Nursing Literature Review 4

NURSING LITERATURE REVIEW 4 Nursing Literature Review

One of the significant nursing challenges in primary care institutions is understaffing, leading to a high nurse to patient ratio. Many states in the United States have tried to recommend the required nurse to patient ratios with the intention to improve the quality and safety of care. For instance, after the State of California mandated the lowest registered nurse to patient ratio, twelve other American states followed suit by creating nurse staffing policies to reduce workloads in healthcare organizations and improve care safety (He, Staggs, Bergquist-Beringer, & Dunton, 2016).

The struggle by these and many other states reveals that there is a substantial relationship between nurse to patient ratio and patient safety. According to Carlesi, Padilha, Toffoletto, Henriquez-Roldà¡n, and Juan (2017) explain that a high nurse to patient ratio contributes to role overload, which is associated with adverse safety outcomes that comprise nosocomial conditions such as hospital-acquired infections. By seeking to answer whether an increase in the nurse to patient ratio reduces patient safety, five research articles will be reviewed to confirm or reject the hypothesis: an increase in the nurse to patient ratios has a link with the decrease in patient safety.

Information from secondary sources ascertains that a high nurse to patient ratio increases the occurrence of negative, patient safety outcomes. For instance, Carlesi et al. (2017) conducted a quantitative cross-sectional study by reviewing medical records to determine any association between workloads in nurses and the occurrence of patient safety outcomes in a Chilean public hospital. They estimated workloads in intensive care units (ICUs) through the completion of the Therapeutic Interventions Scoring System while using the nursing assistant to patient and nurse to patient ratios. These researchers analyzed their data using Pearson correlation, multivariate, and univariate analysis. After analyzing data from the workload of 157 nursing assistants, 85 nurses, and 879 post-discharge records, Carlesi et al. (2017) found a positive correlation between nurses’ workloads and patient fall rates.

As a result, these researchers of this secondary source concluded that a high nurse to patient ratio, which results in role overload, has an inverse relationship with adverse patient safety outcomes such as falls. Similarly, Hall, Johnson, Watt, Tsipa, and O’Connor (2016) conducted a systematic review with the principal goal of exploring the link between the levels of burnout, which are attributed to understaffing of caregivers such as nurses, and the safety of patients. They reviewed article sources that were accessed through a myriad of databases comprising Medline, Scopus, Embase, and PsychInfo. Out of the 27 studies, 16 established a significant correlation between worse patient safety and poor wellbeing of caregivers, while 21 out of 30 studies found a substantial relationship between burnout attributed to understaffing and poor patient safety outcomes that comprise medical errors and patient morbidities and mortalities (Hall et al., 2016).

Further, these researchers found that the wellbeing of nurses and other health professionals was worse in places with massive workloads due to understaffing. A similar trend was realized in situations associated with high levels of burnout. Therefore, this study concluded that understaffing was associated with poor wellbeing and high levels of burnout, all of which had a direct association with the occurrence of adverse safety outcomes in patients such as medical errors. Primary research also provides sufficient evidence to confirm that nurse to patient ratios influence patient safety in healthcare organizations. For example, Magalhães et al. (2017) conducted a cross-sectional study to assess the influence of workloads and nursing team staffing levels on patient safety outcomes in different surgical and clinical units of a large university hospital in South Brazil.

This study was conducted from 2013 to 2015, where the investigated factor was workload, expressed as the mean number of patients per nursing clinician in day shifts and 24 hours. These researchers selected a sample of 502 nursing clinicians and 157,481 patients, making 264 observations to determine safety outcomes. From the results, Magalhães et al. (2017) found that the ratios of patients per nursing technician and per nurse in day shifts were five to six and 14 to 15 per professional, respectively. A significant association was found between workloads in inpatient units and the average satisfaction rates of patients, rates of urinary tract infections associated with invasive procedures, and the length of hospital stay with nursing care.

Consequently, this study concluded that a rise in nursing team workloads is an outcome of high nurse to patient ratios that significantly impact the safety and quality of patient care, leading to the recommendation for adequate staffing. Driscoll et al. (2018) found that the number of nurses in acute hospitals was lower than necessary to match the heightened demand for quality care. They conducted a systematic review and meta-analysis to examine the association between staffing levels and nurse-sensitive patient outcomes across different acute specialist units. They accessed relevant secondary sources published between 2006 and 2017 through nine electronic databases, with the primary outcomes being nurse-sensitive patient outcomes.

Out of 3,429 unique articles retrieved, only 35 met the inclusion criteria. These were mostly cross-sectional studies utilizing large administrative databases. Driscoll et al. (2018) found that higher staffing levels correlated with reduced medication errors, hospital-acquired infections, mortalities, restraint use, ulcers, and increased percutaneous coronary interventions and aspirin administration. The study concluded that optimal staffing significantly influences patient safety outcomes such as mortality and patient-acquired diseases, reinforcing the crucial role of adequate nurse staffing in acute care settings.

