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Nursing Ratios, 2007.
This paper looks at nurse-to-patient ratios and discusses their importance.
3,060 words (approx. 12.2 pages), 39 sources, MLA, £ 61.95
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Abstract
In this article, the writer explains that nurse-to-patient ratios refers to the number of patients each nurse has to care for. Further the writer notes that minimum staffing ratios represent the minimal amount of nurses required to care for the maximum number of patients, without compromising patient or nurse safety. The writer points out that both the public and physicians rank nurse under-staffing of hospitals as one of the most serious threats to patient safety. The writer maintains that patient safety experts are concerned whether or not inappropriate ratios lead to higher mortality rates and a variety of complications and adverse effects as well as higher patient stays at hospitals. The writer concludes that determining nurse-to-patient ratios is an arduous task with no single or definite solution. Further, the writer notes that too many variables exist to develop definitive guidelines to cover every possible situation in an acute care facility.
Outline:
Abstract
Introduction
Quality of Care / Patient Safety
Nurse Staffing / Skill Mix
Table 1. Matrix for Staffing Decision-Making
Nurse Safety / Job Dissatisfaction
Consensus / Professionalism
Patient Outcomes: Studies Supporting the Influence of Nurse-To-Patient Ratios
Patient Outcomes: More Than Just Nurse-To-Patient Ratios?
State Legislation
Federal Legislation
Professionalism and My Role
Conclusion
From the Paper
"Acute 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 American Nurses Association assembled a panel of nursing and health professionals to research appropriate staffing levels."
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Nurse Staffing Ratios, 2007.
This paper examines legislation regarding nurse-to-patient ratios.
2,043 words (approx. 8.2 pages), 14 sources, MLA, £ 44.95
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Abstract
The paper relates that California became the first state to mandate nurse-to-patient ratios. The paper explores the issues surrounding this policy, including the historical background, the stakeholders involved, why this is such a critical issue and how nurses can play an active role in ensuring this policy is adopted by all states in the union. The paper shows how mandatory nurse-to-patient ratios improve the quality of nursing and reduce the nursing shortage through greater retention and interest.
From the Paper
"Nurse to patient ratios have been a source of controversy for over a decade, culminating in legislative action at the state and federal level and nursing associations. In 1999, California became the first state to mandate nurse to patient ratios (Sabin, 2004; Wilson, 2004; Dumpel, 2005; Gedhill, 2005; "Hospitals struggle," 2005; Evans, 2006). The legislation mandated that medical-surgical nurses no longer be responsible for more than five or six patients each. Research has shown the optimal workload for nurses to be four patients ("Nurse:Patient," 2006; Ritter-Teitel, 2004; Wilson, 2004). Increasing the patient count to six patients per registered nurse resulted in a 14% increase in mortality rate within 30 days of hospitalization, increased needle stick injuries among nurses and a significant increase in nursing sensitive patient complications such as urinary tract infections, pneumonia, upper GI bleeding and patients going into shock ("Nurse:Patient," 2006; Ritter-Teitel, 2004; Wilson, 2004)."
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Nursing Ratios, 2005.
This paper discusses an article "Registered Nurse Staffing and Patient and Nurse Outcomes in Hospitals: a Commentary", which reports the research of Sean P. Clarke and Linda Aiken.
1,185 words (approx. 4.7 pages), 1 source, MLA, £ 27.95
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Abstract
This paper explains and reflects on the research of Sean P. Clarke and Linda Aiken, which looked at 168 hospitals in Pennsylvania and found that the ratio of nurses to patients affected negatively patient outcomes. The author points out that the article predicts that nursing will have to be seen as the vitally important role it truly is before hospitals will realize that cutting nursing staff cannot save money without putting patients at risk. The paper suggest that unionization of nurses would be one option to make sure that a financially-strapped hospital cannot force nurses to work so many hours that the quality of care begins to slip.
From the Paper
"Suggesting solutions for this complex problem was not really part of the authors' intent. Nonetheless, they point out that other good research supports their findings. In light of the fact that a body of research exists supporting low nurse-to-patient ratios, they view decisions to cut nursing staff to save money as a callous and inappropriate way to achieve that goal. They note that overworking nurses rather than hiring more staff will be counter-productive in the long run, since it leads to burnout and loss of employees. The authors note that the problem and solutions are interlinked in complex ways. Declining to provide nurses with raises contributes to burnout, but increased cost for nursing staff makes it harder to hire more nurses. Both overwork and being spread too thin can contribute to poor patient outcomes. Thus the issues are clear but complex and without any easy solutions. This is because each solution presents new problems. Hospitals need to provide raises, but the public wants to see a curb put on the rapid rise of health costs. They don't want to spend more, but they want the hospitals well staffed. When nurses are faced with overwork and what they see as inadequate pay, they may discourage others from going into nursing. The authors do not address these problems with clear solutions as that was not the purpose of their research."
