The Nurse to Patient Ratio: What You Need to Know

A1- Public Policy Issue 

The key issues facing hospitals in the United States today is the lack of sufficient health care providers especially the registered nurses. In most emergency rooms they are overfilled with unattended patients. This is due to the lack of staff such as registered nurses. The sad part is that this is not only witnessed in big cities but countrywide but also in rural areas around the country. Nurse to patient ratio is slowly becoming an epidemic in the country, and there should be policies put in place to ensure the ratio is sustainable.

A1a – Issue Selection 

The reason why I chose to write about nurse to patient ratio is that nurses play a significant role in the health industry and the entire nation as a whole and without them, the industry will not function (In Hamric, 2014) . In instances where nurses are less the patients will suffer, this is because there will be a higher workload on the side of nurses and they won’t have enough time to attend to the patients equally; therefore, the best policy that the government can come up is the patient to nurse ratio policies (S.1063, 2017). Several studies have shown that the final outcome of a patient’s health is directly related to the nurse staffing levels, the more the nurses, the more attention a patient receives and hence better outcomes , therefore if this policy is passed the outcome of patients will be much better (In Hamric, 2014) . A health service research conducted in 2014 came to the conclusion that better nurse to patient ratio did lead to better outcomes for patients in the state of California (In Hamric, 2014) . In 2014 another research conducted by the Agency for healthcare research came to the conclusion that the more the nurses, the more talent and skills and hence better outcome for the patient at minimal cost.

A1b – Issue Relevance 

In order for healthcare to mean something and have an effect on the general public, there are several things that clinicians need to have access to. These things include technological tools schedules that promote health and the general well being of the health care providers. However, there is one thing that can never be overlooked, and that is manpower. The number of manpower affects the outcome of the patient directly hence making the ratio of nurse to the patient to be of vital importance (In Aitken, 2015) . If the number of patients exceeds the number of available doctors and nurses to treat them, then hospitals and clinics will be in trouble. It is important to maintain a good nurse to patient ratio since it will ensure proper care to all who truly need them. Good nurse to patient ratio leads to lower patient mortality rates; it will help reduce nurse burnout, readmissions, increased job performance, and improved patient safety.

A good example is of patients who suffer from heart attacks are more likely to survive if they are in a hospital filled with qualified nurses (In Patton, 2015) . A study conducted in 2016 concluded that patients undergoing surgery in a hospital filled with qualified nurses are more likely to have a better outcome than a patient who had the same surgery but with fewer nurses (In Patton, 2015) . The current state of all major hospitals in the United States is one nurse to 15 patients. This is evident in hospitals around Chicago, with such a situation a nurse cannot be able to serve each patient to the full potential hence reducing the chances of a good outcome.

A1c – Financial Impact 

Without any doubt, there will be some few financial strains that come with a good nurse to patient ratio policy. With the higher level of registered nurses, there will be increased operating cost. However , the level of nurses does not mean that there will be a difference on the profit margins of a hospital. Questions such as what will hospitals do during financial hardships will they reduce the number of nurses to sustain their profits? The answer is very simple. The hospitals have to prepare themselves for such hardships in advance. After doing some cost-effective analysis on the patient to nurse ratio, some researchers concluded that lowering of a nurse workload reduces the mortality rates and in turn, it saves on costs. Similarly, hospitals that have s good stuffing ratio of nurses to patients does save a lot of costs since it reduces hospital-acquired infections that are nurses stay in hospitals for shorter times and in the long run improve productivity. However, there are issues like nurse staffing in a competitive market versus a less competitive market that affects the financial performance hospitals (In Patton, 2015) . If a hospital is in a very competitive market, then they have to offer quality services, and that is by improving the ratio of nurses to patients, by doing so it will be able to deal with the competition and hence reduce financial strains.

A2 – Personal Values 

Like most Americans, I have gone to the emergency room, and the situation in all public hospitals is usually terrible . A lot of patients are generally unattended, waiting desperately and some are usually in pain waiting to be attended too. On busy days, the nurses are usually overwhelmed with tonnes of workloads serving more than 15 people. If a nurse was to deal with only two patients at a time that is a ratio of one to two, then emergency rooms would not look so congested (S.1063, 2017). If the policy is passed then the emergency rooms will not look so bad , every patient who walks in the emergency room will be served in under 30 min, unlike the current situation where people wait for over two hours. I personally believe that the policy should be implemented; it will be very hard for me to take a loved one to the hospital and see them suffer without being attended too, this situation does not apply to me only but to every person who takes a loved one to the hospital. I believe that the policy has a lot of value, without the ratio policy there are usually a lot of ethical dilemmas that face nurses in the hospitals, one of them being triage, that is the dilemma that nurses are usually faced with in determining which patient to deal with first but if there are several nurses in the hospital with a good ratio such dilemmas will not be there.

