7706MED: Nursing - Health Project - Report Writing Assessment Answers

Maintaining the mandatory nurse patient ration is very important in order to maintain patient safety and to achieve positive health outcomes. There are various issues in the healthcare system that leads to the problem of increased patient falls and injuries due to inappropriate nurse patient ratio. In the private or public aged care settings of Australia, nurses are found to be overworked, which leaves the old patients towards vulnerability. Nurses are highly overworked due to various reasons, such as lack of staffing, nurse staff shortage, and inadequate skill mix and reduced patient stay. Due to the shorter length of the stay in hospitals, patients are often admitted to healthcare settings at a very severe stage. Such patient requires more attention and support of the nursing staff. In the aged care setting the number of such patients is very high, as the Australian population is rapidly ageing. The aged patients admitted in healthcare setting are in the acute phase of the disease and thus, they require close attention and surveillance of nursing professionals, which increases the workload of nurses. The workload not only challenges the patient safety, but it also the intensity of the nursing care increases work pressure in nurses.

In Australia nurse-patient ration is the topic of great debate and various research studies provide evidences of reduced patient safety due to workload and inappropriate nurse patient ratio. The patient outcomes are evaluated on various factors. Some of the factors are medical and some other factors are related to the care provided by healthcare professionals. In the aged care settings, patients have the incidents of falls and injuries. Patient falls can result in severe injuries, fractures and can also affect the physical mobility and functioning of the patient. Nurse staffing is the term that can be used to specify the number of nurses available to provide nursing care to the patients. The safety and quality of the care is dependent on Nurse staffing.

The number of nurses in the aged healthcare setting must be appropriate to provide quality care. This also increases job satisfaction in professionals and care satisfaction in patients. The number of older patient mortality is very high in Australia, which is highly dependent on nurse staffing shortage and undetermined nurse patient ratio. Mortality in the patients also increases due to falls and overworked nurses. Thus, it is correct that nurse staffing impacts the patient outcomes and requires applying mandatory nurse patient ratio.

Results

This paper used the wide array of the evidence based studies. Different studies are based on the problem of nurse patient ratio and the problem arising due to inappropriate ratio. The results of the study display that inappropriate or unbalanced nurse patient ratio can severely impact the patient outcomes and increase the risk of patient falls. The studies state that nurse staffing, nursing workload and nursing skill mix can impact the safety and health of patient. According to the study of Shekelle (2013), nurse staffing ration can highly reduce the hospital related mortalities. The initial staffing nurse patient ration was considered to be 6:1, which has reduced to 5:1 and 4:1. This ratio is mainly associated with mortality of patients. The study further explains that increasing the nurse staffing can be used as the patient safety strategy.

McGahan, Kucharski and Coyer, (2012), the level of nurse staffing is highly associated with adverse patient outcomes. The study also provided the literature review from the period of ten years and explains that quality and safety of care is dependent on shortage of staffing. After reviewing the various empirical studies it was found that workload of the nurses has increased in the public and private aged care settings. These settings require more support and supervision of the nursing professionals. The work load of the nurses increases, when the patients are admitted in the acute stage of disease and with lack of care support. Nurses have to increase the intensity of care, which not only increases their burden, but also increases job dissatisfaction.

Workload of the nurses also increases their working hours and nurses are forced to work overtime. Due to the shortage of nursing staff, the available nurses have to attend more patients in one shift. If some the nurse is absent on duty then his or her workload is also divided on the remaining nurses, which increases their burden. Due to the workload, nurses have less time to attend patients and to support them. Some of the patients in acute care setting may require support in getting up from bed or for using toilet, in absence of support patients try to get up from their beds and experience falls. Nurse patient ratio may increase to 27 patients per one nurse in one shift.

For the purpose of effective patient safety, it was found that higher survival of the patients is related to higher number of the nurse staffing. The number of the nurses is associated with the survival rate of the patient. The effect of nurse staffing was changed on patient acuity. Patient acuity and satisfaction is important and only be achieved with mandatory nurse patient ratio, which is 4:1. The RN staffing issues and nursing skill mix can significantly impact the patient safety outcomes. The mortality and injury rate can be reduced with improving the nursing shortage in the private and public aged care settings.

Work place environment also have significant impact on the mental and physical capabilities of the nurses. Unsupportive and lack of communication among the nursing professionals and other healthcare professionals can impact the patient care and quality of care. The attitudes and intensity of nursing care are shaped by the organizational policies and procedures. Some of the organization believes that reducing nurse staffing and limiting the number of existing nursing staff can save their cost on healthcare. However, nursing staff shortage has adverse impact on the organization, with reducing the patient safety; it also increases the healthcare cost and other expenses for the organizations.

