9 Apr 2022


Inadequate Nurse to Patient Ratio in the Long Term Care Unit

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Academic level: University

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The inadequate ratio of nurse to patient in a care unit is a problem faced by many hospitals. This happens when the number of nurses is very low compared to the patients in a hospital. This is mainly because of understaffing in a hospital, and this affects nurses more than doctors. The reason why is that sometimes they assume that the nurses do not do a lot, and they can take care of many patients at the same time (Cotton, 2012). The inadequacy of this hospitals has caused significant problems to them leading to the closure of some and others having bad reputations.

The primary stakeholders in such hospitals tend to be the victims in such situations. The stakeholders include the nurses, patients, doctors, hospital board and the community that depends on the hospital for their services. The nurses due to being understaffed, those at work tend to be overworked therefore losing their efficiency and attention required at work. Patients tend to suffer due to waiting to be attended to therefore making their illness worse. 

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The board suffers because due to people knowing of their understaffed situation the number of customers seen a day reduce thus affecting the returns. The community then lacks a hospital that they can count on efficiency, therefore, having to find hospitals elsewhere for quicker and more efficient services (Coffman, Seago & Spetz, 2012). Stakeholders are critical in a hospital because they are the people affected directly or indirectly by the efficiency and quick services. A hospital that does not ensure they are satisfied to tend to suffer and face consequences. Their reputation is usually tainted and when this is done it affects the financial standing of the hospital. Poor economic status affects the resources of a hospital this leads to the downfall of the hospital in general.

According to Cotton (2012), to address the issue, various changes need to be made to address the issue. The nursing workload measurement system is one of the things that need to be changed. It is a system where the framework of workload is well defined and outlined and the number of nurses well listed from the front line nurses to the reporting matrons in charge. The theory has been applied by the Canadian and Australian nurses and has proved to be useful. The proper outlining makes it easier for the nurses to identify their responsibilities and therefore even when understaffed they can easily multitask according to precise shifts. The theory has faced various challenges but with proper training and follows ups, it can lead to an appropriate patient attention by the nurses. The theory was proved to work by research done by the registered nurses of Ontario in 2007 (Collis, 2010).

Standardized nurse-patient ratios that are mandated is another change that will help to solve the inadequate nurse-patient ratio situation. The theory was first introduced in California and Australia in 1999. The parliament had to mandate the rates of nurse-patient in every department in a hospital. Some patients are required for every nurse depending on the unit one is assigned. Different countries and regions have legislation that guides this ratio though some hospitals are not located in such areas. Those that are not located in such areas tend to suffer from the inadequate ratios. Through the legislation, they can manage to change the situation by standardizing the ratio and making it a mandate (Coffman, Seago & Spetz, 2012). 

It will help the overworking of the currently employed nurses and also the patients who have to wait for long to be attended. The theory proved to work after research was done in 2004 following complaints by nurses and politicians in California after the ratios were mandated (Collis, 2010).

The above changes need to be implemented and evaluated in order ensure that stakeholders are satisfied with the services. The first step is to hold a meeting with the interested parties and the politicians. The meeting is to discuss the issues that come up due to inadequate nurse-patient ratio. Discussing this issues will help identify the importance of rectifying them and the advantages of rectifying them. Politicians will formulate the appropriate mandates that they will formulate and discuss with the stakeholders to standardize them (Collis, 2010).

The hospital will then outline a framework of the duties and list all the nurses currently employed in the hospital. The nurses will include the front line nurses and the reporting matrons. They will also include the qualifications of each to identify what each can handle before allocating the duties. They then will assign each task accordingly in each unit allocating the number of patients each should attend to in the various units. The strategy will help in accountability of the patients, efficiency and quality services. The number of patients assigned to each nurse should be according to the discussion held with the politicians and the stakeholders. It will help in the evaluation process because it will not contradict with the formed standardized ratios that are mandated.

Evaluation is done when each of the implementation has to be done. The research will be done in the hospital that has implemented the changes and results will be compared. The results compared are those realized before implementation and after implementation. It will help identify where a significant change has been made and where challenges have been made. According to the previous research, there have challenges faced both in California and Ontario. Through evaluation, the weaknesses of Implementation will also be identified and rectified where possible. The assessment process is the most important stage because it will assist in the future actions taken by the hospital and the stakeholders.

