From time immemorial, human beings have been faced with a myriad of health challenges. While a number of those conditions may be very acute, some may be very chronic. In line with the need of improving the health status of human beings, the field of nursing was developed, and up to date, it remains one of the most vital in providing better healthcare to societies. It is important to note that while trying to offer improved healthcare services, the competence of nurses is affected by several factors, which may either be from the working environment or an individual. Significantly, the working environment, which includes the workload or number of patients that a particular nurse on duty is expected to attend to plays a crucial role. Both remarkably higher and lower ratio between nurses to patients affects the operations and service delivery of nurses. The issue of the patient to nurse ratio should, therefore, be critically considered not only by the management of health institutions, but also other key stakeholders such as the government, non-governmental organizations and policy makers since it has a powerful impact. For any measure to be formulated and implemented with regards to the ratio of nurses and patients, it is important that the background of the issue, benefits, and disadvantages likely to be accrued should be researched accordingly before a conclusion is derived. Having a set number of patients that nurses are required to care for provides numerous benefits to both nurses and patients. Nevertheless, to assure the quality of care, nurse to patient ratios should be mandated by the government.
Background
Nursing is at the core of the healthcare system and so are all factors that may improve or inhibit their ability to respond accordingly to different health needs of the population. As a result of its significance in the health industry, many nations and organizations such as the World Health Organization have been on the forefront in ensuring that an optimum ratio between nurses and patients is achieved. Arguably, research studies indicate that about 20% of newly recruited and existing nurses are at a higher position of quitting the profession as a result of the unfavorable or intolerable ratio (Nurse Buff, 2017). Due to this threat, there is a need to critically come up with a solution to achieve the ideal number of nurses who are supposed to serve a specified number of people. Remarkably, the condition will not only improve service delivery but also make nurses to have a favorable time at work.
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Logically, the ratio can vary significantly and this may be attributed to several factors. Some of the influencing factors include the level of training and experience possessed by a nurse, estimated number of patients to be served, availability of technology and the geographic regions, the magnitude of the needs of patients, and the approximated frequency of discharges, transfers, and admissions (Nurse Buff, 2017 ). Specifically, any healthcare facility located in a geographic region that is likely to experience a higher number of health complications should have a higher ratio. Those regions may include cities and urban centers, areas prone to floods, thunderstorms, and earthquakes. In contrast, the ratio should be relatively lower in rural areas, which are not at very high risk of facing an outbreak of health complications. Technological advancement has developed to be part and parcel of daily human life.
Consequently, technology is being applied in the healthcare industry and its achievements have been tremendous as far as improving the delivery of quality services is concerned. As a result, areas or institutions that are well equipped with technological devices such electronic medical records (EMR) and electronic health records (EHRs) may require a comparatively lower ratio as opposed to healthcare facilities that are poorly equipped. According to the expected frequencies of discharging, transferring and admission of new patients, it can be argued that hospitals located in areas such as black spots of highways should have a very high ratio. The healthy ratio will ensure that in case an accident occurs; there is enough staff to handle the unexpected sudden increase in the number of patients.
The process of coming up with an ideal nurse to patient ratio should also ensure that nurses are involved. Importantly, by involving nurses in the exercise of policy formulation, there is a very high likelihood that the figures achieved will be highly accurate, hence useful. Accordingly, the need to involve nurses is based on the fact that nurses are not executives and they interact with patients in real settings. Thus, they can understand clearly the conditions that affect their ability to serve as required (Pompillio, 2019). Moreover, nurses are seen as the handlers of patients’ mortality, and, thus, can advocate for their rights (Pompillio, 2019). The argument necessitates the need for nurses’ participation in coming up with measures to improve the care that is given to patients. In the U.S., different states have developed laws guiding nurse to patient ratio and California is considered to be the pioneer (Pompillio, 2019). As of 2011, seventeen more states also legislated on the minimum number of nurses required per a population of patients. Having such a policy in place indicates that the issue is very crucial in the health sector.
