Registered Nurse: A Crucial Cog in Improving Healthcare Environments - Research Paper

Introduction

Realizing improved healthcare environments requires the consideration of multiple factors and the needs of the various stakeholders. One of the principle cogs in healthcare management is the registered nurse. Increasingly, the role of the registered nurse in the healthcare environment has received prominence, especially with regards to improved hospital conditions (de Cordova, Pogorzelska-Maziarz, Eckenhoff, & McHugh, 2019). Throughout America and the world over, there is a growing concern that patients face harm as a result of inadequate staffing, which leads to increased severity of illness and complexity of care (Olley, Edwards, Avery, & Cooper, 2019). As the healthcare industry moves towards evidence-based practice, there is an even more urgent need to provide patient-centric care.

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Federal regulation 42CFR 482.23(b) demands that hospitals that seek to participate in Medicare must employ "adequate numbers of licensed registered nurses, licensed practical nurses, and other practical nurses" (Velmurugan, 2017). It also requires hospitals to guarantee the "immediate availability of a registered nurse for bedside care of any patient" (Kuwata, 2016). The idea of mandatory nurse-patient ratios stems from the belief that regulated registered nurse staffing will ensure improved patient outcomes, reduced nursing shortages, increased nurse recruitment, and improved job satisfaction. However, there are conflicting opinions on the overall impact of mandated nurse staffing ratios.

Why Mandated Nurse Staffing Ratios Issue Is Significant to Health Care

The world, in general, and America in specific, has a patient safety crisis. An estimated 700 patients succumb to preventable medical errors in medical treatment, complications arising from illnesses, and hospital-acquired infections each day (Gerard, 2018). At least 250,000 patients die annually due to preventable care, which is avoidable in a safe hospital environment. Considering that this is a conservative estimate, medical errors rank third among the leading causes of death in the United States (Markary & Daniel, 2016). There has been a relative indifference to the situation, even as registered nurses across America sounded the alarm over the evident crisis. Patients continue to remain at risk in an already desperate situation.

Multiple studies have confirmed a now acknowledged situation that there are not enough nurses to offer needed care. From a nursing perspective, one of the surest paths to ensuring patients' safety is through sufficient staffing. In more than half of the states, there are no proper frameworks for guaranteeing a minimum nurse-patient ratio despite the patient safety crisis that continues to worsen (Olley et al., 2019). Hospitals are almost always left to determine the limit to the number of patients a nurse should care for at one time. The situation is even worse for a commercialized healthcare system, where the bottom-line matters most for hospitals.

Over the years, and courtesy of advocacy, there have been failed policy experiments and ill-conceived strategies that replaced nurses with unlicensed, less-skilled staff. The aim has always been to realize a two-pronged result of guaranteeing improved patient care while reducing costs. Further, the introduction of technology into the healthcare setting aims to reduce medical errors at the least cost (Olley et al., 2019).

However, without proper nurse expertise, these technologies have served to introduce additional preventable medical errors. It is in light of these new challenges that policymakers must now consider the more reliable option of adequate registered nurse staffing as a means to save patient lives and guarantee their safety within care environments. Dozens of extant studies have confirmed that safe staffing levels can help to mitigate unnecessary harm to patients by ensuring evidence-based, patient-centric care (Law, Stevens, Hohmann, & Walkey, 2018). A safe healthcare setting also has the potential to reduce mortality, hospital readmissions, treatment costs, and length of hospital stay. Maintaining an appropriate nurse staff level promotes better care.

Potential Impact That Mandated Nurse Staffing Ratios Might Have on Nursing

Mandated nurse staffing ratios will impact on nursing in many ways. Requiring the right ratio would result in a cordial relationship between the American Nurses Association (ANA), the government, and hospitals. It is noteworthy that the ANA has been a principal advocate for improved nurse working environments, which among other things, can occur through proper nurse shifts.

Ensuring flexible staffing levels would help to account for the continuous hospital-environment changes such as the intensity of patient needs. Proper attention to patient needs will help reduce the number of admissions, discharges, and referrals during each shift. More considerate work shifts will allow nurses to have more experience. Further, the approach will allow nursing staff to invest in resources, including technology and ancillary staff.

Mandated nurse staffing ratios have the potential to benefit staff patients and health facilities by way of ensuring proper healthcare environments. Having proper nurse-patient ratios is likely to result in the reduction of medical and medication errors, which will result in improved patient satisfaction levels. Hospitals will also benefit through improved health outcomes achieved by lower mortalities, reduced readmissions, and reduced hospital stays for inpatients. Further, hospitals must improve their capacity to address preventable events such as central line infections, pressure ulcers, and patient falls. Patient-centric care achieved by proper staffing will help to avoid unplanned readmissions and reduce patient care costs.

