The Current Nursing Practice Paper Example

Introduction

Patients and clinicians perceive doctors as the drivers of health care services. However, physicians only spend approximately 45 minutes with patients in a single day, even those in critical conditions, whereas nurses are present at the bedside to attend to the needs of the patients. Nurses spend time with the pharmacists, the physicians, relatives and family to the patient and all other members of the healthcare team. Among all the members of the healthcare team, nurses plays a critical role in ensuring patient's wellness by monitoring the patients to note any form of clinical deterioration, near misses, weaknesses inherent in the health support systems and detecting any error that may occur in the process of care provision. Therefore, for the success of any health care unit, it is important to look into the nurse staffing to achieve the minimum nurse to patient ratio for safe and effective care provision.

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Despite the critical role that nurses play in healthcare provisions, the number of the nurses employed among the care facilities remain low. The patients are therefore at risk of poor care services since no one is there to check on the errors encountered during the healthcare delivery. Nurses' vigilance at the bedside is of critical benefit to the patients as they are able to note any deterioration if the health supporting systems. It is therefore, logical that assigning high number of patients to the same nurse reduces the quality of healthcare provision. The lower the nurse staffing the high chances of patient safety events including the mortality rates and even morbidity. The current situations in majority of the healthcare units is that a single nurse care for seven patients in a single day. The Patient Safety Act passed in 2018 looked into the nurse to patient ratio in a move to improve the quality of healthcare services offered among the health units across the United States.

There is need to improve in the staffing of nurses to raise the ratio on nurse to patient. The move will ensure that hospital adhere to a one-to-one rule to ensure that patients can access to healthcare consultation at all times either in the presence of physicians or even in their absence. Improving the nurse to patient ratio to one-to-one will ensure that there are healthcare providers to meet the unique patient needs. Improving the nurse to patient ratio will solve the situations where nurses are stressed up when dealing with numerous patients with different needs. Dealing with many patients exposes nurses to making mistakes even when it comes to delivering critical incentives including medicine. According to a survey commissioned by Massachusetts Nurses Association back in 2018, it was discovered that wrong medication to patients was directly related to the low nurse to patient ratio.

Coming up with a one-to-one nurse to patient ratio will help improve the effectiveness of nurse communication skills. As situation holds, majority of nurses lack enough time to provide the required comfort to the patients and any form of emotional support for both the patient and the family. They lack the time to engage in patient education, something that would help those in emotional conditions to stay strong and overcome their conditions. Some of the life threatening diseases like cancer demands comfort of the patient to be able to deal with the tough times. The need to develop an improved nurse to patient ratio comes along with the pressure to maximize patient safety through quality care. The only way to improve nurse communication with the patients is to reduce the number of patients under the care of a single nurse. The current situation in majority of the hospital denies patients the time to consult concerning their body reactions on time to enable nurses to alert the available physicians for immediate assistance.

Key Stakeholders

Physicians

Every health facility is under the primary service of the physicians who rely on the nurses, clinicians, pharmacists and laboratory technicians to ensure the wellbeing of the patient. Physicians will have an influence on the implementation of the proposed adjustment on the healthcare facility. Therefore, they will also give their proposals during the implementation of the proposed changes in the healthcare facilities.

Healthcare Centers Management

Coming up with one-to-one nurse to patient ratio will affect the operations among the health facilities. First, the change will imply that more nurses are employed into the facility and hence, financial input is necessary from the management. Some facilities will have to reduce the size of their care services by lowering the number of patients admitted at a given instance. The healthcare management will have to coordinate with the nurse placement board to ensure that the size of the facility can accommodate the proposed number. In addition, there is need for the management to provide the various incentives to meet the changes including the remunerations for the additional nurses. Others will have to provide various facilities like accommodation.

Nurse

Nurses are at the backbone of the proposed changes. Increasing the nurse to patient ratio will imply that more nurses are deployed to a single facility to improve on their service delivery and patient safety. Nurses will come up with the various challenges they face during the patient care services and their opinion for change improvement taken into account during the proposed initiative implementation.

Pharmacists

Pharmacists are part of the nurse health care delivery as they ensure that the nurses get the right prescriptions from the physicians to give to the patients. Improving the nurse to patient ratio will result to sufficient work of the pharmacist who will be able to get the right instructions from the physician before issuing the medicine to the nurses.

