Current Issues in Nursing: Nurse Patient Ratio and Medication Errors
Introduction
Nurse staffing has become a major issue in many countries. The number of nurses in most countries has reduced. For example, the number of nurses in United States has reduced. This has affected the nurse patient ratio. The nurse patient ratio in United States nd other countries is low. This has in turn affected the provision of care in many hospitals. For example, the shortage of nurses in hospitals has affected patient safety in the hospitals. This is because health care facilities are not able to provide quality care and ensure medical safety. It has also affected delivery of care in the hospitals. Studies have proved that hospitals that have low number of nurses or the nurse patient ratio is low have recorded high rate of medication errors. On the other hand, hospitals that have a high number of nurse patient ratio have recorded low number of medication errors. The shortage of nurses is attributed to various factors. For example, the shortage of nurses is as a result of low enrollment in nursing institutions and change in profession. Also, the increase in baby boomers has led to high demand of nursing services and hence shortage of nurses. This paper determines whether nurse patient ratio has an effect on medication errors in acute care setting.
Discussion
Research problem
The rate of medication errors in most of the health care facilities has increased. This is due to shortage of nurses in country. Like other countries, United States does not have enough nurses and this has affected provision of care. Many health care facilities are not able to offer quality healthy care services due to shortage of nurses. The nurse patient ratio in the health care facilities is 1:8. The low nurse patient ratio has influenced patient safety and quality of care. The health care facilities do not offer safe care and hence high rate of medication errors. Also, the nurse shortage has affected outcome of many diseases and resulted to death (Cowen &Moorhead, 2006).
Research purpose
The research is aimed at determining how the nurse patient ratio affects medication errors. The research will determine factors that lead to medication errors in acute care setting. For example, the researcher will determine how shortage of nurses in the country has affected the nurse patient ratio in health care facilities and quality of care offered to patients (Cowen &Moorhead, 2006).
Literature review
Most researchers argue that the current nurse shortage reflects important changes in the nursing profession and health care setting. For example, the nursing shortage reflects dissatisfaction of workers. It also shows the changes in career expectations and work attitudes. The shortage of nurses is as a result of numerous factors. First, the shortage of nurses is due to low admission rates in nursing institutions. Most of the nursing institutions do not have the capability to enroll a high number of nurse students. This is due to lack of learning facilities (Encinosa &Hellinger, 2008).
This has made it hard for many students to enroll for nursing courses. Hence, this has resulted to low number of nurses. In addition, the change in profession has also led to shortage of nurses. Most of the young people in the country prefer to pursue other careers instead of nursing. This is because nursing is demanding unlike other professions. Also, the high number of old nurses and low number of young nurses has led to reduction in number of nurses. Most of the health care facilities have low number of young nurses as the young people do not want to become nurses. Also, most of the nurses start working when they are old and only work for few years before retiring. Lastly, the high number of baby boomers has led to shortage of nurses. Most of the baby boomers in the country are aging and need specialized nursing care. This has increased the demand for health care services. The number of baby boomers who are old is likely to increase in future and lead to high demand of health care services. The demand of nursing care will increase by 40% by 2020 and the nurse vacancies will increase by 29% (Cowen &Moorhead, 2006).
Most researchers have carried out studies to determine the effect hospital nurse staffing has on patient safety and quality of care provided to patients. The researchers argue that nurse staffing affects the quality of care offered to patients and patient safety. For example, nurse staffing affects the outcome of various infections. The nurse staffing has an effect on urinary tract infections, pneumonia and failure to rescue. A series of studies have shown that there is a close relationship between nurse staffing and adverse outcome (Rogers & et al, 2004).
Agency for health care research and quality reviewed 26 studies that focused on the relation between nurse staffing levels and patient safety. The researchers argued that low nurse patient ratio was linked with adverse outcome. The low nurse patient ratio in the health care facilities affected the quality of care offered to patients and patient safety. This is because the nurses attended more than one patient at once.This made it hard for the patients to get quality care. In addition, the low nurse patient ratio in acute care settings affected patient safety as most of the patients were not able to get safe care. This in turn led to medication errors (Rogers & et al, 2004).