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Nurse-to-Patient Ratios, 2007.
An analysis of how nurse-to-patient ratios affect patient and nurse safety.
1,962 words (approx. 7.8 pages), 19 sources, MLA, £ 43.95
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Abstract
This paper discusses the importance of the nurse-to-patient ratio in the care of patients, particularly those in acute care. It discusses the effects of cutbacks in nursing staff numbers to patient safety and how this can be improved by the nursing staff and skill mix. The paper then discusses nurses' safety and positive legislation in California regarding this issue. The paper concludes by briefly discussing individual nurse's roles in ensuring patient and nurse safety.
Table of Contents:
Abstract
Introduction
Patient Safety
Nurse Staffing / Skill Mix
Nurse safety / Job Dissatisfaction
Legislation
Professionalism And My Role
Nurse-To-Patient Ratios: How I See Myself In This Role Now And In The Future
Conclusion
From the Paper
"Determining nurse-to-patient ratios is an arduous task with no single or definite solution. Too many variables exist to develop definitive guidelines to cover every possible situation in an acute care facility. The mix of RNs and LPNs, including individual experience levels of each staff member and training in specialized areas, is a relevant factor to determine appropriate staff. (Currie, Harvey,West, Mckenna, and Keeney, 2005). Needs of patients vary greatly from individual to individual. Many factors determine the acuity of the patient and, therefore, may alter the amount of attention required by a patient. No single ratio solves all problems. Many states have tried passing legislation to mandate ratios, and, all but California, have been unsuccessful. More research is needed to effectively resolve this issue."
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Nurse-Patient Ratio, 2005.
This paper discusses the debate regarding nurse to patient ratios in hospitals and other healthcare settings.
2,250 words (approx. 9.0 pages), 5 sources, £ 61.95
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Abstract
This paper explains that the increased nurse to patient ratio on a given shift is causing an increased burden on nurses. The author points out that this is causing a high tendency for nurses to become overworked and overstressed. The paper relates that this high nurse to patient ratio may lead nurses to burnout and the desire to leave the profession.
From the Paper
"Today's nurses possess considerable challenges in their professional lives. For example, it is anticipated that the typical stressors of the nursing profession provide additional strain on the job in a variety of ways, such as patient care, accountability, quality assurance, and other related factors. Nurses are overstressed and overworked in many instances, and their professional lives are left in disarray due to the tremendous responsibilities that they encounter. For many nurses in a variety of healthcare settings, it is expected that there is a significant requirement to handle extensive caseloads on any given shift, and this may lead to errors on the job, as well as critical lapses in judgment in some cases. The lack of respect for nurses plays a role in the process, and a substantial component of these stressors is the provision for a high ratio of patients assigned to each nurse."
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California Nurse-Patient Ratio, 2006.
A review of the history of the mandatory nurse-patient ratio legislation in Canada.
675 words (approx. 2.7 pages), 6 sources, £ 18.95
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Abstract
This paper discusses how the nursing shortage and repercussions in nursing attrition and compromised patient care led to numerous attempts at forcing mandatory nurse-patient ratio legislation in California until finally, the bill was signed into law in 1999. This paper reviews the bill including the history and ramifications of the legislation and focuses on implications for the nursing profession and others.
From the Paper
"In 1999, California became the first state in the union to impose mandatory nurse-patient ratios (Sabin, 2004; Wilson, 2004; Dumpel, 2005; Gedhill, 2005; "Hospitals struggle," 2005; Evans, 2006). The legislation requires that med-surg nurses would no longer be responsible for more than five or six patients each, during the phased in approach to the bill. According to research, the bill required that as of January 1, 2004, no more than six patients per nurse be assigned and that by January 1, 2005 the number be reduced to the assignment of no more than five patients per nurse (Sabin, 2004; Gedhill, 2005; "Hospitals struggle," 2005; Evans, 2006). Governor Gray Davis signed the California Staffing Ratio Law, AB 394 into law on October 10, 1999, although attempts to pass such legislation dated back to 1193 with the introduction of AB 1445 that was defeated (Dumpel, 2005). "
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Under-staffing in Nursing Homes, 2007.
This paper looks at the topic of under-staffing, focusing on nursing homes.
1,013 words (approx. 4.1 pages), 15 sources, MLA, £ 24.95
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Abstract
In this article the writer discusses that minimum nurse-to-patient ratios represent the minimal amount of nurses required to care for the maximum number of patients, without compromising patient or nurse safety. The writer points out that both the public and physicians rank nurse under-staffing as one of the most serious threats to patient safety. The writer notes that nurse safety advocates are beginning to question how inadequate ratios impact job satisfaction and the ability of nursing staff to improve quality of care. While a problem at all healthcare facilities, the issue is even larger at nursing homes where minimum staffing ratios are very low. The writer concludes that much research is in progress to help nurses maintain a safe environment to practice and to determine how to adequately define what nurse-to-patient ratios should be.
