A Relevant Issue in Today’s Clinical Setting: A Poor Nurse-to-Patient Ratio

When I first started working at Augusta Health, I noticed that in our unit (Skilled Nursing Unit)
there was only 1 Registered Nurse (RN) and 1 Certified Nursing Assistant (CNA) for the entire unit of
patients. Although the unit usually only has around 12 patients, making the nurse-to-patient ratio 1:6,
having only one RN complicates the daily activities in the unit. For instance, since a CNA cannot pass
medications within their scope of practice, so the RN must be the authorized personnel that delivers
every patient’s daily medications. Due to the common theme of polypharmacy, the patients in the unit
can be prescribed around thirty medications. If all 12 patients have 20 medications to be taken in the
morning, in conjunction with the all of the five to seven rights of medication administration that must be
verified by the nurse, morning medication rounds may not even be completed until 1300. Certain
medications need to be taken around the same time every day and the time of day the medication is
taken could alter the drug’s effect on the body. Another complication of a poor nurse-to-patient ratio
includes the increased risk for falls and injuries. At Augusta Health, call bells and bed alarms are
repeatedly activated and without more qualified staff members, the patients are at risk for falls and
decreased quality of care.

The articles I read are accurate, up to date, and unbiased. However, the last article I read was
not based in the United States; therefore, due to the differences in the health care system, the results
may not align correctly, but they are still applicable. The first article I read is entitled, California’s
nurse-to-patient ratio law and occupational injury, researchers wanted to figure out if the “state-
mandated minimum nurse-to-patient staffing ratios in California hospitals had an effect on reported
occupational injury and illness rates” (Leigh, Markis, Iosif, & Romano, 2015) of nurses. Before reading
this study, I have not really thought about the impact on the nurses’ wellbeing when they are
understaffed. A key point in this article is that having a higher nurse-to-patient ratio will lessen the
physical demand on nurses, because their workload will be divided among the other nurses. Another key
point is that with more nurses, the nurses will be able to provide higher-quality, individualized care for
each patient. A final key point includes the inability to expand this law to other states due to the
increased costs of hiring more nurses. From the perspective of the institution, this makes sense because
an institution wants to cut costs rather than raise them. The conclusion of this study shows that the law
in California reduced occupational injuries and illness of nurses by “31.6%” (Leigh, Markis, Iosif, &
Romano, 2015). From this article, the conclusion provides concrete evidence that having a state-
mandated law indicating a minimum amount of RNs and LPNs actually decreases on-the-job injuries of
nurses. I understand that the cost of hiring more personnel deters hospitals from adapting this policy;
however, if the health of nurses and the quality of care that the patients are receiving are important, the
institution should hire more nurses regardless of the costs. I will continue to advocate for my fellow
nurses and the patients by pushing an appropriate nurse-to-patient ratio.

The second article I read was entitled, The Mediating Role of Staffing on Quality of Care in
Nonprofit and For-Profit Nursing Homes in Indiana. The researchers in this study wanted to decipher the
relationships between “ownership, staffing, and nursing home quality” (Gichungeh & AE-Sook, 2015) in
Indiana. Before reading this study, I honestly did not know that nonprofit nursing homes existed. An
interesting point within this study is that nonprofit nursing homes are associated with a more resident-
oriented atmosphere. This statement shocked me because I would have thought that the quality of care
would decrease in an environment where the nurses were not being paid. Another key point in the
study is that having a higher number of RNs working leads to better resident outcomes. The fact that
nurses have such a profound effect on resident’s outcomes is an important factor to include in their
quality of care. The study also mentions that nurses can bring their immense knowledge to residents
which makes the residents feel capable to cope with their own illnesses and setbacks. A final key point
in this study includes the importance of having a higher number of CNAs in addition to an adequate
number of RNs. The study explains that CNAs are in charge of performing most of the activities of daily
living (such as baths, dressing, changing bedding, and feeding meals). Although much of the focus is
usually put on the number of RNs, I like how this study includes the value of the CNAs. The results of this
article “revealed that nonprofit nursing homes have superior quality and record a greater number of
registered nurse and certified nursing assistant hours per resident day compared to for-profit nursing
homes” (Gichungeh & AE-Sook, 2015). Based on this study, I would hope to see the “volunteer heart” of
nurses who work at nonprofit institutions mimicked in those working at for-profit institutions. I strongly
believe that the quality of care that the patient receives should be the pinnacle of a nurse’s shift. It is
disturbing to see that volunteers are putting more heart and soul into their jobs than those who work
daily.

The third study I read was entitled, Ethical and Human Rights Issues in Nursing Practice:
Involvement, Education Preparation and Perceived Educational Needs of Nurses. The researchers of this
study sought to “explore registered nurses' experiences of ethics and human rights issues in nursing
practice” (Monaliza, Kalia, & Ghai, 2015). A key point in this study is a little more than half of nurses in
the study did not know their institution had an ethics committee. Of those who knew that the ethics
committee existed, less than 5% of nurses reported to that committee to help them deal with ethical
issues. This fact opened my eyes about hospital ethics committees. I wonder if some institutions try to
mask the existence of their ethics committee in order to decrease the amount of cases coming their
way, which would keep the brand/name of the institution in high standards among the community.
Another key aspect of this study is nurses are faced with ethical situations with almost every shift. This
shows me that as a nursing student, I should strive to learn more than just the academically significant
aspects of nursing; I should be including ethics within my studies and I need to learn how to respond in
certain situations. A final key point in this study shows that nurses cared more about the quality of care
of the patients over learning how to deal with larger ethical questions such as abortion or organ
transplants. This point counteracts my feelings about the attitude of the nurses in the second article I
read. It makes me proud to have chosen to take part in this uplifting profession where we can always be
a supporter of and compassionate caregiver to our patients. The results of this inquisitive study show
that the “[m]ost concerning ethical [issue] reported by nurses was [the presence of] poor staffing
patterns that limit patient access to nursing care” (Monaliza, Kalia, & Ghai, 2015). After reading this
article, I am going to make sure that I am aware of how to contact my future institution’s ethics
committee. I want the overall best experience for each one of my patients and if I feel as if something is
not right, I will be the one to speak up on behalf of my patients and myself. In addition, I hope to
advertise the existence of the ethics committee to all of my coworkers, so that they can have access to
that asset.
 References

Gichungeh, I., & AE-Sook, K. (2015). The mediating role of staffing on quality of care in nonprofit and for-
profit nursing homes in Indiana. Journal of The Indiana Academy Of The Social Sciences, 1888-
102.

Leigh, J., Markis, C., Iosif, A., & Romano, P. (2015). California's nurse-to-patient ratio law and
occupational injury. International Archives of Occupational & Environmental Health, 88(4), 477-
484. doi:10.1007/s00420-014-0977-y

Monaliza, Kalia, R., & Ghai, S. (2015). Ethical and human rights issues in nursing practice: involvement,
educational preparation and perceived educational needs of nurses. Baba Farid University
Nursing Journal, 8(1), 38-44.