ER Nurse to Patient Ratio and Morale Research Proposal

Excerpt from Research Proposal :

Inpatient Ratio and Morale


Emergency Room: Nurse to Patient Ratio and Morale

Nurse to patient ratios in health institutions is one of the most influential factors in health providence, in any country's health sector. Two states of the aforementioned aspect would comprise of either high or low ratios. The former demonstrates poor patient outcomes that would imply high mortality rates and dissatisfied clientele. On the contrary, the latter would ensure quality patient outcome and positive feedback from patients. The ratio has an impact on cost effectiveness and also nurse turnover rates were highly influenced by the ratios that sometimes dictated the working conditions of these nurses. A recommendation to increase the number of nurses by various implementations needed to be taken sequential would be the ultimate solution. This would be despite the cost that these procedures would reflect, meaning that the budget need to be compromised to endow patients with eminent health care and a conducive working environment for nurses.


The scope of the research was to take into consideration the nurse to patient ratio and see some of the impacts that a range of these ratios have on the ER environment. Morale of nurses will also be scrutinized given the research findings outlining the effect that imbalanced ratios impact on nurses' morale. The main objective for doing this was to get statistics that relate to nurse to patient ratio that include the ratio ranges in different health institutions within a given region, the patient outcome given the various ratios, the cost effectiveness of various ranges of nurse to patient ratios, and the nurses' turnover and its causes that imbalanced the nurse to patient ratios. These statistics would later be used to propose, or rather recommend practice change for health institutions that would help improve the nurse to patient ratio thus enhancing better patient outcomes and at the same time being cost effective. The recommendations should, however, be feasible, meaning realistic, thus an implementation procedure to follow up (McGillis, 2004).

This paper will thus be divided in the various sections as described above. The first section will encompass a review of the research findings and thoroughly dissect the meaning of the results not necessarily bringing out in whole details the results from the field. From these findings, discussions of causes for nurse morale, turnover, effect of nurse to patient ratio on patient outcomes, and cost effectiveness of each nurse to patient ratio scheme. The subsequent section immediately after will recommend on change practice that would elevate the situation to increase efficiency in health institutions. Finally, the feasibility of the recommendations will be discussed with proof being the steps that would be undertaken for implementation. A conclusion will finalize the document with a review of the entire research paper.


This will be the study's main body and will be split into three main subsections: review, discussion and critique of research evidence, recommendations for practice change, and steps and feasibility for the identified change.

Review and Critique of Research Evidence

The evidence level that was focused on while conducting research was Level IV. This meant that the evidence that would be reviewed in this section was integrative, systematic and qualitative. The research also included evidence from theory-based knowledge and borrowed a great deal of opinions from the opinion of experts from recommended scholarly studies. This is thoroughly indicated in the reference list of the paper. The basis of conducting the research from a given region's health institutions objected on propping the clinical studies from the specified institutions. This level was considered adequate given the review of the data that was produced by this level of evidence search.

The study was conducted among various health institutions in the region, with a bias to moderately prominent institutions, discriminating against smaller clinics and specialized health centres. Data was also collected from documented statistics stored at the Labor Statistics Bureau to provide more background for the research topic and current findings on the actual ground.

The main methods used constituted collecting data from the institutions' records on the number of patient admissions and the total number of nurses available. Information collected also included the rate of nurse turnover and the mortality rate at different times depending on the period information about nurse and patient admission was collected. Cost effectiveness for patient outcome data was collected mainly from the finance departments of the institutions and in some cases, the financial institutions that handled the nurses' payment regimes (Clark, 2010).

Most data collected from the institutions equated the nurse to patient ratios ranging from the highest, 1:10, and the least, 1:5. However, the majority of the institutions had the higher ratio of 1:10, justifying the need of such a research to propose a practice change for more effectiveness. The more acceptable ratio that is more advisable for better health care and patient output was come across in limited institution, in fact, with a tendency to spill over to higher ratios that would the alarming to the patient outcomes. Justification is also made here to try and avoid the relapse into inefficiency by the increase of nurse to patient ratio but for the more reduction in the ratio to better effectiveness in the region's health care.

The first effect to be scrutinized from the collected data was the comparison of patient mortality with the various ratios involved. It was observed from collected data that a high ratio of nurses to patients occurred in health institutions that experienced the highest mortality rate. Mortality rate defines the assessments of the number of deaths occurring among a population with direct relation to the scalability of that populace. The high mortality rate experienced in health institutions that had high nurse to patient ratios confirmed the inefficiency of nurses, due to the possible pressure from the high number of patients that one was subjected to take care of in the institutions. The non-committal possibility that nurses dedicated to the various patients they serve may arise to negligence of duty, but the nurses could easily justify themselves by claiming poor, working conditions. In addition, depending with the terms and conditions of the various institutions, blame may be given to the wage or salary allocation for the "overworked" nurses. These findings exposed by relating patient outcome and nurse to patient ratios called for practice change in the institution to reduce the mortality rate. In a study of mortality rates in surgical units it was determined that when a surgical nurse is assigned more than four patients the risk of death increases by seven percent for each additional patient. If the risk of death for each patient is seven percent when the nurse is caring for five patients, the risk would increase to 42% for each patient if the workload increases to ten patients for that nurse. Again, this is a risk factor-it does not mean that 42% of patients will die, there are other variables involved.

On the contrary, less nurse to patient ratios of between 1:7 and the least, 1:5, exhibited much lowered mortality rate. This might arise from the explanation that allocation of less patients for nurses to service and take care of gave the more morale to commit there all. There was also positive feedback from patients in these hospitals, expressing adequate attention from the acre takers, unlike the previous scenario where there was a disappointment of disregard from the nurses and thus dissatisfaction.

The opposite scenario of the above findings dictated an entirely different case in the cost effectiveness of the respective health institutions. The institutions that had more nurse to patients ratio experienced less financial expenditure than the ones that had considerably lower nurse to patient ratios. The estimated cost that was used to save a life ranged from $400,000 to $55,000 in a descending order, where more money was experienced by the institutions with lower nurse to patient ratios. This worked to the advantage of the financial section of the hospitals that had higher ratios but utterly went against the satisfaction and quality that was directed to the patients. It was also harsh to the nurses that had to experience strain in care provision and the burden to serve more heads than they could commit to their all. To this effect, on several occasions both nurses and patients some institutions have raised their voice for the need to better working conditions by employing more nurses, but it all fell on deaf ears given the greed that was entrenched in some administrators' characters.

There is a great deal of empirical research outlining the factors that can lead to poor morale in ER nurses. Burnout and not feeling appreciated are major contributors to poor morale in ER nurses and are most affected by the nurse's perception of being overburdened by a harsh and demanding workload (Carayon and Gurses, 2005) outlined four categorizations of workloads in nursing that could affect morale: the unit-level, the job-level, the patient -level, and the situation-level workload. The four levels are…

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