From the Paper
"A history of nurse staffing and patient outcomes dates as far back as a study by Moses and Mosteller. They found nurse staffing among the significant determinants of mortality. Later, publicly available Medicare data for U.S. hospitals generated more studies on the factors related to mortality. Authors of these studies reported that nurse staffing was significantly related to mortality. Aiken, Clarke, Sloane, Sochalski, and Silber produced the first study to specifically quantify the impact of nurse-to-patient ratios on death rates. They reported that reducing the number of patients that a registered nurse takes care of results in better patient outcomes. A reduction in mortality rates and infections were among the findings. Aiken, Sochalski, and Lake demonstrated that nursing presence, whether measured as RN ratios or as RN hours relative to other nursing personnel hours, is significantly correlated to mortality. Adequate staffing levels allow nurses time to make comprehensive patient assessments, attend to routine nursing duties and effectively respond to emergencies. Specifically, Aiken, Clarke, Sloane, Sochalski, and Silber found that each additional patient assigned to a nurse resulted in a 7% increase in the likelihood of the patient dying within 30 days of admission to the hospital."
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Nursing in the Intensive Care Unit, 2008.
An analysis of the problems in determining patient-staff ratios in the intensive care unit (ICU) and how to address this issue.
2,768 words (approx. 11.1 pages), 10 sources, APA, £ 57.95
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Abstract
This paper addresses the problem of finding a reliable means of predicting the need for nursing care of patients in the intensive care unit (ICU). It looks at present systems devised by nurses to establish nurse-patient ratios and explores these strategies and systems, as well as alternatives. The paper concludes that the preferable course will be a system designed by nurses; without that, legislation will be the only alternative. The paper also looks at the writer's point of view and the relevance of the issue to him.
Table of Contents:
Introduction
Personal Relevance
Relevance to Nursing
The Issue: Nurse-Staff Ratios
Analysis
Alternatives: Staffing Models
Legislation
Recommendations
Conclusion
From the Paper
"Another system for determining nurse-patient ratios is of more interest to the health organization and the government. The diagnostic related groups system is primarily based on the principal diagnosis. Comorbidities and other factors such as length of hospital stay allow outcomes to be costed. The diagnostic related groups are used as a means to calculate costs as well as a system to estimate the cost of nursing care. The problem with the diagnostic related groups system is that, although it is comprised of 475 diagnostic categories, they have never been evaluated in terms of the nursing workload linked with them (Adomat & Hewison, 2004). In general, no patient classification or dependency system that currently is in use is completely effective for determining nurse-patient ratios in the ICU. The problem is found in the variable nature of the ICU so that a set of circumstances cannot be projected onto even the immediate future."
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More Nurses Equals Less Deaths, 2002.
Shows that lower nurse to patient ratios result in better care for patients.
1,900 words (approx. 7.6 pages), 5 sources, £ 49.95
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Abstract
This paper examines the relationship between nurse staffing levels and patient mortality.
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Nursing Stress, 2005.
This paper examines the stressors faced by the nursing profession.
2,250 words (approx. 9.0 pages), 10 sources, £ 61.95
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Abstract
The paper identifies the issues related to mandates of minimum nurse staffing ratios, which often complicate an already overstressed nursing environment in many ways. The paper explains that it is necessary to consider that nurses possess tremendous responsibilities in their work environments, which are complicated even more when minimum staffing mandates are exercised.
From the Paper
"In the modern healthcare environment, it is evident that healthcare professionals are often stretched beyond their means in order to satisfy all of their responsibilities on the job. In the case of nurses, these extensions are particularly evident in many ways, including the requirement to maintain an excessive patient load during work hours, which often compromises a patient's care and treatment plan in different ways. For nurses that are required to maintain a large patient load are at an increased risk of making errors in judgment and medical mistakes, which could potentially lead to serious consequences. These concerns are evident in healthcare facilities throughout the Western world, where high turnover rates and understaffed units contribute to these stressors."
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School Nursing Issues, 2006.
A look at the problems associated with delegating the administration of medication by a school nurse.
1,125 words (approx. 4.5 pages), 8 sources, £ 30.95
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Abstract
One of the major issues that school nurses struggle with is over delegating authority to administer student medications. This paper highlights statistics of student medication use and guidelines, nurse-student ratios and recommendations and delegation options. The paper concludes with a series of recommendations for delegating the administration of medications safely and comments on implications for nursing.