Impact of Mandated Nurse Staffing Ratios From A Positive and Negative Point of View

While there are multiple impacts associated with the implementation of mandated nurse staffing ratios in hospitals, each of these impacts has a negative aspect. In general, the approach would benefit patients by ensuring that they benefit from evidence-based care, are allowed to participate in their care, and that they have a positive perception of care, which has a positive impact on their recovery. However, the resulting inflexibility would not help meet all patient needs. For instance, patients waiting for discharge, and night shifts require fewer nurses (Haegdorens, Van Bogaert, De Meester, & Monsieurs, 2019). On the other hand, patients suffering from multiple chronic illnesses would require more attention and may need a higher nurse ratio. Hence, the inflexibility resulting from predetermined nurse-patient ratios would also work to the advantage of patients in specific situations.

As regards hospitals, mandated nurse staffing ratios have multiple positive impacts. One, it would help to improve healthcare delivery and the implementation of evidence-based care. A closer relationship between registered nurses and patients will help realize patient-centered care and will allow patients to be active participants in the care provision. However, there is also a negative aspect to the anticipated gains. A large number of hospitals would be required to absorb the available number of registered nurses (Haegdorens et al., 2019). There would be difficulty in finding quality nurses, considering the rigor required for the proper training and experience of registered nurses. Further, hospitals would incur costs resulting from an increased workforce, which will threaten their profitability.

On the part of nurses, mandated staffing ratios, as expected, would result in appropriate shifts. Consequently, registered nurses will be able to address issues such as burnout and family-work balance. An improved workload would also help to improve the nurse output and their professionalism (Chen et al., 2019). However, there is a negative aspect of the impact of mandated nurse staffing ratio to nurses. It would lead to a loss of autonomy and flexibility (Qureshi, Purdy, & Neumann, 2018). For hospitals that cannot employ enough registered nurses to serve night and day shifts, the nurse would need to stay longer hours as a requirement or their presence. Increased workloads due to the required presence of nurses next to the patient would lead to low job satisfaction. Further, it would result in more work.

Pro or Con Position on Mandated Nurse Staffing Ratio Impact on Health Care Policy

Despite the few negative impacts of mandated nurse staffing ration, it holds the more positive potential to the healthcare setting. It would be simplistic to disregard research findings that confirm that high levels of nurse staffing result in a positive outcome for patients. Mandated nurse staffing ratios hold the key to reduced length of hospital stay, elimination of hospital-related complications, and reduced mortality. Hospitals also need to consider this approach due to its capacity to improve job satisfaction for nurses. It is noteworthy that the success of hospitals, like other organizations, is a function of employee perception. A positive attitude of the work environment would lead to better performance.

The adoption of mandated nurse staffing ratios would be the best idea for hospitals, as it would help to add professionalism to their investments in hospital information technology. While such technologies promise to reduce medical errors and ensure quality clinical and medical care at the lowest costs, it is noteworthy that they lack the human aspect, which can only occur through the registered nurses. The psychological point of treatment is as useful as the clinical and medical aspects. Hence, ensuring that the nurse has proper family-work balance and that they are adequately motivated would ensure that the same positive energy transfers to the patient.

The rationale for the Supporting Mandated Nurse Staffing Ratios

The hospital environment has improved over the last couple of decades. Over the years, humans have discovered vaccines, antibiotics, and pain relievers. More recently, increased adoption of technology in the medical field has seen improved healthcare outcomes resulting from fast information sharing, early diagnosis, and proper patient-nurse communication. However, these improvements have focused on some aspects of healthcare while neglecting others. For instance, whereas technology is useful in addressing medical errors, it does not provide the human element.

Also, evidence-based care is lauded for its potential to revolutionize healthcare delivery. However, the plight of nurses has always remained on the fringes. Mandated nurse staffing ratios bring the plight of registered nurses to the fore. It helps to address the nurse advocacy concerns for staffing, shift lengths, and the wellbeing of nurses. The role of nurses in ensuring a holistic care environment cannot be wished away. Hence, when addressing ways to improve the healthcare environment, the role of the nurse also needs to be taken into consideration.

Flexible staffing levels would help to account for the continuous hospital-environment changes such as the intensity of patient needs. Proper attention to patient needs will help reduce the number of admissions, discharges, and referrals during each shift. More considerate shifts will allow nurses to have more experience. Additionally, the approach will allow nursing staff to invest in resources, including technology and ancillary staff.

References

Chen, Y. C., Guo, Y. L. L., Chin, W. S., Cheng, N. Y., Ho, J. J., & Shiao, J. S. C. (2019). Patient-Nurse Ratio is Related to Nurses' Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction. International Journal of Environmental Research and...