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Who has jurisdiction over your quality issue – who has control to make change?

Who are the stakeholders, investors or decision-makers in this issue and how do they influence this issues

What are the resources needed to promote change in this quality issue toward improvement?


Staffing Ratio in Nursing

Amisadai Mederos

Denver College of Nursing

NUR415: Policy, Finance, and Quality in Nursing and Healthcare

Dr. Anita Harris

July 18, 2021

Staffing Ratio in Nursing

The staffing ratio can be considered to be both nursing shortage and budgetary restrictions. The nursing shortage is associated with high patient-to-nurse ratios and this leads to the experience of burnout, dissatisfaction, and higher mortality and failure in the rescuing process as compared to the facilities with lower patient-to-nurse ratios. Healthcare organizations with low income as a result of the low reimbursement from the insurance firms and cash received from the patients are unlikely to employ many nurses to meet the healthcare demands of the growing number of patients. Inadequate capital implies that the facility will only employ nurses that they can afford to pay (Halter et al., 2017). The increase in the number of patients in the facility sometimes does not translate to high profit thus making it hard for the facilities to meet the demands for a high number of nurses to help in caring for the growing number of patients.

            The patients in the understaffed hospitals are facing an increase in the rate of in-hospital mortality, rise in the risk of infection, rise in post-operative complications, and higher reported cases of falls. Understaffed hospitals experiences lead to medical errors, absence of engagement, and missed nursing care processes. The inadequate nursing staff also leads to dissatisfaction by the nurses and this leads to poor adherence to the standards of practice thus exposing patients to more falls, medication errors, and some preventable deaths (Dewanto & Wardhani, 2018).

            The understaffing in the facilities leads to an increase in the workload, burnout, and dissatisfaction by the nurses. The majority of these nurses also suffer from mental problems as a result of the experience while handling a large number of patients without a break. Therefore, a majority of them chose to search for a good working environment where the physical and mental well-being of the healthcare providers is being considered. This leads to an increase in nurse turnover hence affecting the retention process by the management (Dewanto & Wardhani, 2018).

            The increase in medication error as a result of the poor staffing implies that many patients spend most of their time in the hospital while being treated for other infections that they acquired while in the facility. The increase in the number of stays in the hospital leads to an increase in medication costs. This leads to dissatisfaction for both patients and nurses since the goal of promoting quality healthcare delivery is not achieved (Halter et al., 2017).

The importance of introducing the issue of staff ratios in the research

            The quality issue is poor nursing staffing that affects the patient care quality. The nursing staffing ratios and patient maximums are of focus concerning healthcare quality. The advocates for enforced ratios argue that patient safety and healthcare quality suffer when nurses are caring for too many patients. The existence of many patient or issues of nurse staffing ratios has an impact on healthcare access (Halter et al., 2017). The mandatory nurse staffing ratios have adverse financial impacts for healthcare facilities while at the same time limiting patient care access.

            As a result of the financial challenges for example the costly and poor allocation of resources, most of the healthcare facilities are forced to high less experience and educated registered nurses and offset any quality and safety improvements. This leads to greater inequity in the provision of healthcare services, less access to local healthcare, and reduction in patient choice (Dewanto & Wardhani, 2018).

            The cross-sectional studies have shown a possible relationship between the increase in nurse staffing and better patient healthcare outcomes. Nevertheless, in any case, a financially constrained healthcare facility makes the tradeoffs by restricting the access to the healthcare services or through a diversion of the funds from other beneficial uses on the balance, the mandated nurse staffing ratios might not benefit the clients (Dewanto & Wardhani, 2018). Mandating healthcare facility to meet the minimum nurse staffing ratios with no sufficient resources leads to unintended and severe adverse impacts in the facilities.

            The Agency for Healthcare Research and Quality (AHRQ) has recognized the association between nurse staffing ratios and patient safety. According to the AHRQ, the presence of the nurses at the bedside is important in ensuring that there is an increase in the ability to promote the safety of the patients. Therefore, it can be logically argued that the assignment of the increase in the numbers of patients compromises the ability of the nurses to ensure that there is safe healthcare (Dewanto & Wardhani, 2018). 

            One of the major attempts that have been made and are still tried up to date to help in addressing the issue of staffing ratio is targeting the reduction of the nurse turnover. Many healthcare facilities are making attempts to ensure that there is an improvement in nurse retention. Job satisfaction is an important aspect in making sure that the numbers of nurses in healthcare facilities are maintained or improved. The absence of satisfaction in the workplaces leads to a high turnover rates and this is negatively affecting the patients and nurses in general (Dewanto & Wardhani, 2018). Nurses suffer from the increase in workload and burnout while patients suffer from the absence of poor or absence of quality healthcare services.

            The lack of satisfaction among workers in the facilities is associated with an increase in anxiety, fatigue, and physical and mental distress. Some healthcare facilities are also lacking inspirational approaches to ensure that the workers feel that they are cared for. According to Herzberg’s theory of motivation, there is a need to have both extrinsic and intrinsic factors to ensure that the hygiene and the satisfaction of workers are achieved. Various interventions have been adopted to help in the promotion of nurse retention approaches. These interventions are aimed at promoting the satisfaction of the nurses within the working facilities for example increase in salary and other financial benefits (Alrawahi et al., 2020). However, many healthcare facilities are taking the route of ensuring that there is availability of healthcare providers to address or off healthcare services to the growing population of patients in the facilities.


Alrawahi, S., Sellgren, S. F., Altouby, S., Alwahaibi, N., & Brommels, M. (2020). The application of Herzberg’s two-factor theory of motivation to job satisfaction in clinical laboratories in Omani hospitals. Heliyon, 6(9), e04829.

 Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC nursing17(2), 1-7

Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., … & Drennan, V. (2017). Interventions to reduce adult nursing turnover: a systematic review of systematic reviews. The open nursing journal, 11, 108.