Nurse - Patient Ratios and outcomes

  1. I am presently doing research for a paper I am writing as a student at the University of Buffalo. Any ancedotal information that anyone is willing to share concerning the affect of nursing shortages and patient outcomes would be greatly appreciated. I am specifically interested in nosocomial infections, dermal ulcers, injuries, medication errors as well as any changes in the injury rate to the staff as well. Thanks
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  2. 17 Comments

  3. by   Dana
    Well, there have been lots of med errors. When we're short staffed the increased workload and crunch for time has people rushing. Whenever people rush, a less careful job is done. Patients have developed heel sores faster and sometimes I've seen scalp sores too. Even if rotation beds are used, many times nurses don't give as much attention to ulcer prevention and they still occur. This happens even when the staff is not overloaded. I would also have to say that the number of nurse back injuries has gone up due to the lack of an adequate number of staff in the area to properly move and turn patients. After waiting for a few minutes, you just have to get the job done, because patients sometimes can't wait.
  4. by   JETomasini
    I agree that when we are short staffed it is often quite obvious that a "less careful job is done". I believe that we as nurses need to advocate for better care for our patients by documenting well and letting management know that staffing is causing these problems. The federal government is aware that nursing roles are changing and having a large impact on health care. There is a report on the net that was prepared by the Urban Institute for the Department of Labor on health care changes and the quality of patient care. It might be of interest to you. You can access it at http://www.urban.org
    At least you are aware of the negative outcomes what frightens me for the clients are the nurses who are not even concerned about this issue. Thanks for your input.
  5. by   LRichardson
    In the last several months our staffing has changed in two ways. First, the charge nurses are now taking a full patient load. Secondly, we are consistently taking three patients. (I work in a general ICU.)

    I have been tracking ICU acquired pressure sores for 6 months and since the implementation of the new staffing policy our incidence has increased 200%. I would think that would be enough to make the point to management but it's not.

    We have had MAJOR errors from younger (in experience not age) ICU nurses who NEED more attention from the charge nurses in administering care. One young nurse was in a hurry and wasn't able to check back on her patient with a sheath in his groin every 15 minutes as ordered. As a result, while he was fidgiting in bed the 3 way stop cock (which the nurse had not put caps on because she didn't have time) was accidently turned on. The patient had to be given 5 units of PRBC. The nurse quit the next day devastated.

    Another new nurse was to titrate Levophed on one of her patients struggling to survive. She titrated LEVOQUIN all day long until another nurse heard her pump beeping and went to change the bag for her. A basic nursing skill to do your 5 point check of medication. However, if one is being pushed to the limits, it's one of the first things to be put aside.

    Another nurse had an order for 2 units of PRBC to be given at 9am. The order was missed, the patient received the blood at 6pm that evening. No apparent complications... this time.

    Another sheath in a groin, patient not checked often enough. Complication of aneurysm from hematoma developed. Required surgical intervention. Patient ended up on a vent for two weeks. Nurse was discharging one and admitting another patient. Nurse transferred out of ICU.

    I could go on. The question is, is it poor nursing? Yes. But it's the CAUSE of it that concerns me. ICU nurses with less than a year of experience ESPECIALLY in a general ICU NEED to have an experienced nurse checking on them throughout the day. Educating them on why the doctors are ordering such and such, complications to watch for, etc. However, with each nurse having up to 3 patients at once and perhaps as many as 6 patients in a day to admit or discharge somethings got to give and it appears to be the quality.