A2a – Ethical Principle 

The principle of beneficence is an ethical principle that addresses perfectly the policy of nurse to patient ration. The principle basically is about how the nurses should only promote good by doing good, and that is doing what is good for the patient (In Aitken, 2015) . If the staffing levels of a hospital are low, then it will hinder the nurse from doing well to all the patients. Here is a good example of how the principle of beneficence applies to this policy let’s say there was a tragic road accident involving two buses and all the casualties are taken to one hospital in the town, if the ratio of nurses and patients is not ideal the nurses will not be able to attend to all the patients adequately. Nurses instinct is to do good for the patients and ensure that they come out of the hospitals better than they came , but if the nurses cannot access all the patients due to patient overload, then they will be going against the principle of beneficence.

B1 – Decision Maker 

I will propose the nurse to patient ratio policy to the governor of Chicago Bruce Vincent Rauner since he has the powers to pass the policies into law.

B1a – Explanation 

In relations to patient outcomes and nurse workload studies conducted by Malas (2017), proved that there is a substantial relationship between patient outcome and nurse workload. The study concluded that decreasing the workload of a nurse and balancing the work environment improves the outcome of a patient. In a study conducted in public hospitals across America by Malas (2017), he identified 26 factors that affect the workload of a nurse. These factors include the likes of work interruptions and high patient turnouts these factors affect the workload of a nurse the most. In hospitals where the nurse to patient level is good the outcomes of the patient are usually positive since the workloads of the patient are usually reduced. In Canada, the overall mortality rates decreased by 25% since the policy was passed, and post-surgical complications have reduced dramatically. Hospitals with a high nurse to patient ratio had a higher mortality rate among the patient , units that were adequately staffed were able to take good care of their patients and did not rely on help from family members.

B2 – Challenges 

The Governor without a doubt is going to face some challenges, one of them being the shortage of registered nurses. States across the United States like Texas, California, and New York have adopted regulations that require hospitals to maintain a specific level of registered nurses; this has led to the shortage of nurses given the fact that the country has always had a shortage of registered nurses (Malas, 2017) . The shortage of nurse will most definitely affect the ratio policy since hospitals will find it hard to fulfill the policy requirements while there are no nurses available. The shortage is expected to become even worse on the ratio policy with the baby boomer healthcare needs (Malas, 2017) . The policy faces another challenge with the nursing schools ; the nursing schools are struggling to expand their facilities in order to meet the policy requirements. Before passing this policy into law, the governor has to consider these facts.

B3 – Options 

The first option that the governor has is to do something about the policy. The best way to go about it is to do a trial with one of the hospitals around his state; by doing so he can do an analysis of the patient outcome is it positive, negative or is it the same this will most defiantly be productive in deciding what he will do with the policy, it chooses to go with the policy this will mean that there will be more nurses in the hospitals and the patient outcomes will be great. The next option is ignoring the proposed policy; the governor can choose to leave the policy alone and continue using the current healthcare policies. The current policy says nothing about nurse staffing levels, and therefore hospitals around Chicago hire nurses on the basis of profitability. This, however , will affect the outcome of patients. The other option that the governor can choose is a different policy from this one, the policy can not necessarily be the same as the nursing to patient ratio, but he can use a policy that has some similarities with the proposed one. The policy may need an increase in the number of healthcare practitioners, interns, or unregistered nurses ; this method is not advisable since the people chosen are not as qualified as the registered nurses.

B4 – Course of Action 

Staffing shortages have been identified as a possible challenge to the proposed legislation. However, the most effective course of action to address the identified issue is offering the Chicago health department adequate funds to import nurses from other states or abroad as a temporary solution. Also, the Chicago authorities and the Illinois state authorities and even the national government can combine resources and expand the existing nursing schools in Chicago which are some of the factors contributing to a low number of nurses every year. Then, the Chicago authorities will launch campaigns in high schools and other institutions convincing the young people why they should pursue a career in nursing and related courses as a permanent solution for the current state of nurses’ shortage.

