Benefits of Low Nurse-to-Patient Ratios
(Editor's note: This guest blog was written by Suzanne LeBeau, BSN, RN, CLNC.)
We all know the scenario. You're getting report on your sixth patient and the nurse who is giving report is spent, burnt out and just wants to go home to her cozy bed. As you may imagine, the conversation may go like this:
First nurse: "In room 320 is Mr. Jones, a 62-year-old patient of Dr. Smith who had a right total knee replacement yesterday. He has no allergies and his history consists of hypertension, hyperlipidemia and sleep apnea for which he wears his CPAP. Oh, and he also has AV malformations."
Second nurse: "Arterial venous malformations?" "Where?"
First nurse: "I don't know. I just got that in report from the previous nurse and I really haven't had a chance to read the chart (as she fumbles through the pages of the chart). Anyway, his vital signs have been WNL, he's afebrile, but he's been nauseous and complaining of stomach cramping for which I've given him Zofran as ordered, and Reglan as a one-time dose at 1430. His dressing is dry and intact, and he has good peripheral pulses. His hemoglobin dropped today to 7.5 from 9.2 yesterday, so he is on his second unit of packed cells now."
This scenario, if continued, might have devastating consequences on the patient. However, if the nurse had simply read the patient's chart, she would have known the patient's AVMs were in his GI tract and could have alerted the MD to suspected GI bleeding sooner. The sad reality, however, is that very few nurses have time to read through all their patients' medical records. Their knowledge of the patient's history, and course of treatment, is passed along from nurse to nurse. Kind of like that game we used to play as kids called, "Telephone." We all know how information can be misinterpreted and changed the further from the source it gets. But in the world of healthcare, this is no game. We are dealing with people's lives.
In 2005, California made history as the first state to implement mandated nurse-to-patient ratios. In med/surg units, this ratio is 5:1. This means that any one nurse cannot have a caseload of more than five patients during her shift on a med/surg unit. The theory behind this legislation is to improve patient outcomes, decrease nursing job dissatisfaction and enhance staff retention in hospitals. There are conflicting studies regarding whether these objectives have been fulfilled, but one truth remains indisputable: Nurses, who are responsible for patients' lives, are too stressed and overworked to fully research their patients' histories and current situations to have a safe and comprehensive understanding of their patients' conditions. If this could be adopted as common practice by all patient care nurses, there would be less errors, better patient outcomes and a higher degree of job satisfaction among the nurses participating.
My daughter just started college this fall and is majoring in nursing. Typically in nursing school, preparing for your clinical experience is a very in depth and meticulous process. A student has 1-2 patients, and spends the evening before her clinical experience carefully reading the medical record, researching meds, diseases and surgical procedures, and devising intricate care plans for each of their patients. It really is a sad commentary that possibly, these students are better prepared to care for these patients than the RN assigned to them who may already have years of experience under her belt.
I want my daughter to have a wonderful and rewarding career. The nursing profession is truly an inspiring path. But it scares me to think of her cast into this world of high stress and less than adequate time to prepare for this position taht every nurse holds over her patients: a literal lifeline. Does the mandated nurse-to-patient ratios really improve the lives and satisfaction of both patient and nurse? That remains to be measured, but I, for one, believe without a doubt that it is a step in the right direction. Acuity is always the best judge of nurse-to-patient ratio, however; logistically speaking, it is always more favorable to have a lower ratio to maintain a high level of knowledge and understanding of the comprehensive care of the patient.
I would certainly like to see this legislation implemented in more states, and I would hope that once my daughter enters the workforce as a full-fledged RN she will do so with a greater sense of self-assuredness and less trepidation regarding realistic workloads. The nursing profession is probably one of the most disrespected, abused and underpaid professions I can think of. I just hope that, in my lifetime, I will be able to experience the joy of seeing this profession rise to the level of respect that it truly deserves.