Patient to Nurse Ratio Evidence-Based Practice Proposal

Abstract

The patient-nurse ratio has been constantly increasing, which has numerous undesirable and adverse impacts on the healthcare industry such as the provision of poor services to patients by nurses, who are overworked and, as a result, often stressed and dissatisfied with their work. Consequently, it becomes necessary for stakeholders to develop a successful long-term strategy that would offer reduced working hours and better working conditions as well as a favorable environment for nurses. In this paper, due to the rising number of patients ailed by abdominal aortic aneurysm compared to the few nurses available to attend to these patients, a solution is proposed to address the problem. The study identified the problem contributing to poor quality of medical care service to be long 12-hour shift. The proposed solution is to shorten the working hours of nurses from 12 hours to 8 hours. The introduction of a shift schedule with few working hours will enable the nurses to be contented with their job. Also, better working conditions and a favorable environment have proven to take the quality of health services to a new level. In order to disseminate the information, the project will use such platforms as journal clubs and publishing, oral presentations, professional committee conferences, and posters. Keywords: patient-nurse ratio, working conditions, working environment, long working hours, abdominal aortic aneurysm, 12-hour shift, 8-hour shift.

Introduction

In modern days, the patient-nurse ratio has been constantly increasing in most healthcare facilities, raising alarm among health practitioners and stakeholders. This changing ratio has numerous undesirable and adverse impacts on the healthcare industry. For instance, the lack of qualified nurses in most healthcare amenities, handling such diseases as abdominal aortic aneurysm, has considerably lowered the quality of medical services provided to patients, as the excessive workload decrease the staff`s concentration and make their work prone to mistakes. The current paper is an evidence-based practice proposal for the project which aims at finding a resolution to the problem of increase in patient to nurse ratio in order to improve the patient care.

The Research Problem

Poor health care services delivered by the nursing specialists, as witnessed today, have resulted from the increase in patient-to-nurse ratio as nurses are having an additional workload. Thus, it has become vital nationwide to increase the number of nurses who are registered or employed to handle the ever-growing number of patients in order to enhance the quality of the offered medical services. The relatively high number of patients ailed by an abdominal aortic aneurysm, compared to the small number of nurses in hospitals causes concern to the government and healthcare officials as well as to patients, whose medical conditions often require careful attention. Moreover, the scarcity of nursing staff might have caused an upsurge in the rates of mortality among patients, who did not receive medical services in a timely manner. . According to Rogowski et al. (2013), poor recruitment of nurses in hospital departments, such as neonatal units, can lead to the situation in which patients acquire infections on the hospital premises and even to cases of infant mortality. According to Shekelle (2013), the existing nursing staff may not be contented with their work as they suffer from exhaustion resulting from work overload, which can make nurses think of changing their occupation or withdraw from the nursing profession, thus further worsening the circumstances.

The Purpose of the Research

The purpose of the study is to develop the best strategy of solving the issue of the patient-to-nurse ratio. To date, an effective solution to the issue of recruitment in the healthcare industry has not been found. The nursing staff ought to be supported in order to achieve the suitable ratio, but the industry lacks regulations on how it should be done. It is really vital that associations for nurses identify the best ratio necessary to guarantee the safety of patients, which in turn improves the healthcare outcomes for patients, along with the increasing probability of survival in patients who are in a critical condition.

Research Questions and Objectives of the Study

It is necessary to explore the key health services offered to the patients, and how they can receive improved medical care on admission to hospital. Simultaneously, it is vital that the intervention procedures are established to ensure that patients get high quality services. Also, parameters which are used to compare the offered services to the patients` needs must be made available. Moreover, the findings of the project and the timeframe are vital elements to consider. Thus, the following research questions arise:

Research question 1: who are the patients or population of interest? The study will pursue to address the patients of interest based on their demographic physiognomies such as gender, age, or population. It will further address the healthcare issue within a particular population, specifically, patients ailed by abdominal aortic aneurysm.

Research question 2: What are the Interventions necessary to stop the disease? With regard to this question, the study will explore the diagnostic, therapeutic, preventive or other medical care interventions essential for the success of the project. The study will aim at ascertaining the appropriate healthcare management plans such as increasing the number of qualified nurses, taking care of patients ailed by abdominal aortic aneurysm promoting smoking cessation and encouraging a healthy diet with low consumption of fat and simple carbohydrates.

