Overview of the Problem.


Institutional Affiliation


Overview of the Problem.

Short staffing in the med/surgical unit has been a significant concern in the Local Community Hospital with its impact felt both by the nurses, patients, and hospital management. The nurses are strained as they attend to the patients; they do not have quality time to visit the patients so that they can help them in their healing process. The patients also struggle to get enough attention as they may require to make enquires and other services that the nurses provide. The hospital management also is strained to live up to the promises of providing adequate health care to its patients. This issue of a nurse-patient ratio is also a thorn in the flesh for the management as the nurses once in a week stage a demonstration calling for safe staffing. The issue of understaffing by the administration it also impacts the relationship between the Hospital management and the nurses’ representatives. The management ought to come up with a scheme that will oversee the employment of nurses so that the patient-nurse ratio will be one to one. With appropriate planning, this is achievable. If appropriately staffed, the unit would consist of eight Registered Nurses, a Charge Nurse without an assignment, a “STAT” Nurse that floats from group to unit to assist with whatever may be helpful to them at that time, and six Nurses. The suggested six nurses attend to five patients each.

Literature Review.

An Act relative to patient safety and hospital transparency relates to how the nurse staffing ratio affects the access to health care and security of the patients. It is true that a one to one ratio between patients and nurses will improve safety and health care access, but this ratio cannot be achieved. Therefore, there should be a safe ratio between the nurse and patients. According to MacPhee (2006), 86% of the nurses say they cannot spend quality time with the patient to give them primary education on their health problems, and 90% of the nurses are unable to help patients and patient families emotionally. Improved ratios, whereby a nurse can attend to a manageable number of patients, will enable patients to receive quality health care as well as access to vital information. However, most hospitals put profits first to patient health care. Thus they minimize the funds for nurses’ salaries, consequently having fewer nurses at the same time admitting more patients. Such a move by the hospital management limits the time that a nurse gets to spend with the patients, as well as the nurses, are strained, which can lead to their ineffective at work. Annals of intensive care study in 2017 found out in their 845 patients’ research that 95% of the patients survived when the hospital enforced the agreed nurse to patient ratio. Thus this report suggests that a reasonable rate guarantees a better survival chance for the patients.

The nurse staffing that will be adequate to handle the hospital patients was the principal finding in the report of the Institute of Medicine Committee on the adequacy of nursing homes and hospitals. The number of nurses in a hospital determined the quality that the patients receive in a particular hospital. However, the quality of the care a nurse offers depends on issues such as personal knowledge and experience. Experience and vast knowledge enable a nurse to have better ways in which they can deal with a different scenario, thus handling the patients better. Human factors such as fatigue play an essential role in the quality of services that a nurse offers. The nurse is a human; therefore, their state of mind should be taken care of: when they work for long, they can do shoddy work as Schwab et al. (2012) notes. The patient’s needs also affect the quality of service a nurse offers to the patients. A troublesome patient is likely to be attended to for a short period compared to a cooperating patient. Working conditions also play a significant role in determining the quality of service that a nurse can offer. For instance, hospitals that remunerate well, pay for extra working hours, and treat their nurses with dignity; their nurses provide quality services to the patients since their individual needs have been satisfied. Maslow, in his hierarchy of needs, insists on this idea and suggests that when individual needs have been met, then they work effectively. This paper indicates that quality health care can be assured provided other factors that affect it have been taken into consideration.

The American Nurses Association has advocated for safer staffing, and this has been their clarion call. The nurses are essential components in the healthcare sector; they are the people who spend the most time with the patients; thus, they hugely contribute to the patients’ healing. When hospitals are understaffed, it leads to several worst-case scenarios. For instance, when the hospital is understaffed, it can lead to patient deaths, more infections, patients’ falls, and medical errors. This can be attributed to nurses working for long hours, compromising the care for the patients, and driving the nurses away from the bedside according to Dunton et al. (2004). When the ratio of nurse to the patient is so high, such issues are bound to occur. Therefore, there is a need that hospital management should have a better nurse-patient ratio, which will facilitate better service delivery to the patients. A manageable number of patients by the nurse is equal to good health care. With the suggested ratio of one nurse to five patients, it will enable a nurse to have enough time to share information with the patient and help them. Also, the errors which are likely to be caused due to the burden of work are eliminated, thus ensuring proper health care. The American nurses association also advocates for legislation that will force hospital management to employ enough nurses according to the capacity of the hospital.

According to Patterson J (2010), nurses in the national health system are concerned that due to large influx patients, the nurses have been overstretched. The overworking of the nurses cannot, therefore, guarantee the safe and quality nursing of the patients. For instance, not only does understaffing affect patient care but also the nurses’ job satisfaction and burn out. As Aiken et al. (2005) notes, nurses working in understaffed hospitals had complaints on job satisfaction nurses with heavy workloads also experienced burnout. The understaffing of the nurses indeed affects them since they have several tasks to carry out as well as spending long hours while working. This affects the nurses working efficiency, which in turn leads to treatment inadequacies. With the proposed changes, nurses will be able to work within their human limits as they look forward to delivering better care and services to the patients. A ratio of one nurse to five patients should be considered and acted upon.

The change process.

I would propose a Quality Improvement Team to be formed; this team will oversee the changes in terms of the nurse to patient ratio as well as the communication channel. The team will deal with the process of proposing that the hospital management can adopt to employ nurses to meet the demands of the patients. The team will include the chief executive officer of the hospital, one member of the hospital management, the head of the nurses, a nurse, and a doctor. The members should give their issues of concern and how nursing affects their various departments to have better formulae to employ more nurses. With the input from the multiple departments, the Quality Improvement Team can come up with a comprehensive plan that will deal with understaffing and a way to provide better health care to their patients. With such a plan in place, a proper channel of communication breakdown should be established. In this case, the information should be breaking down from the upper cadre to the lower staff. That is, the information should flow from the chief executive officer to the manager in charge of nurses, then the nurse in charge it gets to the nurses in general and vice versa. Such a protocol will ensure a centralized way of communicating. Therefore, nurses will be aware of the source of information.


Schwab, F., Meyer, E., Geffers, C., & Gastmeier, P. (2012). Understaffing, overcrowding, inappropriate nurse: ventilated patient ratio and nosocomial infections: which parameter is the best reflection of deficits?. Journal of Hospital Infection, 80(2), 133-139.

Aiken, L. H. (2005). Improving quality through nursing. Policy challenges in modern health care, 177-88.

Bost, N., Crilly, J., Wallis, M., Patterson, E., & Chaboyer, W. (2010). Clinical handover of patients arriving by ambulance to the emergency department–a literature review. International emergency nursing, 18(4), 210-220.

Dunton, N., Gajewski, B., Taunton, R. L., & Moore, J. (2004). Nurse staffing and patient falls on acute care hospital units. Nursing outlook, 52(1), 53-59.

MacPhee, M., Ellis, J., & McCutheon, A. S. (2006). Nurse staffing and patient safety. Canadian Nurse, 102(8).