The objectives from the various studies were included in the paper that has tested the samples of the nurses and patients from various healthcare settings. The results of the various studies are used in this study to evaluate the importance of the nurse patient ratio. The preliminary analysis of the various factors involved in impacting the patient safety in the aged care setting were evaluated on the basis of various studies and their results. These studies provided the various evidences for the factors responsible for risking the health and safety of patients in public and private aged care settings. The factors determined are nursing workload, skill mix and staffing shortage. All the factors are interdependent and influence the patient outcomes and mortality rate.

The cross-sectional and longitudinal studies covered in the paper provide various results, but all of them explain that nursing professionals and patient outcomes have a strong relationship. Nursing professionals in Australia are required to provide quality care and fulfill the duty of care. But due to various organizational and environmental factors, the quality of care is being hampered. The workplace and individual nurse empowerment is important to achieve the patient safety goals.

Workout Level

The psychological behavior and response of the nurses is also significant in providing quality care to patients. But, due to lack of staffing and workload, the psychological well-being and quality behavior of nurses is challenged that impacts patient outcomes and increases the risk of falls. Thus, organization empowerment and support to the nursing professionals is very important, so that patient safety can be increased. Mandatory nurse patient ratio can be beneficial in improving the psychological behavior and skills of nurses. The nurse staffing skill mix and workload not only increases safety risk, but also increases the incidents of infections and medical errors. Appropriate nurse patient ration is important to reduce the prevalence of infections and medical errors, as these incidents increase the risk and reduce the quality of life. Nursing staffing, skill mix and nursing workload is a very complex issue and immediate resolution is not possible. But the literature included in the study concludes that supporting adequate staffing and providing supportive environment to nurses with applying appropriate nurse staff ratio can promote patient safety.

Discussion

Patient nurse ration is the biggest issue in the current healthcare system of Australia. The mandatory nurse patient ratio has gained so much of debate in the evidence based research studies. The recently legislated nurse patient ration proposed is 1:4. This is considered as the most appropriate ration that can improve the patient outcomes and reduce patient falls. The problem is implementing this legislation to the aged care setting. Federal government is looking forward to apply this mandatory nurse patient ration to improve the patient outcomes and to improve the quality of life of the old age patients in aged care settings.

The paper discussed various factors responsible for the posing the challenges to the patient safety in the healthcare settings. The paper provides the vast literature review with various evidence based studies and empirical studies. These studies are based on various researches in different hospitals and private and public healthcare setting for aged people. Population of Australia is rapidly ageing, which has increased the use of healthcare setting and increased requirement of nursing professionals. Due to the heavy workload and unsatisfactory working environment, people are not choosing nursing as a profession; this situation has resulted in the shortage of the nursing staff. In many aged care setting, unprofessional and uncertified staff is working. The healthcare organizations are hiring such staff and creating imbalance of skill mix to save their cost. Bu, in turn this situation is bringing adverse impacts on organizational cost and health of patient. The core concept behind nursing profession is to provide quality care and improve the health outcomes of the patients. Improving the quality of life is the major goal of nursing, but achieving this goal has become difficult due to various important factors. Maintaining the nurse patient ratio is often ignored by the organizations and they avoid the consequences of it. This paper reviewed the literature from various reliable resources and nursing journals.

Even with the wide array of the literature present on nurse staffing and workload, not all pieces of literature are able to provide the accurate results for establishing the appropriate nurse patient ratio, but they provide evidence about the barriers in achieving this ration. Quality of the care is also dependent on the perception of the nurses towards their work and working environment. Working environment in the healthcare settings is determined by the professional support, professional communication and relationship between professionals. If this relationship among the professionals is positive then it can bring positive results in nursing practice. The environment also included the collaborative working. Collaborative and supportive working is important.

Collaborative working and structural empowerment can be very beneficial for the nurses to have positive attitude towards their workload. Workload is resulted due to shortage of the nursing staff and remaining staff have to take more responsibilities and number of patient per nurse in every shift increases. With the increase in the number of patients, every nurse has to reduce the care time per patient, which means that nurse could give less time for caring and supporting to patients. These patients become vulnerable to get appropriate assistance at the time of need. Aged care settings are increasing Australia due to the number of aged patients is increasing. the population is rapidly ageing, which enhances the requirement of aged care setting. Unprofessional and skilled nursing staff is getting recruited in these settings, as they their pay is low and organizations believe in saving money by cutting on number of professional nurses. The skill mix has also increased the patient’s vulnerability towards falls, injuries and mortality, as the proportion of RN and EN has become imbalanced due to nursing staff shortage.