Research Question 3: What is the comparison of interest? In respect to this question, the study will aim at addressing the comparison parameters which will be applied in assessment of the intervention. In the context of the current study, the effectiveness of employing a higher number of nurses will be compared against other strategic measures, for example, developing rules or strategies which regulate a particular ratio of nurses to patients in a medical care service.

Research Question 4: What is the outcome of the project? The study aims to address the project outcome by determining how the target population is being affected by the intervention. The outcome of the project is anticipated to improve the quality of care that is received by patients ailed by abdominal aortic aneurysm, along with ascertaining effective ways of reducing the workload encountered by nurses, and consequently improving their job satisfaction. It also aims at reducing the number of patients ailed by the disease by raising their awareness and developing education programs on ways to prevent abdominal aortic aneurysm.

Project Timeline

The research project is anticipated to take up to four weeks. During the first week, the activities will include literature reviewing and exploring the best methods of the project completion. In the second week, discussions regarding the most effective ways of implementing the project will take place. The following two weeks will involve the practical implementation and assessment of the project.

Literature Review

According to the data provided by Cimiotti, Aiken, Sloane, and Wu, (2012), there is a significant yearly percentage of violations of the deontological ethical principles by medical practitioners as they offer care to patients and as interact with them. Also, it is established that some medics and nurses have no essential skills to establish an emotional contact and a good rapport with patients and, consequently, they cannot or are not willing to reveal their subjective condition of having the disease. According to international qualification standards, it is a very important condition for the specialist’s competitiveness.. A growing role of medical experts as active participants of medical processes and healthcare and prophylactic activities inspires the hunt for new tactics of evaluating the height of their individual qualities, and exploration of those that ascertain the accomplishment in professional career (Cimiotti et al., 2012). Different authors have emphasized the necessity for developing professionally significant qualities in medical personnel. Aiken et al., (2011) inform on the need to investigate the problems of specialized and psychological readiness of the future health specialists to work, which serves as methodical characteristics of the adequate training and the achieved height of these specialized skills.

In the course of performing his or her professional duties, the nurse needs to be able to notice specific characteristics of the patient and take into account the effect of a possible depression if there have any changes in behavior, since the same illness impacts the inner world of the patient and his or relationships with other people in various ways. Nurses mostly find themselves in a tense atmosphere during their working hours, the main reason for this being the inclusion in the course of interaction with patients, their families, and friends (Bae, 2012). The issue of medical principles and ethics is a very important part of training. In spite of the fact that there is an increasing interest in morals, this topic remains inexhaustible. Everybody understands that the patients, their relatives, and associates need to be treated with care and with warmth. In case the nurses or doctors violate a social canon, they do so not because they do not know the regulations, but because they possess no calling to the medical career and no comprehension of the psychology of the patient (Potera, 2011).

The character of the nurse and the doctor, their ethical personality and professional training eventually determine the noteworthy success of a heath care system on the international scale. Regardless of the actual issues related to the rapid progress of the medical science and the application of its attainments in community health practice, development and constant modernization of the material base of health institutions, including modern technology and tools, as well as moral values of health workers, their attitude to their professional duties, and their relevant and regular training remain vital(Rozdilsky & Alecxe, 2012).

Blot, Serra, Koulenti, Lisboa, Deja, Myrianthefs and Rello (2010) examine the effects of the patient to nurse ration on the worsening or easing of ventilator-related pneumonia. These authors, for the secondary examination, used the statistics from previous researches, i.e., the study in 27 intensive care units (ICUs) in nine European republics. The study demonstrated that the ratio of 1:1 is linked to a reduced risk of ventilator-connected pneumonia. However, once the confounding covariates have been altered, it seemed that the change is insignificant.

In their study, Aiken, Cimiotti, Sloane, Smith, Flynn and Neff (2011) aim at demonstrating that low death rate in hospitals is connected to good hospital nurse workers, knowledgeable staff, and, respectively, a healthier working atmosphere. However, because there is a gap between the circumstances under which particular medical institutions operates and shows better results, the researchers try to find a clear and suitable answer. Thus, the study concentrates on the determination of how circumstances and conditions under which the hospital staff work, and such factors as nurse education and working environment influence the patient health outcomes. During their study, Aiken, Cimiotti, Sloane, Smith, Flynn and Neff examined the results of 665 hospitals located in four big countries. The group analyzed the findings with the aid of linked statistics, obtained from abstracts of 39,038 nurse personnel, 1,262,120 patients, and American Hospital Association materials. Consistent with the findings of the study, the reduction of the patient-to-nurse ratio considerably improved the outcomes of the patient in the infirmaries that have favorable working environment, while the results in the hospitals with ordinary working background slightly improved, and in those with unfavorable working background did not improve at all.

