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Tenise Williams
Professor Deborah Strehle
English 1201
14 July 2019

Annotated Bibliography
My research paper is to see how nursing ratio’s affect patient care and patient outcomes.

I believed that the research data I have found will support my theory that nursing ratios does

affect patient outcomes. States who have adopted specific nurse to patient ratio’s, patients have

better outcomes and live longer as a result. This is my annotated bibliography using my working

bibliography.

“Nurse Staffing: Health Care Advocacy: American Nurses Association.” ANA,

www.nursingworld.org/practice-policy/advocacy/state/nurse-staffing/. Accessed 7

July 2019.

The article is about how the ANA, American Nursing Association collaborated with

Avalere to see how using optimal nurse staffing ratios to improve patient outcomes. This

article goes on to point out findings that show how optimal staffing is essential to

providing safe patient care and improve patient outcomes. Several studies also show an

association between higher levels of experienced RN’s and lower rates of adverse

outcomes in the patient population. The ANA supports nurses and legislation model

which allows nurses to create staffing levels that are flexible and unit specific. Currently

there are 14 states with nurse staffing laws and regulations. The American Nurses
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Association is a professional organization to advance and protect the nursing profession.

The American Nursing Association was founded in 1896.

“Calls for Safe Staffing -- a Worldwide Phenomenon.” Queensland Nurse, vol. 35, no. 3,

June 2016, p. 24. EBSCOhost,

search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=116067175&site=eho

st-live.

http://sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=tru

e&db=ccm&AN=116067175&site=ehost-live

This article tells how nurses in Queensland went on a healthcare strike. The nurses wanted

to fight for safe patient ratios. The Queensland nurses came very far with their long-term

campaign and achieved minimum ratios in all sectors. The New York Nurses Association

are focused on taking a bill to legislation for safe nursing ratios.

“Nursing and Patient Safety.” PSNet, psnet.ahrq.gov/primers/primer/22/Nursing-and-Patient-

Safety. Accessed 6 July 2019.

https://psnet.ahrq.gov/primers/primer/22/Nursing-and-Patient-Safety

Nurses play a very important role when it comes to patient safety. Providers spend maybe

45 minutes even with critical ill patients. Nurses must be the eyes and ears for the

providers and must monitor all patients very closely. Nurses are also responsible for

performing countless tasks to make sure patients receive quality care. Nurses are the key

people at the bedside. It is only logical that having increasing numbers of patients will

eventually compromise safe patient care. Several studies have showed a link between
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nursing ratios and patient safety. This is a creditable website. The Agency for healthcare

research and quality is 1 of 12 agencies within the United States Department of Health and

Human Services.

Müller de Magalhães, Ana Maria, et al. “Association between Workload of the Nursing

Staff and Patient Safety Outcomes.” Revista Da Escola de Enfermagem Da USP,

vol. 51, Jan. 2017, pp. 1–7. EBSCOhost, doi:10.1590/S1980-220X2016021203255.

http://sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=tr

ue&db=ccm&AN=129670987&site=ehost-live

This article is about a study looking at nursing workload. This was a cross-sectional

study that took place from October 2013 to September 2015. The sample consisted of

157,481 patients. 502 nursing professionals and 264 observations of safety outcomes.

The study concluded that an increase in the workload of the nursing staff had and high

impact on positive patient care outcomes. According to this study an adequate staffing

ratio promotes a safer care environment and better patient outcomes. The author has a

PhD and is an expert in her field. This study was completed in Mexico.

Shekelle, Paul G. “Nurse-Patient Ratios as a Patient Safety Strategy: A Systematic

Review.” Annals of Internal Medicine, vol. 158, Mar. 2013, pp. 404–409.

EBSCOhost, doi:10.7326/0003-4819-158-5-201303051-00007.
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http://sinclair.ohionet.org:80/login?url=https://search.ebscohost.com/login.aspx?direct=tr

ue&db=ccm&AN=104243729&site=ehost-live

According to this article by Shekelle a percentage of patients die during hospitalization,

and it is believed that better nursing care could have prevented some of these deaths. The

evidence taking from this study shows supporting evidence that a relationship between higher

nurse staffing levels and decreased inpatient deaths. The study results consistently report higher

RN staffing is related to lower hospital related deaths. The article goes on to say that by

increasing RN staffing by just 1 FTE was related to positive cost savings across the broad. We

need more studies that assess an intentional change in staffing ratios. This was a systematic

review written by Paul G. Shekelle who has a MD, PhD. The author is very creditable he has

worked with patients and nurses and probably has seen first hand how staffing ratios affect

patient care and patient outcomes.

Tevington, Pamela. “Professional Issues. Mandatory Nurse-Patient Ratios.” MEDSURG

Nursing, vol. 20, no. 5, Sept. 2011, pp. 265–268. EBSCOhost,

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st-live.

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.aspx?direct=true&db=ccm&AN=104699212&site=ehost-live
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According to this article mandatory nurse ratios remains controversial. The belief is that if

staffing ratios are regulated it will increase positive patient outcomes and increase job

satisfaction for nurses. This article also gives background information on how California

was able to pass Bill 394. Bill 394 which was implemented in 2004, a nurse patient ratio

of 1 to 5 in medical surgical units was mandated. 17 other states have introduced similar

legislation since California passed Bill 394. The ANA advocates legislation to empower

nurses. The passage of bills that will mandate nurse ratios, would promote the value of the

nursing profession and also promote evidence- based practice. It will also empower nurses

to autonomy to use their knowledge, expertise, and skills to provide effective care.

Pamela Tevington is the author of this article. Pamela Tevington, BSN, RN-C, is a

medical-surgical staff nurse. Working as a floor nurse on medical-surgical floor, I think

Pamela is a creditable author for this article.

Windle, Marguerite. “Nurse to Patient Ratios: Where Are We Now?” Med-Surg Matters,

vol. 27, no. 5, Sept. 2018, p. 9. EBSCOhost,

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st-live.

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ue&db=ccm&AN=132428984&site=ehost-live
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This article explains how easy it is to make mistakes when taking care of too many

patients. The article goes on to say that we have been discussing safe patient assignments

for a very long time. In 2004, California enacted a rigid staffing model based on

evidence-based practice. For all California hospitals the law now required specific nurse

patient ratios. Since the law was established, California has seen better patient outcomes.

If we look up the studies on nurse staffing and patient safety, we will see that appropriate

staffing decreases medical errors. The writer’s purpose of this article is have safe nursing

ratios all over the U.S. The audience is other nurses who want to provide safe patient

care. The article was written to tell how one state made a law that has helped patients

and nursing staff with specific nursing ratios. The writer is Marguerite Windle, MSN,

RN, CMSRN. She is an independent contractor providing Clinical Nursing Education

and legal Nurse Consultant services in eastern PA. She is also the AMSN coordinator for

the National Quality Forum and the Nursing Alliance for Quality Care. I will use this

information to tell how smaller ratios help the state of California and how it will help us

here in Ohio too.