The skills of registered and enrolled nurses are being replaced by untrained and unlicensed nurses. These unlicensed staff members are available in bulk and are getting placement in aged care settings. According to the reports of the Australian Nursing Federation, the unskilled staff makes approximately 64% of the staff in aged care settings. Decreasing the cost of staffing has become the goal of healthcare settings. But the cost has been increased for the care recipients and tax payers. Due to imbalanced nurse patient ratio, the old patient often experience hospital falls that result in severe injuries. For curing these injuries, patient’s stay in the hospitals increases, which further elevate the unnecessary financial burden on patients and their families.

The effectiveness of the work provided by nurses is manifested by the quality of care, which they offer to patients. The patient outcomes related to intensity and sensitivity of the nursing care, which includes two types of outcomes. First is quality related outcomes that underline patient’s satisfaction, and patient’s ability to perform self-management and self-care aspects. Second is the risk related outcomes that includes patient safety, Risk of falls, medication errors and infections. While inadequate staffing and excessive workloads have been concerned and implied with the incidence of these risk outcomes. According to the available nursing literature less is known about the other workplace sectors such as available resources, supportive information, knowledge, developmental opportunities and effects of these aspects on the nursing care quality and patient outcomes (Quinn, (2013); Shekelle, P. G. (2013); Thungjaroenkul, Cummings, & Embleton, (2007). Some of the studies used to prepare this research explain that future research is required to focus on the process by which workplace environment and collaborative working affect the patient outcomes. The future research must include the perspectives of the nurses. This study is limited to the evidences available through the literature and does not include the perception of nurses and it has not even tested the objective measures to ensure quality of care for patients, such as the incidents related to falls and fall related injuries and their impact on perception of the patient towards quality of nursing care (Gordon, Buchanan, & Bretherton, 2008; Osborne, 2014; Tevington, 2011). The results of the study explains that nursing workload, skill mix and nurse patient effect on patient outcomes due to nurse staffing issues have severe impact on patient’s safety. The strength of the study lies in the fact that proved the overview of the studies related to nurse patient ration and their impact. The question raised has been accurately answered through the presented literature review and the results.

Conclusion

This project is based on validating and proving that mandatory nurse patients ratio should be 1:5 or 1:4. The main findings of the study are based on the extensive and significant literature review. He literature presented in the study has been selected rigorously from various reliable resources that provide comprehensive details and understanding about the raised question. In Australian healthcare system, nurse staffing and nursing workload is major problems, which is impacting the patient outcomes and reducing their quality of life. Nursing shortage is another problem with which the healthcare system is suffering. There are various reasons associated with shortage of nurses. Heavy burnouts, job dissatisfaction unhealthy professional communication, lack of support and overtime, has increased the number of nurses. People are choosing this profession in very less amount due to the efforts this job requires. Overtime and workload is associated with each other. If the number of nurses is adequate, the patients will be able to receive better care and satisfaction. But, emotional distress, physical exertion and burnouts have increased job dissatisfaction in nurses that impacts their psychological well-being.

According to the evidences presented in the study of McGahan, Kucharski and Coyer, (2012), the aged care settings in Australia approximately 50 patients die every day and other 140 patients sustain serious fall injuries. The mortality and morbidity in the patients has also increased in the acute care settings. This problem can only be avoided by increasing the number of nurse staffing and reducing the workload on the available nurses. The patients admitted in the acute care setting are mainly those, who suffer from serious illness and require close surveillance of the nursing professionals. Some of the studies included in the paper provided the evidences that increasing the number of skilled and professional nurses in the aged care setting can reduce mortality anf fall related injuries.

The quality of care is related to intensity of the care provided by the nurses. This intensity of care can improve or deteriorate the patient outcomes. If the intensity of care is low then patient may have dissatisfactions towards healthcare service quality and may not be able to positively respond to treatments and nursing interventions. The core value of nursing profession is to develop trustful and therapeutic relationships with patients. People admitted in aged care setting a generally vulnerable towards various co-morbidities and have lack of support from personal care givers. Most of the aged care patients live lonely life and have impaired mobility.

These patients require close support, warmth and supportive environment in healthcare settings. But, due to nursing workload and nurse staffing issues, nurses are not able to maintain therapeutic relationships with patient. The number of patient per nurse also increases, due to which care time per patient reduces. Thus, various legislations support the mandatory nurse patient ratio, which 1:4 (Shekelle, 2013). By keeping the correct level of the skill-mix of experienced and qualified nurses, helps in appropriate care support, appropriate monitoring of the patient’s condition; and reducing the incidents of falls, injuries and other health related complications associated with patient’s condition. The better recovery from the serious illness and increased physical mobility are also able to be achieved. According to the results presented in the study prove that maintaining the appropriate level of skill mix can bring positive outcomes in patients and reduce the chances of medical errors (Mark, & Harless, 2007). Increasing the number of Registered nurses and enrolled nurses in public and private aged care setting can help in maintaining the appropriate nurse patient ration and decrease quality issues (Tevington, 2011).