Proper application of the changes discussed above will lead to positive impacts. Firstly, the type of services provided by the hospital will be quality and efficient. The nurses will know the exact duties that they should be executing and the number of patients they should be attending to in the various units (Collis, 2010). With this knowledge, they will not have to work for themselves and therefore give full and undivided attention to the patients. All patients will get quality services, and the nurses will know each of the patients according to their needs and timings of the different medication and attention required. 

Secondly, the hospital will have a well-known good reputation. Quality services leave the stakeholders well satisfied. Therefore, the information is spread to the community. A good reputation is crucial for any hospital because this is what makes people trust it. Trust is built when good results are seen by most of the patients who go the same hospital. Proper services when provided the patients get well faster and in the right way, this gives them a reason to come back in case of an ailment by them or by a relative (Coffman, Seago & Spetz, 2012). Thirdly, the hospital will experience financial improvement and stability. Satisfied clients lead to referrals to their friends and family. It drives more customers who support the hospital financially. The Proper financial standing of a hospital leads to more resources in the hospital which in hand improves the services provided. Example, if a hospital is financially stable, they afford the equipment to do complex tests which are imperative for patients with chronic diseases like cancer. 

The discussed changes are paramount, and they make a significant impact in hospitals and this impact at the end lead to the stakeholders benefiting greatly. Quality services, reputation, and proper financial standing are the primary results that every hospital would want to experience. The impact they make is reflected in the future functioning of the hospital which determines the level and respect at which the community gives it (Donaldson & Shapiro, 2010).

According to Donaldson & Shapiro (2010), there are characteristics that the nurses should have to ensure the success of this changes and proper implementation. The characteristics could be gained through training, education and some come naturally with others. The first that should be considered is the clinical judgment. It is where the nurse can know the best way to deal with certain situations and conditions that come about by some patients. Some patients come with certain emergency conditions that require urgent attention. A nurse should have accurate clinical judgment and patience to deal and attend to the patient.

The second characteristic is a moral agency in that they have the respect to deal with anyone no matter their background or financial standing. There are cases where an accident occurred, and casualties from different economic backgrounds are brought in the care unit. A nurse should not judge or look down on anyone, in fact, they should attend to everyone equally. Their aim is to give quality services and ensure that the patient is taken care of professionally with the purpose of getting well. The financial standing should be the concern of the finance department and not the nurse.

The third characteristic should be collaborative. The nurse is to be a person who works very well with others without any problems. It is important because nurses should be sharing every information of every patient because of change of shifts. If a nurse is not collaborative, this will affect the communication done in the hospital about patients this, in the end, will affect the services provided. They are usually advised to keep it professional at all levels and avoid conflicts because they are dealing with people lives and health status. There have been cases of nurses having conflicts, and it led to serious consequences which include wrong administration of drugs and lack of administration of medication. All this can lead to the hospital being sued. The fourth characteristic is that the nurse should be clinically inquisitive. Every day some new diseases and conditions are coming up. The best way is for the nurse always to have the zeal to learn and inquire anything that is new to them. It will help avoid situations where they administer anything wrong or in the wrong way. An inquisitive nurse avoids making mistakes because mistakes lead to consequences that may result in loss of license or suing the hospital (Coffman, Seago & Spetz, 2012). 

A curious nurse is always learning from experience, training or in medical school. It is advisable that a nurse or any medical practitioner to always be learning and not to stop because this disease keeps evolving and turning into different forms. It is best to be informed and inquire from those well experienced in dealing with a situation that they do not understand. The characteristics named above are vital in the changes required and also in ensuring that the inadequate ratios do not affect the services provided. It is important that a hospital ensures they implement and evaluate this factors to ensure future success.

Summing up, the problem of the inadequate nurse to patient ratio is not unique to any region or country, but it is experienced in many health facilities all over the world. Most of such facilities are understaffed and in the end, it hampers better service delivery to the patients. As a result, it is sad some lives that would have been saved if the hospitals were well staffed with nurses end up being lost. 


Cotton, J. (2012). Building Capacity – The implementation of a critical care/emergency program. Canadian Journal of Nursing Leadership, 7 (7), 80-88.

Donaldson, N. & Shapiro, S. (2010). Impact of California mandated acute care hospital nurse staffing ratios: A literature synthesis. Policy, Politics & Nursing Practice , 11 (3), 184-201.

Collis, J. (2010). Adverse effects of overcrowding on patient experience and care . Emergency Nurse, 18( 8), 34-39.

Coffman, J., Seago, J. & Spetz, J. (2002). Minimum nurse-to-patient ratios in acute care hospitals in California. Health Affairs , 21 (6), 53-64.

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