Another study carried out by agency for health care research and quality, centers for Medicare and Medicaid services and the health resources and services administration showed similar results. The research showed that low nurse patient ratio in most hospitals affected patient safety and outcome of various diseases. The researchers evaluated more than 5 million patients and 1.1million surgical patients. The findings from the study showed that hospitals that had adequate RN staffing had lower rate of medication errors. This is because the provision of care and safety was not affected by staffing in the hospital. On the other hand, the rate of medication errors in hospitals that had low number of nurses was high as the staffing affected patient safety (Rogers & et al, 2004).
Another study carried out by William and Fred (2008) showed that there is a relationship between nurse patient ratio and patient safety and quality of care. The researchers claimed that shortage of nurses in health care facilities had resulted to increase in medication errors and thus affected patient safety. The researchers noted that providing the right intervention in hospitals could improve patient safety and save the cost of care and lives (Rothberg, Abraham, Lindenauer, 2005). For example, increasing the number of nurses in health care facilities could enhance patient safety. This is because the nurses will not serve many patients at once. Hospitals that have a nurse patient ratio of 1:8 have high rate of medication errors than hospitals that have a low ratio. The researchers argued that the nurse patient ratio in the hospital should be almost 1:4 instead of 1:8.
The research showed that medication errors increased the cost of care. This is because the patients have to incur extra costs when trying to correct the medication errors and treating other infections. The research showed that insurers pay additional fee to help patients cater for the medication errors. For instance, insurers pay 52% more for surgical patients who suffer from acute respiratory failure. In addition, the insurers pay 48% more for patients who get infections after being operated. This is in contrast to patients who do not get infections after operation or experience error during operation. Preventing medication errors can help reduce the rate of deaths resulting from medication errors and also reduce health care costs by 30% (Stone & et al, 2004).
This was also evidenced in another study conducted by health grade Inc (2006) showed that nurse staffing affected patient safety and quality of care. The researchers argued that more than 80, 000 patients died every year from 2002 to 2004 from medication errors that could be prevented. The researchers claimed that low number of nurse patient ratio resulted acquiring infections after operation and during treatment of acute diseases. Most of the patients in the hospitals did not get the right care and this resulted to increase in infections resulting from poor care provided to the patients (Joint commission on accreditation of health care organizations, 1998)
Many researchers like Garret (2008) have noted that inadequate staffing in nursing facilities affects the working environment. Most of the hospitals do not have good working environment for their nurses. Majority of the hospitals force their nurses to work overtime so as to be able to meet the needs the patients. The researchers claim that forcing nurses to work overtime leads to burn out among nurses. This is because the nurses are not able to cope with pressure resulting from the working environment. This results to poor performance among the nurses and hence affects patients’ safety and quality of care. Forcing nurses to work leads to medication errors as nurses do not provide when administering drugs, prescribing or carrying out medical tests. Additionally, nurses do not take the right care when taking care of the patients. Hence, this affects the patients’ outcome and can lead to death. The outcome of various infections like pneumonia and unitary tract infections is affected by poor working environment. Most of the patients having acute diseases die due to lack of adequate care and medication errors.
Most of the hospitals have forced their nurses to work in shifts and attend to more than four patients. This has affected the performance of the nurses and quality of care offered to patients. Most of the researchers argue that improving the working environment has a lot of benefits to the health care facilities and the patient. First, improving the working environment helps reduce the cost of care in the health care facilities. This is because the hospitals incur minimum losses by reducing hospital stays and enhancing quality of care. Moreover, improving the working environment helps improve the quality of care offered to patients. For example, patients get good care and nurses consider patient safety an important factor. This helps reduce the rate of medication errors in health care facilities (Joint commission on accreditation of health care organizations, 1998).