The legislated rules about the ratio have been relatively useful. In states such as the Massachautes, the recommended ratio of nurses to patients in the maternity unit was 1:1 as at the 6 th of November 2018 (Pompillio, 2019). While physicality nurses were strictly limited to 5 patients each, surgical and medical nurses were required to have a ratio of one nurse per four patients at most (Pompillio, 2019). On the other hand, all emergency rooms in the state were required to ensure that they have one nurse per every five patients. The law had severe implications for defaulters. Accordingly, a fine of $25,000 was to be fined for each day that those regulations were not followed (Pompillio, 2019). The situation in Massachautes is just an indication of what is happening in other parts of the globe.
Opposing Arguments
High Costs
Even though the nurse to patient ratio may be considered to be a vital tool in improving healthcare services, several disadvantages or challenges are likely to be encountered. The cost of ensuring that an optimum ratio has been achieved is considered to be the main drawback (Votroubek, 2019). The laws may compel hospitals and other healthcare institutions to hire more nurses to improve their staff by the recommended ratios. However, a number of those nurses may end up being idle on many occasions due to an inadequate number of patients. By considering this point from an economic perspective, those nurses may end up being considered to be an inventory, which is not of any help to the employer. For instance, a hospital maybe serving well with about three nurses since the expected number of patients is supposed to be relatively lower, like 20 patients per day. However, the implementation of the laws may, therefore, call for more nurses, say three to be employed. Unfortunately, the number of patients remain constant. In such condition, the hospital's management may have to incur losses in the form of salaries to nurses who are not offering the required services. The institution may also be needed to train nurses further to achieve specific objectives like team-building due to increased staffing ( Griffiths et., 2018 ). The vocational training and recruitment process incurs a lot of costs, which is quite discouraging to the management.
Discrimination
The regulations on the minimum recommended number of nurses per patients may end up behind discriminative. The number of patients at any given health facility cannot be constant throughout. During emergencies, more patients may require to be admitted. The need of patients may eventually collide with the interests and priorities of the administration of the hospital. For instance, the hospital may decide to admit the patients regardless of the current ratio and other factors such as bedding capacity with the aim of saving their lives. However, when such an act comes before the law, it is uncertain on how it may be treated. At worst case scenario, heavy fines may be imposed on the institutions for failing to abide by the regulations. The uncertainty may, therefore, result in fear among nurses and the management of hospitals. Consequently, those hospitals may deliberately require patients to wait for a longer duration or be directed to other facilities to receive the required services (Votroubek, 2019). Remarkably, all those conditions may not have a positive impact on the health conditions of patients in question since their conditions may worsen.
Supporting Arguments
Reduced Burnout
The regulation on the minimum number of nurses per patient is likely to reduce burnout incidences amongst nurses. From time to time, nurses may experience low moments, which may result in giving up or low morale as far as their work is concerned. The most common condition that nurses faces is referred to as burnout. Nurse burnout can be broadly defined as the act or condition whereby a nurse responds adversely to stresses related to the work conditions due to three dimensions which are emotional exhaustion, personal accomplishment, and depersonalization (Gutsan et al., 2018). Due to the absence of regulation in the nurse to patient ratio, the problem of burnout is likely to be pronounced. For instance, nurses may experience higher workload since they are very few as compared to the population of patients. It is also important to note that whenever an emergency has occurred, and the actual ratio is minimal, nurses may be compelled to extend their working hours to meet the unexpected demand. Fortunately, with the introduction of ratio regulation, burnout can be an issue of the past since the number of nurses will be enough to meet the needs, thus, ensuring that nurses are not overloaded.
Improved Patient Safety
The regulation of the number of nurses per patients can play a significant role in enhancing safety. Importantly, the patient's safety should be a vital objective of every nurse and the entire industry. However, safety may not be achieved easily with inadequate staffing. Poor staffing acts as a barrier to the realization of the patient's safety as it serves as a health risk (Abraham, 2018). Individually, overworked or overloaded nurses cannot work to their best. For instance, a single nurse serving more than ten patients per hour is likely to perform poorer that one who helps five people or even less. The poor performance can be linked to lack of concentration, being bored or getting tired. Reportedly, heavier workload due to inadequate staffing has also been a more significant challenge in trying to retain experienced nurses since 90% of nurses are at a higher risk of looking for employment in any other field apart from nursing (Abraham, 2018). However, with such regulations in place, it can be believed that nurses will be happier with their working environment and workload, and as a result, a good number of them may not seek employment opportunities elsewhere. The motivation of nurses would also be improved significantly, thus, enhancing the safety of patients at any given time.