From the Paper
"Delegating the administration of medications to students, especially in elementary schools is one of the most challenging and precarious tasks a school nurse faces. McCarthy (2000) states that for the 5.6% of students that receive daily medication, only 25% of nurses actually administer the medications, with 66% of secretaries, 40% of school aides, 38% of teachers and 18% parents administering the rest. While Healthy People 2010 (US Department of Health and Human Services, 2000) advocates a ratio of at least 1 nurse to every 750 students, this is goal is rarely met, especially with declining funds for education. Price, Dake, Murnan and Telljohann (2003) report that only 52.9% of schools staff a school nurse on more than a 30 hour a week basis, with 43% of elementary schools having a school nurse on staff full time."
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Nursing Burnout, 2008.
An examination of the problem of nurses suffering from burnout.
1,106 words (approx. 4.4 pages), 8 sources, APA, £ 26.95
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Abstract
This paper examines nurse burnout as a prevalent problem in many institutions. The paper explains that nurse burnout can be attributable to inadequate staffing and points out that the consequences of under-staffing are observed in terms of the decline in overall well-being of the nursing staff: staff exhaustion leading to high levels of stress and burnout, nurse dissatisfaction, absenteeism, and higher risk for disfranchisement from the profession. The paper then looks at the common method for calculating the nursing workload internally - the nurse-patient ratio. The paper concludes that while the evidence cited in the paper reflects different institutions, the extent to which burnout is seen should be assessed, as well as evaluated, to help find the possible contributing factors, both within and outside the hospital setting.
Outline:
Identification of Clinical Problem
Review of Literature
Research Critique
Conclusion
From the Paper
"Managers have attempted to adapt to the situation by maintaining flexibility in staff schedules depending on changing unit demands which are constantly changing. When a patient is so seriously ill that one nurse cannot perform care, one or more other nurses are needed for a limited time. At other times, such is not the case. However, the central problem in staffing is not attaining staff flexibility congruent to the unit's needs. The reality that it is not recognized by higher management, nor is it under the control of nurses further complicates the problem."
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Nursing Staff Levels, 2007.
An analysis of the study "Registered Nurse Hours Worked per Patient Day: The Key to Assessing Staffing Effectiveness and Ensuring Patient Safety", by Joanne Ritter-Teitel.
921 words (approx. 3.7 pages), 4 sources, MLA, £ 22.95
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Abstract
The paper reveals that the majority of preventable medical errors are due to inadequate staffing of registered nurses. This paper provides a critique of the study performed by Joanne Ritter-Teitel that sought to demonstrate that an increase in patient safety levels corresponded to an increase in the nurse:patient ratio.
From the Paper
"The majority of preventable medical errors are due to inadequate staffing of Registered Nurses. Wilson (2004) believes that adequate RN staffing, versus nursing support services, is necessary in order to maintain quality patient care. Wilson (2004) cites statistics as high as a 7% increased mortality rate for each patient above the 4 to 1 ratio and that preventable medical errors cost an average of $17 billion per year. With this problem in mind, and the growing number of state legislative bodies either enacting mandatory nurse:patient ratios or currently debating the topic, the current study sought to contribute to the body of existing literature demonstrating an increase in patient safety levels with a corresponding increase in the nurse:patient ratio."
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Accounting Ratios, 2006.
This paper defines the term accounting ratios and details why they are a significant tool applied by accountants when presenting accounting statements.
1,841 words (approx. 7.4 pages), 10 sources, MLA, £ 41.95
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Abstract
The writer of this paper examines the importance of accounting ratios in business. Accounting ratios illustrate the present as well as the prospective, so that shareholders can visualize how much gain a business attained, the total worth of the assets and the level of cash reserves available. This well-researched paper discusses the advantages and disadvantages of accounting ratios. One significant drawback of the accounting ratio is that it depends too heavily on the conventional costs that lead to twists in quantifying performance. Ratios are required to be represented meticulously. They can entail the evidences to the performance of the company or financial environment. However, they are unable to demonstrate whether the performance is good or bad out their own. The writer details the manner in which the final figures of accounting ratios are achieved, while discussing the fact that these ratios necessitate some quantitative information for an informed analysis to be made. The writer contends and clearly explains why accounting ratios are completely dependent on the supplied data which may or may not be accurate.
Table of Contents:
Introduction
Discussion
Conclusion
References
From the Paper
"A markedly low accounts ratio may give rise to angry suppliers and remarkably high inventory turnover ratios may lead to supply shortages and angry customers. The one that is correct for one company may not be considered appropriate for another one. Besides, no two companies are found to be similar irrespective of the fact that they are competitors in the same industry or market. Application of ratios to evaluate one company with another provides misleading information. Businesses may be within the same industry but have distinguished financial and business risk. Ratios are completely dependent on the data that may or may not be accurate."
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