky. (2005). Making policy when the evidence is in dispute. Health Affairs, 24(1), 102-113.
Feilding & Briss. (2006). Promoting evidenced-based public health policy: can we have better evidenced and more action? Health Affairs, 25(4), 969-978.
Wharam & Daniels (2007). Toward evidenced-based policy making and standardized assessment of health policy reform. JAMA 298(6): 676-690.
Nurse-Patient Ratios.
This is a legislator information sheet on nurse-patient ratios (as adapted from Aikan et al. 2010) for a busy legislator who will only have time to read bullet points:
The ratio of nurse patient is lower in California than in other states with nurses in CA having at least one patient less than nurses have in other states (as for instance in New Jersey and in Pennsylvania as mentioned in Aikman et al. (2010))
California nurses had lower nurse-patient ratio on medical and surgical units when compared to other states. The average amongst CA nurses was 2 patients less than those in other states.
The lower the nurse-patient ration, the lower the level of mortality amongst patients
When nurses' workloads paralleled those of workloads of Californian nurses, the following results occurred:
a. nurses' burnout decreased
b. nurses' job dissatisfaction decreased
c. nurses reported consistently better quality of care
d. Nurses took greater care in improving their…...
mlaSources
Abood, S. (2007). Influencing health care in the legislative arena. Online Journal of Issues in Nursing, 12(1), 12 pp.
Aikan, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H. (2010, April 9). Implications of the California nurse staffing mandate for other states. Health Services Research. Retrieved from http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf
Many advocates of the move feel that lower patient to nurse ratio would lead to additional savings because it would reduce nurse turnover rate, lawsuits, complications and length of stay. Nursing unions in the state of California have asked for a PTN ratio of 3 to 1. The health association however agreed on 5 to 1 which sound more reasonable than the originally proposed 10 to 1. (othberg, 2005)
Patient to nurse ratio when it is too high can definitely adversely affect care. And with baby boomers aging and needing healthcare, we know that number of people looking for healthcare will continue to rise in the coming years. However staff shortage continues to pose a serious problem. And unfortunately, the problem doesn't always lie with cost control. While it is true that most of the problems with staff shortage can be attributed to hospitals cutting down their costs and hence…...
mlaReferences
Michael Rothberg, 2005. Improving Nurse-to-Patient Staffing Ratios as a Cost-Effective Safety Intervention Med Care 2007;45: 571-578)
Patricia W. Stone, PhD,* Cathy Mooney-Kane,
Nurse Working Conditions and Patient Safety Outcomes.
Nursing Shortage
eview On Nurses Shortage
The supply of professional nurses relative to the increase in demand for their services has been on a general decline over the years. As a career choice, nursing has been facing perennial shortage of professionals. Most healthcare organizations will affirm that their daunting tasks were recruiting fresh nurses and retaining the ones already in practice. The 2008 projections from the Bureau of Labor Statistics showed that the demand for professional nurses would increase from the then two million to three million, which represents sixty percent increment. In ideal situations, the number of those who have enrolled in nursing will be sufficient to supply the rise in their number. Nevertheless, this would not be the case if nothing were done to salvage the worrying trend of most students not graduating or resorting to other careers. According to Benjamin Isgur of PWHC Health and esearch Institute, of the…...
mlaReferences
American Association of Colleges of Nursing. (2009, September, 28). Nursing Shortage Fact Sheet. USA: AACN.
Buerhaus, P.I., Staiger, D., & Auerbach, D.I. (2009). The future of the nursing workforce in the United States: Data, trends, and implications. Boston: Jones and Bartlett Publishers.
Blakeley, J., & Ribeiro, V. (2008). Early Retirement among Registered Nurses: Contributing Factors. Journal of Nursing Management, 16(1), 29 -- 37
Cummings, G., et al. (2008). The Relationship between Nursing Leadership and Nurses' Job Satisfaction in Canadian Oncology Work Environments. Journal of Nursing Management, 16(5), 508 -- 518.
Nursing profession is among the oldest in history. Currently, there is much debate that surrounds the profession because of the need for more trained nurses. In recent years the nursing shortage has become a major problem for the medical profession and has resulted in poor patient care and slower patient recover. The purpose of this discussion is to provide an in depth examination of the nursing profession. We will discuss the current state of the nursing profession, including the causes for the shortage and the solution. We will also explore the status of the nursing profession in Australia. Let us begin our discussion by providing a comprehensive definition of what is means to be a nurse.
Definition of a nurse
According to the American Heritage Dictionary, a nurse is defined as " a person trained to care for the sick or disabled under the supervision of a physician." (American Heritage Dictionary, 1982)…...
mlaReferences
American Heritage Dictionary. (1982) Second Edition.
A www.questia.com/PM.qst?action=openPageViewer&docId=5000534396
Bashford, A. (1997). Starch on the collar and sweat on the brow: self sacrifice and the status of work for nurses. Journal of Australian Studies, (52), 67+. Retrieved August 24, 2003, from Questia database, http://www.questia.com .
Nursing Workforce Issues and Concerns
The article, "Nursing Workforce Issues and Trends Affecting Emergency Departments" by obinson and colleagues (2004) looks at the range of contemporary issues which directly impact the quality of care which is received in America's emergency rooms (E).The authors argue that looking at the most pertinent issues which impact the nation's Es is a sound way of taking the temperature of the general healthcare climate as a whole. Examining things like workforce issues, staffing issues and the ratios of patients to nurses can help all individuals involved get a better sense of the challenges that this professional arena faces when it comes to delivering a high quality of care. One of the strengths of this research article is that a host of strategies are engaged in to better improve the quality of care for patients while bolstering the number of qualified nurses and other staff team members…...
mlaReferences
Robinson K.S.; Jagim, M.M.; Ray, C.E. (2004). "Nursing Workforce Issues and Trends
Affecting Emergency Departments" Retrieved from nursingcenter.com:
http://www.nursingcenter.com/lnc/journalarticle?Article_ID=532283
The Shared Governance arrangement:
offers an apparatus for registered nurses to show guidance in the development of practice decisions authorizes all nursing staff to add to work redesign advances the quality of patient and family outcomes.
In the shared governance arrangement, the staff nurses are a big piece of the course, designated and chosen from their units to stand for an area of practice on one of many councils. it's all about shared choice making and authorizing staff nurses to affect their practice atmosphere and have a say in unit choices (Shared Governance at Henry Ford Hospital, 2011).
A new nursing deficiency is revitalizing shared governance. This pioneering organizational model gives staff nurses power over their practice and can expand their affect into administrative areas formerly controlled solely by managers. But nursing shared governance is tough to describe. Its configurations and procedures are dissimilar in every business. Shared governance, is an organizational…...
mlaReferences
Drenkard, Karen. (2010). Going for the gold: The value of attaining Magnet recognition.
Retrieved February 18, 2011, from Web site:
http://www.americannursetoday.com/article.aspx?id=6378&fid=6276
Estlund, Sarah. (2010). List of Nursing Labor Unions. Retrieved February 17, 2011, from Web
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