Running Head: NURSE TO PATIENT RATIO IN LTC 1

Nurse to Patient Ratio in Long-Term Care

Manaia Genovia

Nurse 211

Professor Nadamoto

November 9, 2015
NURSE TO PATIENT RATIO IN LTC 2

Nurse to Patient Ratio in Long-Term Care

In the long-term care setting, the nursing assistant has the most direct contact with

residents and provides most of the front-line services, so their ability to ensure resident

safety while still providing high quality of care is essential (Zhang, Punnett, McEnany,

Gore, 2015). Studies have been shown that work stressors including sleep quantity, work

schedules, heavy workload, and insufficient number of staff have a negative impact on

the health of nursing assistants (Zhang et al., 2015). Registered nurses have the

responsibility of administering medications to multiple residents within a critical time

frame to ensure therapeutic effects. The cost of employing an adequate amount of

nursing staff to patient ratio is an ongoing concern as administrators focus on plausible

minimum staffing for providing quality care (Spilsbury, Hewitt, Stirk, Bowman, 2011).

An analysis of the nurse to patient care ratio reveals that effective workplace

interventions should address work stressors including sleep quantity, work schedules,

work overload, and the number of nurses on staff are essential in improving the health of

nurses and overall quality of care of residents in long-term facilities.

Inadequate Sleep

Sleep is a universal necessity among all individuals; its quantity can affect

perception, mood, attention, concentration, emotions, and overall health. Nurses provide

continuous services around the clock; as a result they are at risk for decreased sleep

quality and quantity, continuous sleep deprivation, and cumulative sleep debt (Zhang et

al., 2015). An article by Olds & Clarke (2010), agrees with this by stating, chronic

partial sleep deprivation has cumulative effect on alertness and performances (pg. 153).

Safety amongst residents is the number one priority in the long-term care setting.
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Registered nurses with fatigue from shift work and poor sleep increases the chances of

medication errors because of their decreased ability to concentrate affected their work

performance and possible the safety of the resident receiving the medications. In an

article by Zhang et al., (2015) health care workers had better work features when they

have a longer sleep duration and better sleep quality; the impact of nurses sleep affects

residents safety and quality of care.

Quantity of Nurse Staff

As the population ages, the role of providing care for dependent older

people will require a demand for nurses in the geriatric field. Nurses provide care,

management, and treatment, however in some facilities there is sometimes a shortage of

staff, which compromises providing the best quality care for residents especially in the

labor-intensive long-term care setting. The quantity (number of staff) is of equal

important to the quality (hours, activities, performance). Poor quality care has been

associated with inadequate staffing and poor skills mix. (Spilsburg et al., 2010).

Shuldham, Parkin, Firouzi, Roughton, Walker (2009) stated, higher levels of staffing by

registered nurses are associated with lower rates of urinary tract infections (pg. 987).

The higher the amount of staff - the more attention a resident receives, consequently the

better care they receive.

High Nurse Workload

The maximum amount of hours to work in the week is forty. Nurses have a duty

to provide care for residents in long-term care who cannot independently care for

themselves. Olds & Clarke (2010) found that adverse events and medication error

variables were significantly related to working more than forty hours in the average week
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(pg. 153). Some states have regulations that prohibit mandatory overtime for nurses,

however there are no restrictions to voluntary overtime hours that nurses may chose to

work. In the long-term care setting, preventing infections and pressure ulcers is a major

concern due to the susceptibility of the elderly and the amount of hours nurses work plays

a role because in Olds & Clarkes (2010) article higher overtime increases the likelihood

of catheter-associated urinary tract infections and decubitus ulcers (pg. 154). Nurses

working in long-term care have a high workload with the nurse-patient ratio being high

and other factors such as the amount of hours worked in the work that contribute to their

work ethic.

Conclusion

The relationship between nurse to patient ratio in long-term care and quality

nursing care is positively correlated. If there is a registered nurse or nursing assistant

shortage in the long-term care facility it could adversely affect schedule of residents

regarding their feeding, medication, activities, etc. due to the time limitation the nurses

are able to give each resident. Nurses with the highest patient to nurse ratios were

around twice as likely to experience job-related burnout and to be dissatisfied with their

jobs compared with nurses with the lowest ratios (Shuldham et al., 2009). With a high

nurse to patient ratio the risk for medication errors is increased due to the high workload

of the nurses. This can impact future nursing care because the aging population will

increased and there will be a greater number of people requiring long-term care.
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References

Zhang, Y., Punnett, L., Mcenany, G., & Gore, R. (2015). Contributing influences of work

environment on sleep quantity and quality of nursing assistants in long-term care

facilities: A cross-sectional study. Geriatric Nursing.

Spilsbury, K., Hewitt, C., Stirk, L., & Bowman, C. (2011). The relationship between

nurse staffing and quality of care in nursing homes: A systematic review.

International Journal of Nursing Studies, 48(6), 732-750.

Olds, D., & Clarke, S. (2010). The effect of work hours on adverse events and errors in

health care. Journal of Safety Research, 153-162.

Shuldham, C., Parkin, C., Firouzi, A., Roughton, M., & Lau-Walker, M. (2009). The

relationship between nurse staffing and patient outcomes: A case study.

International Journal of Nursing Studies, 46(7), 986-992.