In their investigative work, Aiken, Sloane, Bruyneel, Heede, Griffiths, Busse and Sermeus (2014) confirm the link between the hospital mortality rate following surgeries and the deviations in patient-to-nurse proportions along with educational qualifications of health workers in 9 out of 12 nations that have similar patient dismissal statistics. Those who took part in the study were 422,730 patients of 50 and above years, who underwent surgeries in 300 hospitals of nine countries in Europe. Moreover, 26,516 nurses were surveyed so as to determine their educational level and assess their knowledge. The study found that the infirmaries in which the majority of nurses (about 60%) have bachelor’s degree and care for about six patients have lower mortality rate than the infirmaries in which the nurses care for more than eight patients, and in which the proportion of nurses holding a bachelor’s degree was below 30%.

You, Aiken, Sloane, Liu, He, Hu, and Sermeus (2013) demonstrate the relation between patient results and the nurse qualifications. 5786 patients and 9688 nurses from 181 hospitals in China took part the investigation to assess the link above-mentioned correlation and the nurse working topographies. The study findings proved that the improved quality of working environment and conditions, along with a larger number of nurses having bachelor’s degree, are the key factors that have a positive impact the health outcomes for patients China.

After a thorough analysis, Schwab, Meyer, Geffers, and Gastmeier (2012) concluded that a recruitment parameter that reflects the intellectual potential of the nurse may allow better evaluation of workload. As stated in Aiken, Sermeus, Heede, Sloane, Busse, Mckee and Kutney-Lee, (2012) in 12 states of Europe and America, cross-sectional surveys of 11,318 patients and 33,659 nurses in Europe and 27,509 nurses and 120,000 patients in America were conducted to analyze whether a good organization of healthcare activities affect patient health outcomes and personnel efficiency. The study findings showed that the low quality of hospital care was a mutual concern in all states. The authors determined that the security and quality of care in infirmaries and the gratification of t patients might be improved considerably by a comparatively inexpensive tactic of upgrading of the hospital working conditions and environment.

Researchers Sink, Hope, and Hagadorn (2010) analyzed 1019 monitoring phases in the group of 14 infants with the objective of inspecting the relationship between the attainment of oxygen immersion goals in premature infants and the sum of patients. The findings of their study demonstrated that, the smaller number of patients the nurse served, the healthier was the oxygen immersion purposes. However, the study showed that the impact may be dissimilar in the case of a varied mode of respiratory maintenance.

Other researchers, Schubert, Clarke, Aiken, and Geest (2012), using cross-sectional correlation strategy, examined the linkage between the patient`s death and verifiable allocating of nursing care, the nature of healthcare providers , work conditions and atmosphere ,and the patient-to-nurse recruitment proportion in Swiss medical facilities. The results of their study proved higher chances of survival for those patients who are treated in infirmaries with the uppermost rationing level.

On a different note, various studies have been conducted on the impact or effectiveness of various shift patterns. According to Stimpfel and Aiken (2013), nurses have a preference for the 12-hour shifts since it gives them more opportunity to rest ,which reduces the seriousness of conflicts relating to their responsibilities at home as wives or mothers. Numerous studies have examined the relationship that exists between the shift length and its influence on the patient care product. Geiger-Brown, Rogers, Trinkoff, Kane, Bausell and Scharf (2012) claim that lengthy working hours, which are connected with the 12-hour shift pattern, cause extreme fatigue in nurses along with stress, which eventually leads to undesirable patient results. Nurses who work in 12-hour shifts produce a lower quality of care and safety for the patient, compared to those who operated on the shift pattern with few hours. Moreover, shift patterns with extended hours have negative impacts on the nurses as majority of them experience work exhaustion and, in the long run, professional burnout. As stated by Bae, (2012), the nurses who operate in 12-hour shift face a higher probability of being involved in work-related accidents and greater risks of falls or needle injuries.

Theory

The theory of change suggested by Lippitt, Westley, and Watson (1958) will be employed for facilitation of the study. (Jung &Lippitt, 1966). The researchers elongated the Three-Step Change Theory founded by Kurt Lewin in 1951, which comprises such steps as moving, unfreezing, and refreezing. In their turn, Lippitt, Westley, and Watson, developed a theory that consists of seven stages and is focused more on the duty and the role of the change medium rather than the change development. During the process, data and information are continuously shifted and exchanged (Jung & Lippitt, 1966).