Additionally, data from the National Database of Nursing Quality Indicators highlights a strong inverse relationship between nursing staffing levels and positive patient safety outcomes. He et al. (2016) studied the longitudinal relationship between staffing levels and safety outcomes, including hospital-acquired infections and falls. They examined variables such as registered nurse skill-mix and total nursing hours per patient-day. The findings indicated that higher staffing levels were inversely associated with adverse safety outcomes, suggesting that better staffing reduces the likelihood of patient safety incidents across various healthcare units (He et al., 2016).

Paper For Above instruction

In modern healthcare systems, the issue of nurse staffing levels remains a critical factor influencing patient safety outcomes. An extensive body of research consistently demonstrates that high nurse-to-patient ratios contribute to increased workloads, which in turn have detrimental effects on the quality and safety of patient care. These effects manifest in higher incidences of adverse events, medical errors, infections, and overall patient morbidity and mortality. Ensuring adequate staffing levels is, therefore, essential for fostering a safe and effective healthcare environment.

The relationship between staffing and patient safety has been explored through various research methodologies, including cross-sectional studies, systematic reviews, and longitudinal analyses. For example, Carlesi et al. (2017) conducted a quantitative cross-sectional study in a Chilean hospital, revealing a positive correlation between increased nurse workload and patient fall rates. Their research underscored the dangers of role overload, which diminishes nurses’ capacity to monitor and respond appropriately to patient needs, ultimately compromising safety. Such findings highlight the importance of optimal nurse-to-patient ratios in reducing patient falls and other safety incidents.

Systematic reviews further corroborate these findings. Hall et al. (2016) analyzed multiple studies and established significant links between understaffing, caregiver burnout, and patient safety outcomes. They found that nurses experiencing high workloads and burnout are more prone to medical errors, medication mistakes, and adverse patient events. Burnout not only affects individual performance but also threatens overall care quality, emphasizing the need for staffing policies that prioritize nurse well-being alongside patient safety parameters.

Primary research also provides compelling evidence. Magalhães et al. (2017) examined nursing workloads in a Brazilian hospital and found that higher patient loads per nurse correlated with decreased patient satisfaction, increased infection rates, and longer hospital stays. These outcomes reinforce the critical role of appropriate staffing levels in maintaining high-quality care and preventing avoidable complications. Similarly, Driscoll et al. (2018) demonstrated that hospitals with lower nurse staffing levels experienced higher rates of adverse outcomes such as infections and mortality. Their systematic review emphasized that increasing staffing not only enhances patient safety but also reduces the burden of medical errors and hospital-acquired conditions.

The importance of staffing adequacy extends beyond individual studies. Data from the National Database of Nursing Quality Indicators reveal consistent patterns: higher staffing levels are associated with reduced adverse events such as falls, infections, and medication errors (He et al., 2016). These findings suggest that staffing levels are a crucial modifiable factor that can significantly improve patient outcomes across diverse healthcare settings.

From a policy perspective, these research findings advocate for legislated staffing ratios and institutional standards that ensure sufficient nurse staffing. California’s legislative mandate exemplifies this approach, with subsequent states adopting similar policies to protect patient safety. Moreover, healthcare administrators should consider staffing as a strategic priority, recognizing that investments in nursing personnel lead to safer care environments and potentially lower healthcare costs by preventing complications and readmissions.

In conclusion, the overwhelming evidence indicates that nurse staffing levels directly influence patient safety outcomes. Insufficient staffing results in role overload, burnout, and compromised care, which increases the risk of adverse events. Conversely, adequate staffing enhances nurses’ capacity to deliver safe, patient-centered care and reduces safety incidents. Therefore, healthcare systems must prioritize staffing policies that align with best practices and research findings to safeguard patient well-being and improve overall healthcare quality.

References

• Carlesi, K. C., Padilha, K. G., Toffoletto, M. C., Henriquez-Roldà¡n, C., & Juan, M. A. (2017). Patient safety incidents and nursing workload. Revista Latino-Americana de Enfermagem, 25, e2841.
• Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(1), 6–22.
• Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLoS ONE, 11(7), e0159015.
• He, J., Staggs, V. S., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: A longitudinal study on trend and seasonality. BMC Nursing, 15, 60.
• Magalhães, A. M. M., Costa, D. G., Riboldi, C. D., Mergen, T., Barbosa, A. D. S., & Moura, G. M. S. S. (2017). Association between workload of the nursing staff and patient safety outcomes. Revista da Escola de Enfermagem da USP, 51.