Nurse to Patient Ratio Change

Nurse to Patient Ratio

Change theory in a healthcare setting

The change that is needed: lower nurse to patient ratios in hospital settings

According to the Massachusetts Nurses Association a research study conducted by the Healthcare Research and Quality agency discovered that patient outcomes improve dramatically on nursing units with lower nurse to patient ratios. The optimal workload for a nurse was four patients. Increasing the workload to six patients resulted in patients 14% more likely to die within thirty days of admission. A workload of eight patients vs. four patients was associated with a 31% increase in patient mortality. Improved patient satisfaction and quality of care, less stressed nurses, and higher nurse retention levels can all be improved by lowering the patient to nurse ratio on a unit. Lowering the nurse to patient ratio in my own workplace setting, that of a dialysis clinic, is essential to providing better quality care to patients, and improving the quality of workplace life for nurses.

Identify potential allies in planning the proposed change. Who are they and how can they assist you in making this possible?

Nursing organizations as well as patient's rights organizations have seen the benefit of improving nurse to patient ratios. The International Council of Nurses has praised California for setting mandatory upwardly adjustable minimum nurse patient ratios. Contacting the American Nurse Association and asking them for help to mobilize change and for information as to how similar proposed changes have been implemented in dialysis would be a positive first step. The ANA has extensive experience lobbying lawmakers and hospitals to promote positive changes in healthcare, and they would be an informational resource as well as a possible change agent.

On the dialysis unit where I work, I believe the collective unit of RNs will support the proposed changes. A single Registered Nurse (RN) is responsible for the care and safety of ten patients at a time. Even when the RN is financially compensated by overtime for his or her 'round the clock' service, the pressure can be difficult to withstand. Each RN is responsible for all ten patient's pre and post treatment care; the physical assessments of all ten patients; giving all the patient the correct medications on a schedule; supervising the technicians; operating kidney dialysis machines; initiating, monitoring, and discontinuing dialysis treatments, assisting physicians on their rounds, calling in prescriptions, making doctor's appointments for patients, and assisting patients with transportation issues, patient education, and writing physician orders.

Patients, noting the overstressed staff, have voiced their concerns. They have said they feel that their care may be compromised due to the attending nurse being over-extended. Dialysis technicians would also support a change in nurse-to-patient ratios because they are often over-burdened by work, and additionally, many of the technicians have no formal medical training and have a limited knowledge of patient care.

Where are key points of resistance within and outside the system? Why would there be resistance? Utilize systems theory in describing the role that groups and individuals would play in the process.

In terms of the profession itself, of the barriers to changing the ratios is the continuing nursing shortage in the nation. While most job markets are contracting, the Bureau of Health Professions predicts that the current shortage of 150,000 nurses nationwide will grow to 800,000 by 2020. My area hospitals have had a tremendous problem trying to recruit new nurses. Most of the hospitals offer a $5,000.00- $10,000.00 sign-on bonus for a one-year commitment by a nurse. In short, increasing the nurse to patient ration will be expensive, as well as logistically difficult. However, by failing to hire new nurses, there is a self-fulfilling prophesy -- the worse conditions become for nurses in the clinic in terms of workload, the fewer talented new recruits wish to join the unit or to stay. However, organizations tend to focus on short-term rather than long-term savings and strategies of improvement.

Dialysis organizations would be another opponent to the change due to the cost. Raising the costs of treatment might be necessary to hire new nurses. Dialysis clinics, because of their small size, often have fewer resources than large hospitals and the increased cost of wages of new hires would place a an additional stress on the unit's already limited budget, perhaps if estimates by the American Hospital Association are correct, as much as $270 million dollars a year.

Elaborate on potential negatives that individuals or groups might bring up in discussions and how you would counteract this.

Some nurses, despite their generally strong feelings in favor of the proposal because of their workload, may fear having to take a pay cut, or have overtime hours cut, because of the increased costs and influx of new nurses. Administrators may adopt a different type of change-resistance technique, and simply assert that it cannot be done, given the current nursing shortage, although effective recruiting techniques could be deployed, like tuition assistance, for example, flexible hours, as well as sign-in bonuses, to attract current students looking for jobs upon graduation as well as career nurses.

Based on change theory, how long do you anticipate that it would take to socialize the idea, propose the specific change, and initiate implementation?

The difficulty with persuading others to adopt the change is that it requires a long-range view. Trying to save on costs by increasing nursing workloads is a classic example of being 'pennywise but pound foolish.' Although there may be initial cost savings on nurses' salaries, the costs that will be incurred because of increased rates of patient ailments, increased duration of hospital stays because of complications, and even the costs of potential lawsuits because of the deaths that arise in a clinic with a less-than-desirable staff to patient ratio will far outweigh the initial costs of hiring more nurses.

Nurses already overburdened and overstressed in terms of the demands made upon their time, will likely welcome this initiative, even after initial temporary resistance to possible pay and overtime cuts. Introducing new people to an organization, of course, may also cause some friction. Socializing the idea to the current healthcare employees will likely be relatively easier than persuading managers who do not have to shoulder an increased workload and who are resistant the costs of implementation.