Haylie Walker

English II

Professor Morean

29 July 2020

Safety in Numbers: Nursing Ratios

Taking care of ourselves is something that we push to do everyday, and sometimes that

leads us to hospitals, doctor offices, or nursing homes. We may find ourselves in the hospital on

Christmas day, graduation day, or even a random Tuesday. The only thing that those things

have in common with one another is that nurses are also at the hospitals that day, but they’re

taking care of you. When you go to the hospital you assume you're safe with the staff, but how

would you feel if you were 1 of 9 people a nurse would care for in the hours you're in the ER,

or 1 of 12 patients a nurse is balancing when you just got done with a procedure? Do you still

feel safe? In this paper I will bring information to your attention that will show the effect high

staffing ratios have on patient safety, nurse burnout, and readmission risk.
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Imagine you just had a minor surgical procedure, everything went great. You’re in post

op and you feel like you’ve got a great nurse but she seems a bit overwhelmed? When she

tells you how many patient’s she has, you don’t think too much about it but when you arrive

home and have a post op infection you begin to think that maybe if the nurse had less patients

she would have known that your WBC was teetering on the high side and pushed for the

doctor to intervene. An actual study showed, “...of 232 342 surgical discharges from several

Pennsylvania hospitals, 4535 patients (2%) died within 30 days of hospitalization; the

investigators estimated that the difference between 4:1 and 8:1 patient–nurse ratios may be

approximately 1000 deaths in a group of this size”. (Shekelle, 2013.) This shows that if we cut

patient loads in half, that it can reduce those death rates.

Most people do not realize the importance of a nurse or nurse's aide.People do not

understand that the number of patients you have is not always the most important factor.

Depending on the area in which you work within the hospital the acuity of the patients can

change drastically in seconds. When you have someone walk through the front door of the

Emergency Room you never know what you are going to get. Upper Management and higher

up people do not realize how quickly this can change and without the proper staffing this can

put the nurses and patients in danger. The overall standpoint of patients in the ER is constantly

changing which affects how the nurses are able to care and protect each patient.

Nurses are lifelines for patients; they see the ins and the outs, they know how many

times they have urinated and if they had the bowel movement they needed to have to be

discharged. When patient loads are increased, the nurses being lifelines drastically decreases,

“An OR of 1.07 implies that the odds of patient mortality increased by 7% for every
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additional patient in the average nurse’s workload in the hospital...” (Aiken, 2002). Aiken also

discusses how doubling a nurse’s patient load can double the mortality rate. This kind of

information makes you second guess that procedure you need, and makes you question how

many patient’s your post op nurse is going to have. The thing is though, we cannot blame the

nurses, they are the ones greatly affected by the hospitals patient ratios. A nurse going into a

job could be told her patient load on a daily basis should be 4, but what she isn’t told is how

often her fellow nurses will be pulled onto another floor, making the one she is planning to

work on short staffed.

Healthcare providers talk to people within their place of employment about how

frustrating it can be to work short staffed. The Emergency Room may be staffed correctly but

nurses and providers that work inpatient are getting new admissions and it's taking a toll on

each nurse because they can not provide for the patient and take care of their needs like they

should be. Interviewing nurses that work within the hospital allows us to get a personal

perspective on how the healthcare workers that we know personally say that the facilities near

us are treating their patients' viruses how they should be. One nurse stated to me during my

interview with her that, “I would not want to take my loved one to a facility that they were this

short staffed especially with the way things have been going this year and myself not be able

to be there to help care for them”(Abbott,2020). Hearing people that take care and work in

these facilities not wanting to take their loved ones to them because they are so short staffed

should say something. Employees that work in any healthcare facility will have their honest

opinions on the situations and how they are handled. At some point all opinions are alike in

some way that people tend to just overlook for many reasons.
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Think about going to visit your grandma at the nursing home, you don’t realize the kind

of work the staff there puts into ensuring that grandma is taken care of. You don’t think about

the CNA that bathed your grandma also took care of 18 other residents that morning, or the

nurse who gave grandma her blood pressure medicine has 36 other residents she was giving

medications too. What happens when grandma gets a pressure sore to her bottom? You see your

parents blaming the nurses and aides, yelling at them for not taking grandma to the bathroom

soon enough or for not laying her down for her afternoon nap. What they don’t realize though

is, “11% of nursing home residents had pressure ulcers in 2004” (Park-Lee, 2009). Can this

11% be contributed to the decreased amount of staff in nursing homes compared to the high

volume of patients. If we gave CNAs less patients they would be able to ensure everyone was

dry and laid down in the afternoon. Instead they have to pick and choose who is able to lay

down and who is going to stay up. This can ultimately lead to CNA and nurses feeling guilty,

therefore causing burnout in the healthcare industry.

Residences in nursing homes and patients that are inpatient in the hospitals notice

whenever staff is being rushed. Patients and residents need assistance they may not be able to

get in a timely manner which can cause there to be multiple different issues once the healthcare

staff is able to tend to the needs of these people. This allows for people to get an opinion about a

facility that could leave a lasting impression on them depending upon how their stay goes. This

is not the nurses and CNAs fault for not being able to assist the patients like they are supposed

to, only so much they can do with other call lights going off and being the only one tending to

them with the amount of patients they have on the floor. The healthcare staff expects the blame

and raft of the upset families but reality is that it is not their faults.
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While working within the healthcare field you hear and understand how the mental

stability of a physician, nurse, or aide is not in the state that it should be. Mental stability is

something that all healthcare providers receive after working long hours and many days being

short staffed. This makes it very difficult for people to want to continue going to work and

caring for their patients because some days they may not even want to care for themselves.