According to the report of the Productivity commission of Australia, it has been found the nurse’s ability to deliver quality care in the aged care setting has reduced, due to workload issues (Hughes, 2011). The most relevant causes of reduced quality of care are nursing workload and poor skill mix. The people living in residential aged care have become more vulnerable to the infections, co-morbidities and reduced life expectancy. The imbalance skill mix and reduced staffing has directly impacted the nurse patient ratio (Osborne, 2014). The workload has increased that leaves nurse with less time to give to patient’s screening and improvement. Nurses are also facing many physical and psychological challenges in their life. Workload has not only reduced the care quality, but on the other hand it has increased aggression, dissatisfaction, fatigue and burnouts in nurses. The cross sectional and longitudinal studies included in the paper have shown significant relation between staffing shortage, workload and patient outcomes. All most all the aged care setting in Australia suffers with these issues.

Recommendations

This project is very important and significant as it raises the question about the most essential need in the healthcare system of Australia. Staffing issues in the healthcare system are required to address in a more critical manner as it impacts various aspects of the healthcare delivery and quality of care. This project is based on providing the overview of the most complex problem in Australian health care delivery system in aged care settings. The project addressed various aspects the nursing practice and their impact on patient outcomes. Nurse staffing are need to be addressed on the hospital level as well as on the unit level (Hughes, 2011). By completing this project, it was identified that various aspects of the nursing practice are still required to be considered while developing the strategy. The future strategy must include the aspects related to the length of the stay of patients in aged care setting. The small length of the stay increases the burden and workload of the nurses, for which they require positive and supportive organizational environment. The new strategy must implement the policy of increasing the supportive environment in healthcare setting. With increased professional support nurses would be able to provide quality care and job dissatisfaction will be reduced.

The studies included in the project continuously recommend that nurse staffing ration can highly reduced falls and mortality in hospitals. The changes in organizational policies and procedures are required. Organizations should ensure that patient is receiving quality and supportive care with specialized nursing facilities regardless of the wards they are admitted. The planning to locate the patient in the appropriate ward should be planned so that patient may receive good quality care and nurse staffing may not impact their outcomes. The nurse staffing issue can be addressed by recruiting more professional and skilled nurses with appropriate credentials to provide quality care. The post of RN and EN must appropriately fund for particular wards to maintain the nurse patient ratio (Kane et al, 2007). The nursing managers must be accountable and responsible to ensure nurse staff roster so that workload on the nurses can be reduced. Nurses should be provided with breaks at the workplaces and should have the right to maintain their health and efficacy. The nursing staff requirement should be appropriately planned and this planning should be done with the predictable variations about the availability of the nurses (Mark & Harless, 2011). The adjustments for the unplanned and planned leaves of nurses should be addressed, so that workload on nurses may not unnecessarily increase. The capacity of the nurse staffing must meet the needs of patients and with unplanned leaves of nurses.

Nursing workload increases with the increase in the number of patients and unplanned leaves of the available nurses. Thus, for maintaining the appropriate nurse patient ratio the availability of the nursing staff in aged care settings should be increased. The nursing staff deficits must be addressed and wit lack of staffing no compromises should be done to staff nurses in wards. Staff training and education is also important. By improving and promoting the education of the nurses, they can develop resilience and coping skills with workload. The organizations and healthcare settings should promote the involvement of the nurses in different skill enhancing programs. The quality of nursing care can be achieved with enhance knowledge and experience.

Various studies have demonstrated that reducing the workload and maintaining the appropriate level of nurse staffing can reduce injuries and mortality in patients (Glance et al, 2012). Failing to respond to the needs of the aged care patients, is the biggest challenge that needs attention of the policy makers and Australian Government. Safe staffing requires increasing the number of registered nurses and applying the mandatory nurse patient ratio. Understaffing not only endangers the patient’s life, but also challenges the behavior, physical and psychological health of nurses (McGahan et al, 2012). They suffer from job dissatisfaction and psychological problems. Inadequate staffing can also result in various health issues for nurses. They may suffer from depression, musculoskeletal disorders, cardiovascular diseases, hyper tension and neck or back injuries (Duffield et al, 2007). According to the literature included in the project it is proved that every patient added to the nurse increases the workload and also increases the risk of mortality by seven percent (Shekelle, 2013; Twigg et al, 2011). With the falls and injuries caused due to nursing workload increases the hours of nursing care. This can result in the greater possibility of poor outcomes. Thus, for reducing the nurse patient ratio to 2:4 is very important to improve the quality of services and care and to increase job satisfaction in nurses. Below target RN staffing must be significantly addressed in the new strategy to improve patient outcomes.