Proposed Change to Nurse Staffing Ratios – Health System Example

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"Proposed Change to Nurse Staffing Ratios" is a great example of a paper on the health system. Even though hospitals that have a low nurse staffing level typically have higher degrees of poor patient outcomes, attempts to increase the levels of staffing are not easy. The key factors that contribute to the decreased staffing levels consist of the needs that are associated with the higher acuity patients of today for increased care and a countrywide gap that exists between the positions that are available and the number of registered nurses who have the qualifications and are enthusiastic to fill the positions.

This can be clearly seen from the mean vacancy rate of thirteen percent. The issues faced today are additionally made more complex by other variations in-hospital care which include new technologies in medicine as well as a diminishing mean length of stay which have resulted in increases in the degree of care that patients need when they are hospitalized (Zimmermann, 2002). The new advancement in medicine has allowed most of the less extremely sick individuals who may have required inpatient surgical assistance formerly to get access to their care in the outpatient setting (Oleske, 2009).

Moreover, those patients who in the past would have to stay in hospital in their early stages of recovery are discharged to other skilled nursing institutions or to homes. Between 1980 and 2000, the mean length of time that inpatients stayed in hospital decreased from seven and a half days to approximately five days. A critical significance of the variations is that hospitals developed an increased general awareness of individuals who are sick and require more care. Problem Hospital staff nursing is an issue that has needs a lot of attention because of the impact it can have on the safety of patients as well as the quality of healthcare.

Nursing-sensitive outcomes are among the indicators of the quality of care and a number of adverse patient outcomes that are possibly profound to nursing care are UTI’ s, shock, prolonged hospital stays as well as thirty-day mortalities among others (Nickitas, Middaugh & Aries, 2011). There is a connection that exists between subordinate levels of nurse staffing and increased rates of adverse events which have led to growing workloads on nurses as well as increasing rates of burnout and dissatisfaction in their jobs.

The skill mix of nursing staff is also shifting as hospitals keep increasing the number of nursing aides making the registered nurses acquire responsibilities that are supervisory and these take them away from the patients’ beds at the moments when the patients are in need of their care. Concerns that are associated with increased acuity in patients, as well as the assumption of additional administrative responsibilities, seem to be directly linked to job dissatisfaction shown by nurses. Despite the fact that insufficient staffing levels burden the nursing employees and the adversative happenings are a source of pain for the people in the hospitals, there are significant monetary costs that have to be reflected.   Adverse events in the patients can be linked to increased costs and for instance, the costs associated with caring for patients who contract pneumonia while they have been hospitalized increases by eighty-four percent.

Treating this condition will raise the costs by approximately six thousand dollars while increasing the length of stay at the hospital.

Ulcers as a result of pressure which also fall into the classes of adverse patient events profound to care provided by nursing have been estimated to cost more than eight and a half-billion dollars per year. There is a remote association between higher nursing workload and increased patient mortality as well as increased probability of failure to rescue escalate when the nurse staffing level decreases thus the need to increase the nursing ratios to adequate numbers (Vallano, 2008). The staffing of nurses may also be measured by their level of education alongside the number and percentage of the registered nurses who are among the nursing staff.

Studies have demonstrated a ten percent increase in the section of nurses that hold a degree which was linked to a five percent decrease in the probability of surgical patients dying inside thirty days after admission and chances of failure to rescue.   Proposed Change Most of the stakeholders in the health care system, particularly the government, hospitals, and other organizations have an awareness of the insufficient numbers of qualified nursing and associated issues and are seeking solutions.

At the federal level, the Nurse Reinvestment act was passed by Congress and this instigated a number of measures that are aimed at enhancing the employment and retaining of nurses. This Act will come up with a National Nurse Service Corps that will afford scholarships as well as loans to students studying nursing if they are prepared to serve in hospitals that have shortages in nurses for a period of two years. It also develops a loan clemency program for the nurses who are receiving advanced degrees and will provide instruction at nursing schools while offering them continuing education, training in dealing with the elderly as well as career ladder programs that will allow them to progress in their jobs. There should also be involvement by the state governments through the legislation of minimum nurse staffing ratios.

Nevertheless, such measures may create opportunity costs that may not be easy to measure and which may overshadow the benefits. For instance, hospitals may be forced to reduce their spending on other personnel such as the unlicensed caregivers and other subordinate staff (Dickson & Flynn, 2009).

The quantity of work that is not associated with nursing done by the registered nurses in the inpatient units could intensify and investment in medical technology, as well as facilities to enhance the quality of care, may have to be postponed. The hospitals which will increase their nurse staffing across all the units or in specific units should be concerned with the effects of these steps on their finances. Nonetheless, increasing the staffing of registered nurses does not considerably reduce the profits that a hospital realizes even though it increases the operating costs of the hospital. Evidence As a result of a number of issues, the American Nurses Association does not recommend mandated nurse-patient rations but supports staffing systems with requests that registered nurses providing direct patient care have given to staffing decisions and the level as well as the intensity of care be seen in the staffing system.

In a number of states, some solutions to nurse-patient rations have evolved like in New Jersey where hospitals are supposed to publicly post the ration of healthcare workers who include registered nurses (American Nurse Today, 2009).

There is also a public disclosure law that is in existence in Illinois although this disclosure only takes place on request and this provides the consumers the information they need to decide which hospital to go to while applying pressure to the hospitals to hire more staff to fill deficits. Habitually, hospital administrations have reduced costs by decreasing nursing staff since the salaries associated with nurses make up almost fifty percent of the operating budget of a hospital. The demand for nurses is increasing and a number of published reports suggest that nurses are important to maintaining patients’ safety as well as quality patient outcomes.

Conversely, the supply of nurses is dwindling without administrative intervention as the current nursing workforce is aging and there is a decreased enrolment in nursing school as well as increased turnover making the situation worse. Conclusion Assumptions that trigger the nursing discourse include the fact that there is an optimum staffing ratio that will allow the best outcomes for patients. Regrettably, research has not yet identified this ratio and the link between the costs of hiring additional nurses and the patient outcome is still poorly understood.

Researchers of the nursing field have continually investigated staffing dynamics and outcomes and this makes it hard to connect staffing ratios with particular outcomes. In the prevailing health care system that is mainly market-oriented, nurse staffing levels are optimum when the impact on nursing care on the outcome of patients is the same as the cost associated with nursing care. In the event that the benefits are higher than the costs, then more nurses are required and if the cost of additional registered nurses is more than the benefit, then fewer registered nurses are required.

Hospitals in America have not identified the optimum ratios for nursing staff in these terms since they have not to be paid depending on the quality of care they provide. Currently, hospitals will no longer be compensated for increased length of stay connected to adverse events like infections acquired in the hospital. This change may force hospitals to make more investments in nursing.


Dickson, G., & Flynn, L. (2009). Nursing policy research (1st ed.). New York: Springer Pub. Co.

Nickitas, D., Middaugh, D., & Aries, N. (2011). Policy and politics for nurses and other health professions (1st ed.). Sudbury, Mass.: Jones and Bartlett Publishers.

Oleske, D. (2009). Epidemiology and the delivery of health care services (1st ed.). New York: Springer.

Vallano, A. (2008). Your career in nursing (1st ed.). New York, NY: Kaplan Pub.

Zimmermann, P. (2002). Nursing management secrets (1st ed.). Philadelphia: Hanley & Belfus.

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