Until we understand that these people are working in unsafe conditions and work to get this

fixed, we may not know the mental state of those caring for our loved ones. Everyday people

realize one extra or one less nurse makes a huge difference in every department.

Looking at nursing home facilities you may notice quite the difference between a non-

profit nursing home and a for-profit nursing home. An article found, “Not-for-profit facility

ownership is associated with higher staffing levels. This finding suggests that public money

used to provide care to frail eldery people purchases significantly fewer direct-care and support

staff hours per resident-day in for-profit long-term care facilities than in not-for-profit

facilities” (McGregor, 2005). This makes you wonder, why exactly nonprofits have less

staffing? Are they paying less due to budget? Why are they not getting more money to ensure

proper patient care? Also what are for-profits doing that can ensure they are making money

and have adequate staffing. Research diving into this was few and far between but the major

difference was that nonprofits were short staffed while for profits had lower patient to nurse

and patient to aide ratios.

While in nursing school you think about taking care of others and doing no harm. The

reality of the situation is you're going into an industry that is going to put as much pressure on

you as they can, and if you break under the pressure they expect you to come back the next day
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all pieced back together. When you first become a nurse you think of it as a forever job what you

fail to realize is, “... nurses in hospitals with the highest patient-to-nurse ratios are more than

twice as likely to experience job-related burnout and almost twice as likely to be dissatisfied with

their jobs compared with nurses in hospitals with the lowest ratios” (Aiken, 2002). Being

dissatisfied with the job, can lead to nurses going into different careers, which does not fix the

problem just makes it larger and harder to fix.

As nurses are being called heros in the news for Covid-19, they are struggling mentally.

An article centering around 2020 being, ‘The Year of the Nurse’ states, “We are taxed in caring

for the sick in that we are lacking basic equipment to care for ourselves. Additionally, there just

aren’t enough of us on the ground to do the job. We need to address nursing shortages ”

(Gennaro, 2020). We are calling nurses heros, but they are putting themselves at risk to do

something no one else is willing to do. They spend their time hoping they won’t bring an

infection home to their loved ones, all while hoping their patient won’t die alone in isolation.

After this all is over with, do we really believe these nurses and doctors on the frontline will

want to continue being healthcare professionals? One can only hope they will. 2020, the year

Florence Nightingale predicted would be the year for nurses.

The year 2020, Coronavirus has swept through the world. A pandemic that no one sees

coming. We look to our nurses, doctors, and healthcare specialists for guidance. Families have

had to put their trust in healthcare providers to make sure that not only the patients are well

taken care of, but to inform the worried family of how things are going. While being in this

pandemic many things have changed with policies and staffing within the hospitals. Staffing

hours have been cut in some areas and raised in others. Visitors are no longer allowed in with
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their loved ones. This makes the nurses and physicians the soul providers for everyone to make

sure all needs are met and understanding how everyone feels with the situation that everyone

has been placed in. Coronavirus has made healthcare employees have to work in a completely

different environment.

Day in and day out we see the world we live constantly changing. Patients acuity

changes within seconds in a hospital setting. Nurses still continue to try to give continuous

excellent care to their patients on a daily basis. While being in the hospital you want to know

and feel safe in that environment especially when you do not feel good. Emergency room or

just out of a procedure the patients may already be scared and then hearing or being able to tell

that the nurse that they have is severely overwhelmed does not give them a warm feeling. As

healthcare providers we need to make sure that our patients and their families feel safe with us

caring for their loved ones. By having a better nurse to patient ratio makes situations much

more safe and everyone much happier.

Everyday we turn on the television hoping to see that we have flattened the curve with

the coronavirus. Through this paper and everything else going on in the world I hope to help

others understand that while you are calling nurses heroes, we are struggling. We want better

staffing ratios, we want to be able to do our jobs effectively, and we want to provide the best

care possible for every patient we are able to touch. If we were to implement lower patient to

nurse ratios, the mortality rate would decrease, readmissions would decrease, and nurse

burnout would decrease. Something so small could have such a huge impact on so many

people.
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Works Cited

Abbott,Breanna. “Nurses Experiences in Hospital Setting.”

Personal Interview 5 July 2020.

Aiken, Linda H., et al. "Hospital nurse staffing and patient mortality, nurse burnout,

and job dissatisfaction." Jama 288.16 (2002): 1987-1993.

Barrows, Katie. “Safe Staffing: Critical for Patients and Nurses - Department for

Professional Employees, AFL.” CIO, Department for Professional Employees, AFL-CIO, 15 Apr.

2019, www.dpeaflcio.org/factsheets/safe-staffing-critical-for-patients-and-nurses.

Gennaro, Susan. "2020: The Year of the Nurse as Seen Through a Coronavirus Lens."

Journal of Nursing Scholarship (2020)

McGregor, Margaret J., et al. "Staffing levels in not-for-profit and for-profit long-

term care facilities: Does type of ownership matter?." Cmaj 172.5 (2005): 645-649.

National , Nurses. “RN-to-Patient Staffing Ratios.” National Nurses United, 31 Mar.

2020, www.nationalnursesunited.org/ratios.Park-Lee, Eunice, and Christine Caffrey. "Pressure

ulcers among nursing home residents; United States, 2004." (2009).

Shekelle, Paul G. "Nurse–patient ratios as a patient safety strategy: a systematic review."

Annals of Internal Medicine 158..5_Part_2 (2013): 404-409

Wofford, By: Portia. “Nurses Say Staffing Ratios In Long Term Care Facilities Are

Unsafe.” Nurse.org, 11 July 2019, nurse.org/articles/nurse-staffing-unsafe-long-care-facilities/.