Reduced Cost Incurred by Patients
A higher ratio may result in better healthcare. Since patients are likely to receive the best services, their conditions are likely to improve and not get worse as it would be as if they received poor services as a result of inadequate staffing. A relatively lower number of nurses is linked with the failure to offer efficient medical care since a lot of omissions may be encountered (Griffirths et al., 2018). Importantly, the regulation of the ratio would probably act as an ideal opportunity to ensure that possible medical errors, duration of staying in hospitals and readmissions are lowered. With an improved ratio of nurses to patients, the available nurses have an adequate time to attend to the needs of patients, and as a result, fewer incidences of medical errors are likely to be reported. An overloaded nurse due to poor ratio may make errors especially in diagnosing diseases. For instance, a nurse may make a false conclusion that a patient is improving, but in reality, the patient's health conditions may be deteriorating further. Similarly, nurses’ confusing due to poor ratio can make a patient to be discharged, but after some time, the condition may worsen. Fortunately, these errors can be avoided through the introduction of regulation on the minimum number of nurses for a given number of patients.
Conclusion
The field of nursing is significant to human beings. In line with the administration of health services to patients with different health conditions, the number of patients and nurses must be critically considered. Due to the impact of the nurse to patient ratio, different organizations and administration units have come up with a recommendable ratio. Just like any other law, those regulations have a harsh consequence on defaulters. Good examples of states that have affected those regulations include Massachautes and California, which are considered the first states to have such type of legislation. In Massachautes , any institution that fails to abide by the regulation is charged a fine of up to $25000 per day. The ratio is not uniform in every healthcare facilities since some factors come into play. Those factors include but not limited to the geographic location of the hospital, the expected frequency of patients turn out and transferring and also the level of training and experience that nurses have. Technological advancement also plays a vital role in influencing the possible ratio of nurse to patients. While it is necessary to ensure that hospitals and other healthcare units meet the minimum threshold, the regulation comes with some challenges that must be considered as well as the benefits likely to accrue. Some of the difficulties include high costs, legal implications and the possible outcome in case an emergency is experienced. It is essential that a mandatory figure between nurses and patients should be introduced and implemented to the latter. The need to have improved medical care for patients offers reliable and error-free services, and also to enhance the safety of patients dictates that an optimum ratio should be achieved. The issue of burn out and chances of nurses leaving the industry due to workload can also be eradicated by ensuring that an ideal ratio is obtained. The rate will not only be beneficial to the patients but also nurses, and, thus, there are all reasons to advocate for the introduction of regulations on the minimum threshold. Having a set number of patients that nurses are required to care for provides numerous benefits to both nurses and patients. Nevertheless, to assure the quality of care, nurse to patient ratios should be mandated by the government.
References
Abraham, T. (2018). Fight for mandated nurse-to-patient ratios heats up. Retrieved from: https://www.healthcaredive.com/news/fight-for-mandated-nurse-to-patient-ratios-heats-up/525225/
Griffiths, P., Recio ‐ Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., & Missed Care Study Group. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of advanced nursing , 74 (7), 1474-1487.
Gutsan, M. S. H. A., Patton, J., Willis, W. K., & PH, C. D. (2018). Burnout syndrome and nurse-to-patient ratio in the workplace.
Nurse Buff. (2017). How Many Patients per Nurses? Correct Nurse To Patient Ratio. Retrieved from: https://www.nursebuff.com/nurse-to-patient-ratio/
Pompillio, E. (2019). Nurse to patient staff ratio. Retrieved from: https://www.elitecme.com/resource-center/nursing/nurse-to-patient-staff-ratios/
Votroubek, W. (2019). The Pros and Cons of Required Minimum Nurse-to-Patient Ratios. Retrieved from: https://www.legalnursepdx.com/the-pros-and-cons-of-required-minimum-nurse-to-patient-ratios/