According to Jung and Lippitt (1966), the first stage of the theory is identification of the problem. The second stage is the evaluation of the incentive and extent of change. The third stage is the evaluation of the instruments and resources of the transformation medium (i.e. devotion to power, endurance, and change). The fourth stage is the selection of the principal change objects, where the team will create the action plan and the approach that will be used in the further investigation. The fifth stage is the selection of the change representatives’ role, where all parties need to clearly comprehend the role of the alteration agents since only then the anticipations will be comprehensible, clear, and attainable (for instance, the nurse may obtain the role of a purely health worker, a buddy, a counselor, a listener, a supporter, etc.). The sixth stage is maintenance of the change, which includes such vital elements as feedback, communication, team cooperation and harmonization of the change process. The last stage of the theory is progressive termination of the assisting relationship. As the time flows, the change agent must cautiously withdraw from their role. Normally, it occurs when the change becomes so integrated into the business culture that it is considered a part of it.

Proposed Solution

According to Potera (2011), the 12-hour shift in the nursing practice has become a custom with several nurses being very content with the timetable within their medical care facility. However, the 12-hour shift has numerous negative effects on the quality of care offered to the patient, as it leads to an excessive workload on the nurses, which consequently causes both the patient`s and the nurse`s dissatisfaction. The nurses get work stress and even start thinking of resigning from their job. The suggested solution to this issue is the implementation of a shift timetable with fewer working hours. It is essential that a shift interval of fewer hours is applied, and that the timetable format and on-off work arrangements are taken into consideration. The scheduling strategies ought to be friendly to the medics with defined shift start and end times.

Implementation of the shift pattern with fewer working hours, allowing the nurses to be contented with their job, is the proposed solution. The suggested approach considers whether staff can operate for 8 hours without producing any change or undesirable effects in terms of the efficiency and quality of the offered healthcare services Majority of the nursing tasks can be executed on short shifts, with certain tasks like inspection of patients being better suited for shorter shifts. In the suggested solution, the working environment factor is also of great significance as exposure to dangerous working conditions is not advisable during extended shifts (Potera, 2011).The eight-hour pattern will benefit the nurse`s career and will consequently improve patient gratification, leading to a better quality of healthcare.

To implement the proposed solution, it is essential to ensure that it is authorized by the hospital management and other stakeholders. It is vital that all the interested parties are involved so that they can support the implementation of the plan. This will be accomplished by spending time and building confidence with the involved parties to better understanding theirneeds. Moreover, there must be a consolidation of efforts of all the stakeholders and interacting in a manner that does not result in a conflict of interests. Additionally, it is necessary for the stakeholders to be actively involved in the formation of metrics along with outcomes to be measured. The hospital management has to give their consent for the implementation, and there is a clear need for an official communication explaining the whole plan and how it is will be implemented. The plan will be executed in t way that would not in any manner affect the functioning of the hospital.

There are certain reasons justifying the shortening of working hours for nurses. Although the lengthy 12-hour periods are commonplace and more desired by most caregivers, the shift duration has caused so much concern that it encouraged an initiative to introduce shorter shift patterns. One of the reasons why the 12-hour shift model adversely impacts the care of the patient is that nurses would opt to work lethargically and complete fewer tasks within the period to finish the 12-hour shift, which clearly needs to be changed. Moreover, the proposed solution of having fewer working hours within a shift would enhance the degree of care offered to the patients, and simultaneously, the nurses would be more satisfied with their career and will accomplish a lot more within the short period of time that is given in the suggested shift pattern. Thus, this model of reduced hours will be more effective since it will lower cases of nurse turnover or displeasure with the job and improve the healthcare quality.

Implementation and Evaluation Plan

The incorporation of the proposed solution will be a continuous process, which is anticipated to last approximately six months from the commencement. This is to make sure that there is an insignificant change or influence on operations of the hospital. Several healthcare stakeholders will accept the responsibility for implementing the change. The responsible person who will lead the change will be the infirmary director and the administrator, who will produce new schedules that will be applied. The implementation progress will be supervised by the hospital director or the leading physician in charge of activities within the healthcare hub. This is to warrant that the entire hospital is in agreement with the implementation of the suggested solution.

Some resources will be needed for the effective implementation of the proposed solution, including well-articulated pamphlets and handouts describing the new timetables and requirements to the nurses according to the novel shift patterns. Simultaneously, the implementation procedure will include meetings and will necessitate PowerPoint presentations for easy comprehension of the new timetables by the different stakeholders involved. Because it will also include a survey, evaluation tools will be needed in the form of questionnaires and assessment tests. Also, there will be expenses connected to training the staff, buying new resources, and data analysis.