The Chicago authorities will face some challenges if he chooses to adopt the policy, the most obvious one is the shortage of nurses. The current state in most hospitals today is that there are not enough nurses; the governor must find a solution and fast, because if the policy is passed and hospitals are required to have a proper ratio in a year, then there will be a shortage of nurses most defiantly. This is because the hospitals will have used all the nurses available the only option left will be to import new nurses from other countries (Stalpers, 2015) . There is a bright side to importing nurses the nurses will come with new skills and energies to better the current state of the hospitals. Another problem that the governor will be faced with is the nursing schools, the schools admit a certain number of students, but if the policy is passed, it will mean that the schools have to admit more students in order to meet the demand. Given this problem, the governor has to pitch in the schools’ budget and build more facilities in order to meet the requirements. However, there are some ways that the governor can use to easily persuade the people that this policy is good the main one that people would love to here is that the job market will increase, and students all through the country will be guaranteed a good job if the policy is passed. When people here that there will be the availability of work no one will refuse the policy .

B5 – Success of the Policy Brief 

Process successes of the policy will be determined by several factors. One of these factors is finding a legislator who will sponsor the bill and support it all the way until it gets passed. By using a legislator, it will be easy for the governor at the top to be convinced and buys our idea. The governor will be able to evaluate our policy and sees the good that it will do to the people. The long-term success of the policy will be very great for the Chicago people and the Illinois state at large since the patient outcomes will have improved greatly . Good nurse to patient ratio will lead to lower patient mortality rates; the workload of nurses will reduce and hence reduce nurse burnout, readmissions of patients will be low, increased nursing jobs, and improved patient safety. In the long run, patients who suffer from heart problems will have a better outcome since the nurses will be filled with qualified nurses. Patients undergoing surgery will have a much better outcome .

C1 – Collaborating Organization 

The partnering organization of my choice will be the American Nurse Association

C1a – Summary of Expressed Interest 

The United States has over 3.1 million registered nurses, and the American Nurses Association is the only organization that represents their interest. This is the main reason I choose to partner with them; the organization has been very helpful in passing this policy in other states like Texas and New York (Neuraz, 2015). The organization has been operational since 1896 that is a century worth of experience. Through its associations with other big organizations , the ANA has been very successful in promoting the rights of nurses in the workplace, Congress and regulatory agencies, with this organization nurse, will have a relief on their workload.

C2 – CBPR Principles 

One of CBPR principle is recognized a community as a unit of identity. This will help our group in having an emotional connection with each other. We will share norms and values, common language and the best part of it all we will have the same goals and interests. The principle of identity is usually based on a given geographical area and in our case we are in the same geographical area, and we share a common sense of identity.

CBPR basically builds on strengths and resources within the community. Such strengths and resources in our setting include: using the skills and necessity of nurses and the bargaining tool in achieving our goals. There is strength in numbers the more united the nurses are, the stronger we are and the better chances of our grievances being taken seriously.

CBPR helps in educating and capacity building among all members. CBPR groups help in the transfer of knowledge and capacity building a good example nurses can learn from the American Association of nurses how they used to deal with healthcare policies in the 20th century and which methods can be used to pass the nurse to patient ratio today.

C2a – Approach and Collaboration 

The first step that I would use to approach the American Nurses Association is by first emailing them my full proposal and asking for an appointment with the chairperson of the organization. The best way to make them collaborate with us by showing how the policy will benefit the ANA directly. The truth is that the ANA will benefit since the policy goes hand in hand with their goals and that is making the work environment for nurses the best. When the members ANA find that the policy is a good course and that it will help both the patients and the nurses I will most defiantly have some volunteers who will be willing to work with me. T he best way to ensure that there is loyalty among the group members is by having a group meeting every two weeks.

C2b – Goal Alignment 

I do know for a fact that the American Nurses Association will work with us this is because my goals and their goals go hand in hand, their goal is for a good working environment for our nurses. While our goal is ensuring that there is a good ratio in the hospital and if the ratio is good then the workload of nurses will reduce and hence a better working environment. If we do collaborate and make this policy work, we will use my skills and the skills of the ANA to achieve a good working condition for nurses. The first step will be to gather as much support from nurse’s countrywide as we all know that there is strength in numbers, by getting the numbers everything from there is possible.

