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Nurse Staffing and Quality of Care

Alexandra C. Zitsch

School of Nursing, James Madison University

NSG 462: Issues in Contemporary Nursing Practice

Dr. Jill Delawder

November 12, 2021

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Abstract

Appropriate nurse-to-patient ratios are necessary in order to provide effective and quality care

throughout the medical field. Increased staffing among nurses creates positive outcomes among

patients and lowers psychological stress among nurses. This paper reviews multiple articles

consisting of qualitative studies, quantitative studies, and meta-analysis, identifying the effects of

an ineffective nurse-to-patient ratio including patient safety, nurse burnout, and patient

satisfaction. The purpose of this paper is to determine what effects poor nurse staffing has on the

nurses themselves as well as the patients. In order to determine an appropriate nurse-to-patient

ratio, more research needs to be conducted on a basis that is individualized to the hospital and

unit.

Keywords: Nurse staffing, nurse-to-patient ratio, burnout, patient satisfaction, patient

safety, mortality rates

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Nurse Staffing and Quality of Care

As medical experts continue to investigate diseases processes, complexities that were

previously unknown are now being brought to light. The combination of new discoveries, an

increase in growth of our aging population and the need for improved technological advances all

increase the cost of care. In order to manage that cost of care, nurses are assigned more and more

patients. Appropriate nurse staffing has been a major discussion over the past 10 years primarily

due its effect on safety, burnout, and patient satisfaction. Determining staffing levels can be

difficult due to various unit acuity, ward, and staffing factors, but their adverse effects make

them a primary concern. An analysis of multiple studies reveals that to increase quality of care,

nurse staffing needs to be high enough to promote safety, lower burnout and increase patient

satisfaction.

Discussion

Patient Safety

Patient safety is the number one priority when it comes to the medical field, but it can

often be compromised by medical errors. Medical errors are one of the leading causes of

mortality and injury, so it is vital that we do everything we can to prevent these from happening.

Patient safety can be compromised in two different ways—the wrong thing being done, or the

correct thing not being done (Cho et al., 2016). Poor staffing levels is one of the key components

that contribute to safety issues and medical errors. Higher staffing levels have shown to decrease

mortality rates, adverse events, and longevity of stay within the hospital. In addition to staffing

levels, the length of shift also negatively affects patient safety. In order to promote patient safety

and reduce medical errors, it is obvious that an appropriate nurse to patient ratio needs to be

implemented.
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Nurse Burnout

Around the world, nurse burnout has continued to grow especially over the past year with

COVID. In fact, Gutsan et al. (2018) found that burnout has increased a substantial amount to

about 60-70% over the past ten years. According to Gutsan et al. (2018), “Nurse Burnout has

been a chronic response to work-related stress comprising three components or dimensions:

emotional exhaustion, depersonalization, and personal accomplishment.” A high nurse to patient

ratio has very real consequences which include increased stress levels, mental exhaustion leading

to adverse effects, and even malpractice lawsuits (Gutsan et al., 2018). As the population

continues to grow due to the gradual increase in age within the older population, staffing levels

become more difficult to manage. In 2009 it was found that the turnover rates across the board

for medical personnel was about 50-75% (Gutsan et al., 2018). Although burnout rates have

increased across the board, nurses were of particular concern with burnout because of the

emotional connection they have with their patients and the exhaustion that ensues due to their

particular scope of practice. The likelihood of burnout increases to about 23% per patient added

to the nurse’s assignment. Burnout results from significant psychological, mental and physical

difficulties, which can be avoided by providing nurses with the proper nurse to patient ratio.

There is no clear connection between whether or not burnout also results in permanent self-

removal from the nursing field, but the psychological distress it creates is extremely clear (Chen

et al., 2019).

Patient Satisfaction

As a nurse, we see our patients go through so many ups and downs throughout the day.

Patient satisfaction is almost always directly related to feeling heard about whatever it is they

want to say. When there are staff shortages and nurses do not have the time to stop and listen to
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what the patient is feeling, patient satisfaction goes down. Nurses make it their main priority to

get the essential interventions out of the way for each patient, and if there is time remaining, they

have the opportunity to go back to the patient and take the time to understand how the patient is

feeling and coping with their situation. When staffing levels for nurses are low, the patients do

not get the one-on-one interactions that they are so desperate to have, which is why patient

satisfaction decreases. Winter et al. (2020) very clearly states that “patients are significantly less

satisfied with their care when staffing ratios are low, which confirms existing studies.”

Discovering the effects on patient satisfaction implies that there are more things other than

measurable events like, safety, mortality and adverse events, that are taking place.

Conclusion

Sufficient staffing for nurses has shown to significantly influence patient’s experiences

within the hospital as well as their medical outcomes. There is a direct correlation between

nursing ratios and how that affects a nurse’s psychological, emotional, and mental wellbeing as

well as their efficacy when it comes to caring for patients. Although this conversation has been

going on for quite some time, the medical field has yet to come up with a solution to the

problem. Nurses are still overworked and understaffed. Hospitals are desperate for nurses and are

consistently offering bonuses as an incentive for nurses to work an additional 4 hours at the end

of a 12-hour shift. Because units and hospitals are so different across the board, there cannot be a

standard nurse-to-patient ratio, but policymakers need to make it a priority to determine an

appropriate individualized ratio that fits that particular unit/hospital. The longer nurse-to-patient

ratios go unaddressed, the more mortality rates will continue to increase, patient satisfaction will

continue to decrease, and nursing burnout will continue to worsen.

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References

Chen, Y., Guo, Y., Chin, W., Cheng, N., Ho, J., & Shiao, J. (2019). Patient-nurse ratio is related

to surses' intention to leave their job through mediating factors of burnout and job

dissatisfaction. International Journal of Environmental Research and Public

Health, 16(23), 4801. https://doi.org/10.3390/ijerph16234801

Cho, E., Lee, N., Kim, E., Kim, S., Lee, K., Park, K., & Sung, Y. (2016). Nurse staffing level

and overtime associated with patient safety, quality of care, and care left undone in

hospitals: A cross-sectional study. International Journal of Nursing Studies, 60, 263-271.

https://doi.org/10.1016/j.ijnurstu.2016.05.009

Gutsan, E., Patton, J., Willis, W., & Coustasse, A. (2018). Burnout syndrome and nurse-to-

patient ratio in the workplace. Management and Health Care Administration.

Winter, Vera., Schreyoog, J., & Theil, A. (2020). Hospital staff shortages: Environmental and

organizational determinants and implications for patient satisfaction. Health Policy,

124(4), 380-388. https://doi.org/10.1016/j.healthpol.2020.01.001