There are different ways that hospitals can improve the working environment. First, nurses can improve the working environment by ensuring there are adequate nurses in the hospital. Having adequate nurses in the hospital will ensure nurses serve at least 4 patients and do not work in shifts. It will also help prevent burn out among nurses and thus improve patient safety, quality of care and reduce medication errors. It will also improve the nurse patient ratio in the hospital and reduce medication errors. In conclusion, low nurse patient ratio has affected patient ratio and led to increase in medication errors and deaths (Joint commission on accreditation of health care organizations, 1998).
Research questions and hypotheses
Research hypothesis
The researcher will use both null hypothesis and alternative hypothesis. In null hypothesis the researcher will determine whether nurse patient ratio has no effect on medication errors in acute care setting. In alternative hypothesis, the researcher will determine if nurse patient ratio has an effect on medication errors in acute care setting.
Null hypothesis: Nurse patient ratio has no effect on medication errors in acute care setting
Alternative hypothesis: Nurse patient ratio has an effect in medication errors in acute care setting
Research questions
The researcher will use a wide range number of research questions. The research questions will be based on the literature review section. First, the researcher will determine whether nurse patient ratio affects medication errors in acute care setting? In addition, the researcher will determine factors that affect nurse patient ratio in many hospitals like in adequate staffing. He will also determine how nurse staffing affects patient safety and results to medication errors. Lastly, the researcher will determine how to reduce the rate of medication errors in acute health care setting. The research questions include;
Does nurse patient ratio have an effect on medication errors in acute care setting?
What factors affect nurse patient ratio in health care facilities?
How does nurse staffing affect patient safety and lead to medication errors?
How can health care facilities reduce medication errors in acute health care setting? (Dellinger &Parillo, 2001).
Variables and definitions
The research will employ both independent and dependent variables. The independent variable represents the variable that is being manipulated. On the other hand, the dependent variable represents the results being observed from the independent variable being changed. The independent variable in the study is nurse patient ratio. On the other hand, the dependent variable is the medication errors. The researcher will change the nurse patient ratio to show how the ratio of nurses to patients affects the rate of medication errors (Dellinger &Parillo, 2001).
Methodology
Research design
The research will employ a quasi experimental research design. A quasi experiment is a kind of observational study in which the participants to be observed are not assigned to various groups so as to measure their outcomes. The quasi experimental study will be a, retrospective descriptive study. A descriptive study is aimed at determining patterns in a particular condition, but not the cause linked to different elements. A descriptive study helps generate hypothesis, but not tests them. The descriptive study will help determine the patterns of medication errors. The researcher will look at the exposure of patients to medication errors for the last few years due to low patient nurse ratio. This will help determine whether nurse patient ratio affects medication errors in acute care setting (Dellinger &Parillo, 2001)
Sample
The research will use patients and nurses from different hospitals. The researcher will use 400 patients and nurses from 20 hospitals. Each hospital will have 10 patients and 10 nurses. The participants will be selected according to age, gender. The participants will be 200 females and 200males. Each hospital will have 10 females and 10 males. That is 5 male patients and 5 nurses. Also, the hospitals will have 5 female patients and 5 female nurses (Dellinger &Parillo, 2001).
Setting
The research will be conducted in the hospital as the researcher will utilize patients and nurses from various the hospitals (Dellinger &Parillo, 2001).
Data collection
The researcher will use observation technique to collect data from the participants. The observation technique will help the researcher observe the subjects and record the necessary details. The investigator will observe the participants without interfering with them. Using observation method has a lot of advantages. First, it makes it easy for the researcher to collect data from participants who are not able to read and write. This ensures data collected and results are valid. In addition, using observation technique in collecting data eliminates biasness and subjectivity as the researcher does not interfere with data and results. However, using observation method makes it hard for the researcher to seek clarification (Dellinger &Parillo, 2001).