Once the implementation of the plan is completed, the evaluation plan for the suggested change will be executed. The plan will involve formulating the questions that are intended to be answered in the evaluation (Saunders, 2013). Once the questions are formulated, the methods which best handle the question of extended hour shift design will be determined. The most appropriate method of evaluation of the anticipated change will be observing and getting feedback. This method will include several elements including the process measures, result measures, and the observational system.

The report on goal accomplishment will be available in the evaluation plan, which will monitor the exact date and effect of the proposed alteration on the quality of healthcare offered by the nurses. The report will be compiled and utilized as an evaluation to assess the development of the implementation plan (Saunders, 2013). Moreover, the behavioral surveys will be conducted, which will be essential in discovering the risk factors that are related to different shift patterns in nursing. Additionally, the evaluation plan will involve interviews with several stakeholders and important participants within the hospital, for instance the nurses and the patients. Conducting the interviews will be useful in assessing the effect of the initiative as well as identifying the factors which can have an influence on the accomplishment of the initiative. There will be hospital evaluation indicators which are verified markers, operational in facilitating the assessment of the outcome of the initiative.

Dissemination Plan

The distribution of evidence or facts in nursing necessitates that an investigator or a nurse adopt the best tactic towards information sharing. The existing options consist of journal clubs and publishing, oral presentations, professional committee conferences, along with posters, and hospital based periodicals. With regards to this study, four of these strategies will be used to present the evidence-based results to a team of specialists. Moreover, the reason why these methods are used in disseminating evidence-based information is the confirmed effectiveness of these strategies.

To begin with, the evidence dissemination through oral presentation involves preparing the material so as to deliver it verbally (Waddell, 2002). The first phase will entail gathering knowledge regarding the target spectators and their result anticipations. The important issues to consider in this context include the educational heights and the current knowledge on the currently presented topic presented. Moreover, it is vital to take into account such logistical matters as the number of participants and the length of the presentation.

In addition, it important to ensure the audiovisual equipment availability as it is one of the key success factors. The verbal presentation will be made at a meeting, which will entail health care specialists with a high or reasonable level of comprehension of the matter. Within such a background, it is anticipated that the audiovisual apparatus will be available so as to enable the communication with the experts who will be present the conference. The professional site of the meeting will be the Global Nursing Conference 2016, which is programmed to happen in Sao Paulo, Brazil (Nursing Conferences, 2016). The specialized venue is suitable for the purpose of the verbal presentation because it will be made to persons who comprehend the subjects revolving around evidence-based performance. Also, the Global Nursing Conference 2016 will be the suitable for giving the presentation as it attracts nurses from all around the world, consequently resulting in nursing leadership and intervention across the globe.
Another feasible platform for disseminating the information is poster presentation, which may facilitate spreading information among coworkers within a professional association. The poster presentation will be inventive, and the pattern will aim at capturing the attention of the audience. In this context, the poster presentations will act as an instrument which follows a strict layout, therefore, it will include the problem statement of the study, clinical research questions and methods of collecting evidence. Moreover, this platform will i present information as a medical practice implication. The convenience of this form for associates is that it could be sent to them through email without having to make the actual presentations (Waddell, 2002). Most significantly, coworkers can give their response as part of the mail thus assisting in the upgrading or clarification of particular issues in the evidence-based report. Consequently, the poster presentation will utilize less time in comparison with the time consumed for preparing and making an oral presentation.

Lastly, the information on the evidence-based practices can be presented in a journal for the purpose of peer review (Bennett, 2016). The BMJ publication group will offer a suitable publishing agency to prepare the journal materials for print. The aim of publishing the data on processes or outcomes in a peer-reviewed journal is to enable the journal club participants to express their opinion on the article, and make critical remarks or even censure information in the journal. Additionally, the journal club members will help review the methods applied to the statistics and data gathered for the study. After all the elements of the article or study are painstakingly analyzed, it can be utilized as a source of evidence for other investigators.

Conclusion

In summary, as evidenced by the paper, there is indeed a real problem concerning the reduced nurse-patient ratio and long working hours, which leaves the nurses exhausted and thus offers poor health services to patients. It is recommended that health professionals should communicate with patients in a friendly manner, and learn to follow the code of medical ethics and standards both during their direct activities and also in the process of interacting with colleagues, patients, their relatives, and friends. As proven by the current study, the formation of positive relations between the patient and the nurse will directly impact the patient`s overall opinion regarding the healthcare system.