Laboratory Technicians

Laboratory technicians are critical healthcare providers that deal with the examination of the patient health through the available devices within the facility. Before coming up with a one-to-one ration of nurses to patients, there is need to ensure that available facilities for patient examination are adequate. Besides, reducing the number of patients admitted to a given health facility may imply that few laboratory technicians may be in charge of the facility.

Healthcare Agencies

Healthcare agencies carry out various duties especially in policy formulation in matters dealing with healthcare provision. Improving the number of nurses staffing among the health facilities come along with various contentious issues including the reducing the capacity of a given facility. Increasing the ration will imply that more nurses serve in a given care unit, and the result will be congestion among the care facilities. The only way out is to minimize the number of patients admitted to a given healthcare unit to match the number of available nurses for care provision? Considering the pressure from the nurse unions, the agencies are able to negotiate on behalf of all the interested parties to ensure that their interest are part of the discussion during the proposed changes.

Implications Level of Evidence

Welp et al, 2015 Emotional exhaustion and workload predict clinician-rated and objective patient safety. Maintaining clinician health and ensuring safe patient care are important goals for hospitals. 1425 physicians, nurses in the intensive are units. Patient safety related to burnout, trainee status and the professional role. Clinician's psychological health directly relate to patient safety..II

Holcomb et al, 2015 Transfusion of plasma, platelets, and red blood cells in a 1: 1: 1 vs a 1: 1: 2 ratio and mortality in patients with severe trauma Early transfusion of blood among severely injured patients result to low health complications. 680 severely injured patients in 1 of 12 level trauma centers. Mortality improve in the ratio of 1:1.2 among the patients receiving urgent blood transfusion. Patients with major bleeding require immediate attendance by clinicians. III

MacPhee et al, 2017 The impact of heavy perceived nurse workloads on patient and nurse outcomes There are concerns about the number of nurses attending the patients considering the poor health outcomes in the recent past. 472 acute care nurses from British Columbia in Canada. Job level perceptions coupled with heavy workloads had a direct impact on the patient health outcome. Administrators should work closely with the nurses to help identify the best strategy for improved patient health outcome. II

Rahman et al, 2015

The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals Nursing shortage jeopardize the quality healthcare provision among patients. 652 nurse working in surgical wards in private hospitals Nurses with high ratio to patient indicated low quality healthcare outcome. Staffing level of nurses directly affect the patient outcome.

There is need to improve on the nurse shortage in health facilities I

Hall et al, 2016 Healthcare staff wellbeing, burnout, and patient safetyThe wellbeing of the healthcare professionals directly affect the patient outcome. Reviewed research outcomes 67% of the studies found a significant correlation between the nurse staffing and the patient safety and health quality outcome. Poor wellbeing and high rates of burnouts among nurses and other health professionals directly affect patient safety. IV

Legend:

• Level I: systematic reviews or meta-analysis
• Level II: well-designed Randomized Controlled Trial (RCT)
• Level III: well-designed controlled trials without randomization, quasi-experimental
• Level IV: well-designed case-control and cohort studies
• Level V: systematic reviews of descriptive and qualitative studies
• Level VI: single descriptive or qualitative study
• Level VII: opinion of authorities and/or reports of expert committees

Evidence Summary

According to research conducted by Welp et al, 2015, the work overload among nurses result to emotional exhaustion that directly influenced the patient safety. To maintain clinical health and ensure patient safety, Welp confirms that health facilities should have a low patient to nurse ratio. This allows nurses to work within the appropriate time and discharge their duties without the influence of moral anguish. The study also confirmed that patient safety depend on the level of burnout among nurses and the trainee status that directly define the competency in job delivery. In conclusion, it was evidenced that the psychological health of nurses and other clinical officers determine their work competency and patient outcome.

Holcomb et al, 2015 conducted a study to determine how nurse to patient ratio is necessary in handling emergency healthcare services such as the transfusion of plasma, platelets and red blood cells. This research indicates that the patient outcome depends on the level of emergency in conduction the transfusion process. Early transfusion cases result to low instances of complications while delays could even lead to death of the patient. The morality rate improves significantly with improved staffing that ensures efficiency in conducting emergency operations. Patients with major bleeding demands urgent healthcare provision and the only way to improve this is through improving the nurse staffing capacity.

In another research conducted by MacPhee et al, 2017, nurse workload had a direct impact on the patient outcome. The number of patients under the care of a single nurse defines their flexibility and soberness when i...