Data analysis
Data collected will be analyzed using statistical methods. The researcher will code the data and use SPSS to analyze data coded. This will help determine mean, median and mode. The results will be present in tables and charts as this will make it easy for the reader to interpret them and compare the variables (Dellinger &Parillo, 2001).
Ethical consideration
The researcher will take into consideration different ethical issues. For instance, the researcher will consider the privacy and safety of the patients. The researcher will not be required to interfere with the privacy of the participants. For instance, the researcher will not expose private details of the participant’s without getting permission from the participants. Also, the researcher will not share data collected with other people without the consent of the participants. The researcher should get permission from the participants before conducting the research. The researcher should not force participants to participate in the research if they are not willing. He should also inform the patients the importance of the research and negative effects of the study (Milstead, 2004).
Implications practice
The researcher should fund the study because of the benefits that are linked with it. First, the research will help determine how the nurse patient ratio has affected medication errors and patient safety and find the right solutions. This will in turn help improve the quality of care provided to patients and patient safety by providing enough nurses. The research will determine the risk nurse patient ratio poses on patient health and life through medication errors. Also, the research is inline with the millennium development goals and health people 2010 goals. This is because it will help reduce the mortality rate in the population by providing quality medical care. Funding the project will help the government attain the health people 2010 goals and millennium development goals.
The research has implication on different people. First, the research has implication on the government as it will provide enough information on how to improve patient safety and quality of care. The government will use the information to reduce medication errors by ensuring adequate staffing and hence enhance quality of care. It has an effect on health care facilities and the patient. Information gotten from the research will help hospitals increase the nurse patient ratio so as to reduce medication errors and improve quality of care and patient safety. This will in turn save the patients life (Milstead, 2004).
Conclusion
In conclusion, most studies have shown that nurse patient ratio has an effect on patient safety, quality of care and thus medication errors. Most researchers argue that inadequate staffing in most hospitals has affected patient safety and quality of care. This has in turn resulted to medication errors. Most of the countries have experienced shortage of nurses. The shortage of nurses is due to increase in demand of health care services and poor enrolment in nursing schools. This has led to understaffing in health care facilities and affected nurse patient ratio and led to medication errors. The study above is important as it will help eliminate medication errors by improving staffing in hospitals.
Reference
Dellinger,P.R.,&Parillo,J.E.(2001).Critical care medicine: principles of diagnosis and management in the adult.Elsevier Health Sciences
Cowen,P.S.,&Moorhead,S.(2006).Current issues in nursing. Elsevier Health Sciences
Encinosa,W.E.,&Hellinger,F.J.(2008).The impact of medication errors on 90- days
costs and outcome. An examination of surgical patients. Health services research. Retrieved from http://www.protectmasspatients.org/pdf/HSR-04-0005%20R3%20Encinosa.pdf on 12./05/2011
Garrett,C.(2008).The effect of nurse staffing patterns on medication errors and nurse burnout. AORN J. Vol 87, Issue No 6, page 1191-204.
HealthGrades, Inc.(2006).EathGrades Quality Study: Third Annual Patient Safety in American Hospital Study
Joint commission on accreditation of health care organizations.(1998).Medication use: a systems approach to reducing errors. Joint Commission Resources
Milstead,J.A.(2004).Health policy and politics: a nurse’s guide. Jones & Bartlett Learning
Rogers,A.E.,& et al (2004).The working hours of hospital staff nurses and patient safety. Health affairs, Vol 23, Issue no 4, page 202-212
Rothberg,M.B., Abraham,I.,Lindenauer,P.K(2005).Improving nurse to patient
staffing ratio as a cost effective safety intervention.Medical care, vol 43, issue no.8
Stone,P.W .,& et al.(2004).Nurses working conditions. Implications for infectious diseases. Emerging infectious diseases,Vol10, issue no 11.
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