    Egad I'm depressed from writing this.. <sigh>
  6. by   NurseNita
    Since early this year, my hospital has been experiencing financial difficulties. Because of this, nursing staff and benefits were drastically cut. These cuts have caused many problems . Patient satisfaction is at an all time low;morale is at an all time low;med errors are higher than ever documented ; and absenteeism has increased
  7. by   elizabeth
    What the heck is going on!!? Why is the obvious ignored by the powers to be? My hospital consistantly runs us short of help, especially on the weekends. Every shift fills out a variance grid for the up coming shift to determine whether there are too many of too few staffers .. well when the staff not only felt the shortage but could see it in black and white - complaints/comments to administration ensued. The result? We were told that we were NOT short and the grid was taken away so we could no longer see how many we were supposed to have! Further more we were chastised for not taking our dinner breaks and requesting that we be paid for the time we did not take for the break - Hey we would dearly love to take a break! But no time and we still don't get paid for the dinner we worked through. Not to mention the increase in errrors and testy attitudes which spreads like wild fire. I believe staffing ratio is one of the most important issues for nursing - it will make us or break us (and our patients) Whew!
  8. by   elizabeth
    What the heck is going on!!? Why is the obvious ignored by the powers to be? My hospital consistantly runs us short of help, especially on the weekends. Every shift fills out a variance grid for the up coming shift to determine whether there are too many or too few staffers .. well when we not only felt the shortage but could see it in black and white - complaints/comments to administration ensued. The result? We were told that we were NOT short and the grid was taken away so we could no longer see how many we were supposed to have! Further more we were chastised for not taking our dinner breaks and requesting that we be paid for the time we did not take for the break - Hey we would dearly love to take a break! But simply no time! and we still don't get paid for the dinner we worked through. Not to mention the increase in errrors and testy attitudes which spreads like wild fire. I believe staffing ratio is one of the most important issues for nursing - it will make us or break us (and our patients) Whew!
  9. by   elizabeth
    What the heck is going on!!? Why is the obvious ignored by the powers to be? My hospital consistantly runs us short of help, especially on the weekends. Every shift fills out a variance grid for the up coming shift to determine whether there are too many or too few staffers .. well when we not only felt the shortage but could see it in black and white - complaints/comments to administration ensued. The result? We were told that we were NOT short and the grid was taken away so we could no longer see how many we were supposed to have! Further more we were chastised for not taking our dinner breaks and requesting that we be paid for the time we did not take for the break - Hey we would dearly love to take a break! But simply no time! and we still don't get paid for the dinner we worked through. Not to mention the increase in errrors and testy attitudes which spreads like wild fire. I believe staffing ratio is one of the most important issues for nursing - it will make us or break us (and our patients) Whew!
  10. by   elizabeth
    Sorry for the three repeating messages - I'm new to this! The third one is the one I wanted....Elizabeth
  11. by   Pearl
    Staffing is a HUGE problem on my unit. I am an OB nurse, and just tonight, I had two women in labor at one time and a mother/baby couplet. Policy states that once a client becomes complete and pushing, the nurse is to remain with her. Toss that out the window. I was pushing for two and a half hours prior to delivery. The delivery and repair took another hour. Total time lost from my other three clients.....three and a half hours!!!
    I was blessed tonight in that my other lobor client was only dilated to 2 and was easy to catch up on. My co-workers were able to check in on everyone for me, but ultimitly it was my license on the line. Everything turned out alright but I just got home and my shift ends at 2308.(it is now 0130)
    Turnover is high. Med errors have greatly increased and client are being neglected.
    Just yesterday i got report from a nurse whose client had delivered 4 hours earlier. The jest was everything was great. I enter the room to find mom asleep and baby in cold stress. Temp 96.4 rectal, HR 91, Resp 22, glucose 29. That baby was still in NICU this afternoon. The nurse prior to me that day went from one delivery to the next for a total of three deliveries in an 8 hour shift. No one was available to take over her delivered couplets. Who is really to blame for the neglect????mmmmmmm
    I really love my job, but some days I am really frightened. Most night I come home and can't sleep. That's why I am here tonight. It feels better to vent though.
  12. by   miami
    I am in a 300-bed facility and our staffing, which is based on pt. acuity is pretty much on target. The major problem here is staff calling-in!! If everyone CAME to work that was scheduled to BE HERE, staffing wouln't be such an issue, and patient care would improve. I am a nursing supervisor (mostly on 3-11 and 11-7) and find a dedicated work ethic to be sadly lacking in many employees. Another problem is when the same people call-in again and again, and though I inform the Unit Manager of this problem, nothing seems to get done for months and months. We do have a PRN pool to help with call-in coverage, but many times the call-ins exceed the coverage that we can give........and this facility has been operating at full capacity all winter long. If anyone out there has any ideas of how to cut down on staff calling-in, or how to get the remaining staff to exert a little "peer pressure", I would love to hear from you. My e-mail is sandy.mcfarland@nghs.com................
  13. by   Miss RNC
    I work on a 32 bed med/surg floor that is primarily oncology pts, general medical, urology, and a few thoracic surgical pts. The following is our grid, with is not written in stone of course. We also use the acuity system.
    7-3 shift 6-9 pts 2 nurses
    10-14 pts 2 nurses 1 aide 1 secretary
    15-18 pts 3 nurses 1 1/2 aide 1 us
    19-20 pts 4 nurses 2 aides 1 us
    21 pts 4 nurses 2 1/2 aides 1 us
    22-24 pts 4 nurses 3 aides 1us
    25-26 pts 4 1/2 nurses 3 aides 1 us
    27-29 pts 5 nurses 3 aides 1 us
    30-32 pts 5-6 nurses 4 aides 1 us

    3-11 shift 6-9 pts 2 nurses
    10-11 2 nurses 1 aide
    12-14 2 nurses 1 aide 1 us
    15-18 3 nurses 1 aide 1 us
    19 4 nurses 1 aide 1 us
    20 4 nurses 1 1/2 aides 1 us
    21-24 4 nurses 2 aides 1 us
    25-26 4 1/2 nurses 2 aides 1 us
    27-32 5/2/1

    11-7 6-11 2 nurses
    12-18 2/1 aide
    19 2 1/2 nurses/ 1 aide
    20-24 3/1
    25-29 3 1/2 nurses 2 aides
    30-32 4/2

    We do primary nursing. The CN on 7-3 and 3-11 does not take pts unless census is low. We have transporters that come from other depts to take pts for tests and surgery, etc.. Lab draws all bloodwork except from VAD's. We give chemotherapy regularly. The aides do baths and linen changes, VS, and help answer call lights. Basically on the average we have 8-9 pts each with never less than 6. All it takes is one really sick pt to totally mess the system up. Or just take about one TURP fresh post op, a chemotherapy pt and one little confused person and your day is a day from he............
    Hope this gives everyone an idea. Thanks


  14. by   bluesboyj
    I have worked in a critical care setting recently where there were nurses with less than 6 months experience taking care of vent pt's, pt's wirh art lines, etc. And they are float nurses who are lucky to get one night of orientation and no time for education. Why? The answer is managed care. It's all about the bottom line. These people we care aren't patients, they're market shares.$$$$ in bed to be gotten out quickly so thet can get more$$$$, Elizabeth, check with the NLRB, there are federal laws regarding not being able to take a lunch break and not getting paid for it. The hospital may be out some $$$ in overtime pay.

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    Blues Forever

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