Under-staffing in Nursing Homes

Paper Summary:

In this article the writer discusses that minimum nurse-to-patient ratios represent the minimal amount of nurses required to care for the maximum number of patients, without compromising patient or nurse safety. The writer points out that both the public and physicians rank nurse under-staffing as one of the most serious threats to patient safety. The writer notes that nurse safety advocates are beginning to question how inadequate ratios impact job satisfaction and the ability of nursing staff to improve quality of care. While a problem at all healthcare facilities, the issue is even larger at nursing homes where minimum staffing ratios are very low. The writer concludes that much research is in progress to help nurses maintain a safe environment to practice and to determine how to adequately define what nurse-to-patient ratios should be.

From the Paper:

"A history of nurse staffing and patient outcomes dates as far back as a study by Moses and Mosteller. They found nurse staffing among the significant determinants of mortality. Later, publicly available Medicare data for U.S. hospitals generated more studies on the factors related to mortality. Authors of these studies reported that nurse staffing was significantly related to mortality. Aiken, Clarke, Sloane, Sochalski, and Silber produced the first study to specifically quantify the impact of nurse-to-patient ratios on death rates. They reported that reducing the number of patients that a registered nurse takes care of results in better patient outcomes. A reduction in mortality rates and infections were among the findings. Aiken, Sochalski, and Lake demonstrated that nursing presence, whether measured as RN ratios or as RN hours relative to other nursing personnel hours, is significantly correlated to mortality. Adequate staffing levels allow nurses time to make comprehensive patient assessments, attend to routine nursing duties and effectively respond to emergencies. Specifically, Aiken, Clarke, Sloane, Sochalski, and Silber found that each additional patient assigned to a nurse resulted in a 7% increase in the likelihood of the patient dying within 30 days of admission to the hospital."

Sample of Sources Used:

• Aiken, L. H. (2005). Improving quality through nursing. In D. Mechanic, L. B. Rogut, & D. C. Colby (Eds.), Policy Challenges in Modern Healthcare (pp. 177-188). New Jersey: Rutgers University Press.
• Aiken, L., Clarke, S., Sloane, D., Sochalski, J., & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288 (16), 1987-1993.
• Aiken, L. H., Sochalski, J., & Lake, E. T. (1997). Studying outcomes of organizational change in health services. Medical Care, 35(11), NS6-NS18, Supplement.
• Blendon, R. J., C. M. DesRoches, M. Brodie, et al. 2002. Views of practicing physicians and the public on medical errors. New England Journal of Medicine 347: 1933-1940.
• Fleck, C. (2002, April). Nursing home care is found wanting. AARP Bulletin.

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