C2c – Action steps 

The very first action step that we will take is creating awareness about nurse to patient ratio. Once everybody knows that there is a thing called the nurse to patient ratio, then we will go to the next step that is educating the masses about the importance of nurse to patient ratio and how it can save lives. After that the next step is gathering support from the nurses and legislators, after gathering enough support, we will be hosting some meetings on how to improve our idea and further recruit more people. By following these clear steps, we will be able to create an environment where both the patient and the nurses are well taken care of.

C2d – Roles and Responsibilities 

The first role needed in our group is a chairperson; he will be responsible for approving every step that the organization takes. Another key role is that of a secretary he or she is vital , he or she will be responsible for writing all the letters that are to be sent to all officials’ other responsibilities will be writing speeches the last role will be the service men and women their work will be more of field work they will be recruiting more supporters and spreading the word. The members of the community are vital to these policies since they are the ones who benefit directly from it, if they are not satisfied with the policy, then they can make the policy to be revoked or changed further (S.1063, 2017) . In cases of any problems that we come across, we will form a committee of people from various parts of the health sector and brainstorm on methods of solving the problem. Our community capacity building will mostly use benchmarks; we will try and copy other countries like Canada who have successfully implemented the policy, we will critically analyze their process and the challenges that they have faced, another method that we will use is brainstorming sessions that will be held monthly, to improve our skills better .

C2e – Key Elements 

The first principle is identifying the community as a unit of identity all the recruited members will be united not only by the same goals, but they will be united emotionally. The group will also share their strengths and skills in order to achieve the final goal. Any group that has the unit and furthermore united emotionally can achieve any goal that they want. In our case our main goal is ensuring that the policy is passed since the group is working as a unit that is connected under one identity we will most defiantly achieve our goals since we have that determination.

C2f. Community/Organization Plan 

The best way to evaluate our progress is by keeping records. With well-kept records nothing can go wrong, we will always have something to refer to, in the long run, we will be able to see how far we have gone and the setbacks we have faced. Record keeping in a bottom-up approach is vital since we are dealing with a lot of people and a lot of activities and they have to be recorded so that we can learn from a mistake of a particular action that we undertook and that we do not repeat them. The records will also help in keeping the community in check ; we will be able to document every grievances and solution to them. The success through the bottom up approach will be evaluated by the number of new nurses who are committed to this course, the support from the Chicago people by the number of new patients going to Chicago hospital once the policy is adopted compared to the current numbers.

D1 – Strengths of Each Approach 

The greatest strength of the bottom-up approach is that there is no shortage of manpower; we are fully sorted to undertake any challenge that comes our way since we have the numbers. The strength of the bottom-up approach is that there is a huge pool of skills and resources, with a lot of people involved there are a lot of skills that come with it (Adler, 2014) . In our case, we have a huge number of nurses who come up with all sorts of good ideas that can help us in achieving our goals. Furthermore, with a bottom-up approach, we are fully represented all over. The top-down approach has its benefits since we deal with the policymakers directly with them you can easily convince them without a lot of struggle. Another advantage is that it is cheaper to deal with the top since it does not require a lot of recourses. Unlike the bottom-up approach with the top-down approach, we will end up saving a lot of money and energy in trying to achieve the goals.

D2 – Challenges of Each Approach 

One challenge of the top-down approach is that dealing with the people at the top is usually very hard this is because they are usually very occupied and busy that they do not get time to hear you out. For example, the governor of Chicago he is usually given a lot of policies to review to the extent that he is not easily impressed by any policy so with our policy we have to do a lot of convincing and take different and unique approaches in an aim to impress him. The bottom-up approach has similar challenges it is challenging to convince people let alone the entire fraternity of nurses. In order to convince the nurses that the policy is the best way for them, I will have to present it in a very unique and convincing way.

D3 – Most Effective Approach 

The top-down approach is the best approach; the very first advantage is that it is cheaper there is zero to no expense at all. All that one has to do is book an appointment with the influential person and take his or her grievances to him. In our case, it is the governor of Chicago all we have to do is create an excellent presentation that is unique that will show the governor that the policy is very effective and it will help the people. The very first appointment with the governor will determine the progress. If the governor seems impressed, then there are hopes for the policy.

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