1. Patient Safety Related to Patient - Nurse Ratio
Problem: High Patient to Low Nurse Ratios create an unsafe environment.
Group 5
Amy Balsavage – Rebecca Bernardo
Alison Dahl – Melanie Gonzalez
Keval Harisprashad – Cailey McConnell
Omar Ortiz – Stacey Raffler
Nerymar Rivera – Karenna Williamson

2. QSEN Competency: Safety
The Quality and Safety Education for Nurses (QSEN) Initiative defines the competency of safety as the “minimization of risk that may create harm to patients and providers through both system effectiveness and individual performance.” (Cronenwett et al., 2007).
Research validates the notion that nurse-patient ratios, particularly those unregulated, greatly impact overall patient safety.

3. Identifying the Problem
In a study completed by the American Nursing Association, 70% of nurses felt they had inadequate time to plan and deliver all aspects of care to their patients. Another 85% of nurses reported that lack of staffing was a determining factor is steps being missed from patient care (Cherry & Jacobs, 2014, p.129). Support from nurses and supporting staff call for intervention to address these concerns that affect the care being delivered to patients.

4. Identifying the Problem (Cont.)
Increasing the workload of nurses, which is often done, directly correlates with a higher mortality for patients.
This has been proven through a large international study consisting of 30 countries and the examination of nurse staffing levels and the quality of health care the patients received.
Part of the study covered 617 European hospitals and found that after common surgical procedures, the patient deaths were vastly lower with staffing ratios of fewer patients per nurse.
This study also found that poor nurse to patient ratios also resulted in a decreased likelihood of elderly patients returning to an associated living facility after being hospitalized.
It was found that every patient added to a nurse’s workload, added a 7 percent increase in hospital deaths following common procedures.
Simply put, more nurses means lower mortality.

5. Investigating the Problem
Last year the state of Massachusetts passed a new law that mandates a one-to-one nurse-to-patient ratio in the ICU of every private and public hospital. 
Many legislators and hospitals opposed the bill initially but the Massachusetts Nurses Association (MNA) were able to provide data that showed how such limits would deliver better patient outcomes which was measured using key clinical indicators. 
They also showed that the ratio would reduce financial penalties associated with:
30-day readmission
nosocomial infections
mortality rates. 
The opposing argument was that the staffing limits don't consider patient acuity so the law that passed solved that by requiring nurses to assess patients' stability with an acuity tool.  This tool would allow a one-to-two ratio if it is deemed safe. 
The MNA are hoping to go to ballot in 2016 to have limits set in all areas, not just the ICU.

6. Investigating the Problem (Cont.)
Higher nurse to patient ratios can create unsafe and unsatisfactory care for patients. This issue shares its prevalence internationally.
Many researchers, no matter the location, agree on many points. As an example, Zhu, et al (2012) discussed these finding from China.
Many basic skills such as adequate patient surveillance and skin care were reduced with the increase in patient load. While patient dissatisfaction negatively correlated and increased with lower nurse to patient ratio.

8. Identify and analyze possible solutions to the problem.
When assigning patients, charge nurse should take into account:
The patient’s acuity and expected outcome
The nurse’s education, experience and training
Avoid placing nurses in units where they are not trained
Develop career programs to move nursing graduates through graduate studies more rapidly and identify options beyond the entry-level role of staff nurse such as faculty, researcher, and administrator.
Promote more adequate compensation in the healthcare community based on a better understanding of educational preparation.
Reach out to youth (ages 12-18) through counselors, youth organizations, schools, etc. to promote recruitment of a younger, more diverse population of nurses.
Implement strategies to retain experienced nurses in direct patient care such as:
Greater flexibility into work environment structure and scheduling
Rewarding experienced nurses for their contributions
Salary and bonus incentives

9. Identify and analyze possible solutions to the problem. (Cont.)
Use of technology to enhance and shorten duration of patient care - with regards to CFR
Linen baskets in the room to avoid unnecessary trips
Vital signs machines within each patient room so the nurse or tech can immediately assess instead of having to track down a machine down the hall
Bed alarms on the bed to avoid having to track down a portable bed alarm and having to search another unit if one is not available
Updated electronic heath record to allow more user-friendly and timely documentation of patient care

10. Implement a staffing committee at CFRH:
As proposed by the “Nurse Staffing Committees in Hospitals - SB 1342” bill:
“By September 1, 2015, each hospital shall establish a nurse staffing committee, either by creating a new committee or assigning the functions of a nurse staffing committee to an existing committee. At least one half of the members of the nurse staffing committee shall be registered nurses currently providing direct patient care and up to one half of the members shall be determined by the hospital administration.”
All staff members should meet monthly or quarterly to discuss staffing plans based on:
The number of patients in each unit every shift
The acuity of patients and the RNs capability of taking care of them (education and experience)
Hospital layout
Availability of equipment (e.g. vital sign monitors and bed alarms)
Hospital’s staffing budget
Evidenced-based staffing information or guidelines that have been adopted or published by healthcare organizations or nursing associations
Additionally, review injuries, illnesses and falls that occurred during every shift to determine if staffing was a factor.

11. Conclusion
Ensuring adequate staffing levels in hospitals has been shown to:
Reduce medical and medication errors
Decrease patient complications
Decrease mortality
Improve patient satisfaction
Reduce nurse fatigue
Decrease nurse burnout
Improve nurse retention and job satisfaction

12. References
Aiken, L. (2015). Ratios save lives. Lamp, The, 71(1),
American Association College of Nursing. Strategies to Reverse the New Nursing Shortage. Accessed at: on April 2nd, 2015.
American Nurses Association. (n.d.). Safe Staffing: The Registered Nurse Safe Staffing Act H.R. 1821/ S Retrieved on March 22, 2015 from _600_copies.pdf?docID=2181
Cherry, B., & Jacob, S. R. (2014). Contemporary nursing: Issues, trends, & management (6th ed). St. Louis, MO: Elsevier Mosby.’
Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3) Retrieved March 25, 2015, from
Florida Nurses Association (2015). Legislative Activities. Retrieved on March 31, 2015 from

13. References (Cont)
 Florida Senate (2015). Senate Bill Retrieved on March 31, 2015 from
Wilmont, S. (2014). Massachusetts Nurses Achieve Safe-Staffing Victory. American Journal of Nursing, 114(10), Retrieved April 3, 2015, from
Zhu, X., You, L., Zheng, J., Liu, K., Fang, J., Hou, S., & ... Zhang, L. (2012). Nurse Staffing Levels Make a Difference on Patient Outcomes: A Multisite Study in Chinese Hospitals. Journal Of Nursing Scholarship, 44(3), doi: /j x