Nursing Literature Review: Lack of Nurse to Patient Ratio

Workload is a significant issue in the contemporary healthcare sector as it affects the nurses’ welfare and working ability. The concept pertains to the volume of work that nurses have to undertake in their daily operations and greatly affects serious outcomes, such as patients’ morbidity and mortality (MacPhee, Dahinten and Havaei, 2017). Abed-Ali, Athbi, and Nawam, (2016), indicate that nursing is a stressful work that deals with illnesses and health, while Kieft, de Brouwe , Francke, and Delnoij (2014) state that work environment is important in the nursing field. Koy, Yunibhand, Angsuroch, and Fisher (2015) believe that nurse staffing influences the quality of work executed by nurses. Gulavani and Shinde (2014) state that nurses have become increasingly prone to job-related stress that causes dissatisfaction and affects the quality of nursing care. This literature review aims at examining how the nursing work overload leads to patient dissatisfaction.

The literature review question is as follows:

How does lack of nurse to patient ratio lead to patient dissatisfaction?

The hypothesis of the literature review is:

There is an association between nursing work overload and patient dissatisfaction since the former lowers the emotional and physical ability of nurses to offer quality healthcare.

In a study conducted by MacPhee, Dahinten and Havaei (2017), the authors tried to shed light on how the job-, unit- and task-level workload factors affect the three negative patient outcomes, namely patient falls, medication errors, and urinary tract infection as well as the two nurse outcomes that are job satisfaction and emotional exhaustion. The method used was a correlational study involving 472 nurses from the acute care section in Canada and British Columbia. The study considered several factors related to the workload, and these were patient acuity, patient dependency, staffing of registered nurses at the unit level, and interruptions at the task level among others. The study also tested the mediating effects, namely nursing tasks left undone and compromised standards of nursing. The results observed in the study established that job-level perception of heavy workloads as well as the interruptions at the task level adversely affected nursing outcomes as well as patient satisfaction. The tasks left undone had a mediation effect between the heavy workload and patient satisfaction as well as between interruptions and patient outcomes. Compromised standards of professional nursing also mediated between the interruptions and workloads on one hand and nurse outcomes on the other, thus contributing to lower quality services that imply lack of patient satisfaction. Concerning the findings, it is clear that there is the need for administrators to ensure that the staffing ratio is commensurate to the workload.

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Abed-Ali, Athbi, and Nawam (2016), conducted a cross-sectional study that was descriptive in nature in the AL-Najaf City between December, 2014 and March, 2015. The aim was to establish the impact of nurse burnout as a result of heavy workload on patient satisfaction. The study entailed a non-probability sample of 25 nurses and 107 patients from surgical and medical units. The researchers used interview, questionnaire and scientific data analysis. The results were that 80% of nurses were in a fair practice environment, 84% were burnt out at times due to the environment in which they worked, and 70.1% of patients were satisfied with the interpersonal support. 62.6% of the participants further reported that they were partially dissatisfied with a nurse. The study concluded that nurses were exposed to some burdens due to the workplace environment and thus they feel burned which had an impact on patients’ satisfaction with care. The study thus recommended further studies on the impact of nurse burnout on patient satisfaction as well as the factors that may improve working conditions for nurses thus reducing burnout and patient dissatisfaction.

Another study was done by Kieft, de Brouwe, Francke, and Delnoij (2014), to establish the views of the Dutch nurses regarding how their environment and work promoted positive patient outcomes. The researchers employed a qualitative research design to collect information. They established four focus groups with each having 6-7 registered nurses in a mental facility, nursing home care, home care and hospital care. The researchers recruited 26 nurses through a purposeful sampling and then conducted interviews that were recorded in audio format, transcribed them and put under thematic analysis. The nurses touched on important requirements that would make patient outcomes more satisfactory. They talked of collaboration at work, competency, adequate staff, nurse autonomy, patient-centered culture, managerial support, and control over nursing practice among others. They also highlighted a number of factors that would hurt the patient outcomes, and they include pressure to increase productivity leading to high workload, cost effectiveness policy, and transparency goals for external accountability. As noted, nurses mentioned several factors that could improve patient outcomes, and one of them was adequate staffing. On the other hand, nurses revealed that some factors hindered the patient satisfaction, and one of them was excessive workload. In relation to these points, it is clear that excessive workload leads to burnout and compromising the quality of services, thus making patients dissatisfied with care.

Koy, Yunibhand, Angsuroch, and Fisher (2015) carried out a literature review to establish the relationship between nurse staffing, job satisfaction, burnout, and nursing care quality. The researchers employed a database search that borrowed from CINAHL, HINARI, Medline and Embase, PubMed, Google, and Science Direct. The terms involved in the search included the quality of nursing care and nurse staffing among others, and the papers included were on the basis of their significance to the field. The study revealed that there was a relationship between nurse staffing and job satisfaction, burnout as well as the quality of nursing care. It is worth noting that burnout occurs due to the presence of large volumes of work for the staff thus making them overwork and get tired. As such, the study reveals that inadequate staffing leads to increased workload, burnout and poor quality care which result in patient dissatisfaction while proper staffing reduces the workload and helps avoid burnout promoting the quality of service and improving patient outcomes.

Another study by Gulavani and Shinde (2014) indicates that job related stress adversely affects the nurse outcomes and worsens the quality of care provided to the patients. The researchers used a descriptive design that entailed an explorative approach to research which involved 100 nurses in a convenient sampling. According to the results, the nurses reported that they were prone to stress and 59% attributed the same to the workload which led to job dissatisfaction. Even though the research did not dwell much on the workload as a factor that causes stress and dissatisfaction, 59% of the respondents attributing workload to dissatisfaction are enough to prove the claim that excessive workload leads to dissatisfaction. A rational scholar can therefore derive the point that the excessive workload leads to nurse burnout thus causing poor quality services. In the end it leads to patient dissatisfaction while reduced workload promotes quality of service thus improving patient satisfaction.

In conclusion, workload is a serious issue in the healthcare sector. In the light of the reviewed sources, it is evident that workload influences nurse burnout thus affecting the quality of care and patient satisfaction. The examined sources have proven that when there is understaffing, the nurses get more work and consequently they get too tired which makes them lower the quality of work. Patients are dissatisfied with the nursing care that they receive from such a nursing team. In reference to the findings on the discussion, it is clear that health facilities and relevant authorities should cooperate to ensure that there is adequate staffing in hospitals, so that the nurses can have a reasonable workload that will enable them to provide the best services to the patients to promote their satisfaction.