Most Common Consequences Of Unsafe Nurse-to-Patient Ratios (For Patients, Nurses, & Organizations)
Written By:
Darby Faubion
Darby Faubion RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Darby lives in Louisiana and loves exploring the state’s rich culture and history. Darby has a passion for caring for veterans and a special interest in those affected by post-traumatic stress disorder. In her quest to make a difference for veterans, she founded a non-profit called “Operation Battle Buddy.” Read Full Bio »» RN, BSN, MBA
If you are a nurse, you know the importance of providing safe care to patients and what it takes to accomplish it. Whether you are a new nurse or have been in the profession for years, chances are, you have seen or experienced situations that made providing safe, effective patient care difficult. One of those challenges is unsafe nurse-to-patient ratios. While no one likes to think of having inadequate nurse-to-patient ratios, many people may not realize what this imbalance may cause. Perhaps you wonder, “What are the most common consequences of unsafe nurse-to-patient ratios?”
I have been a nurse for more than 20 years, and I have seen the effects of working with inappropriate or unsafe nurse-to-patient ratios. In this article, I will share the 15 most common consequences of unsafe nurse-to-patient ratios for patients, nurses, and organizations. Although some circumstances that lead to short-staffing and unsafe nurse-to-patient ratios are unavoidable, if nurses and leaders work together, it is possible to reduce the risks and consequences.
What are the Most Common Consequences of Unsafe Nurse-to-Patient Ratios for Patients?
(The following are the 5 most common consequences of unsafe nurse-to-patient ratios for patients.)
CONSEQUENCE #1: Longer Hospital Stays
One of the main consequences of unsafe nurse-to-patient ratios is that they often lead to longer hospital stays. When nurses are responsible for more patients, providing effective, timely care becomes challenging. As a result, patients may experience prolonged waiting times for care, delays in receiving treatment, or increased risk of complications. Any of these circumstances can lead to prolonged hospital stays.
CONSEQUENCE #2: Increased Risk to Patient Safety
Years ago, I worked at a hospital and was part of a Risk Prevention Team. One of our goals was to identify factors that increased risks to patient and staff safety, and one of the main contributing factors we found was that poor nurse-to-patient ratios directly impacted safety numbers and scores.
When there are insufficient staff to care for the number of patients, patient safety is compromised. Some examples of patient safety events include medication errors, falls, hospital-acquired infections, missing important symptoms or signs during an assessment, and delayed response times in providing patient care.
CONSEQUENCE #3: Greater Healthcare Costs
Another way patients are impacted by unsafe nurse-to-patient ratios is increased healthcare costs. When organizations lack enough staff to safely care for patients, the risk of longer hospital stays, readmissions, and preventable complications increases. Unfortunately, these factors contribute to higher costs of healthcare services, which patients must pay if they wish to continue receiving care.
CONSEQUENCE #4: Higher Readmission Rates
Despite positive efforts on the part of nurses, inadequate nurse-to-patient ratios are often associated with suboptimal care during hospitalization, which often leads to higher readmission rates. One study by the
National Institute of Nursing Research indicates that each additional patient per nurse over the recommended nurse-to-patient ratio increases the chance of being readmitted to the hospital within 30 days of initial discharge. One of the things that is frustrating about this consequence is that it only compounds the problem, especially if staff numbers remain low as patients are readmitted.
CONSEQUENCE #5: Poor Patient Outcomes
Another consequence of unsafe nurse-to-patient ratios is that they are associated with poor patient outcomes. Understaffing in nursing is associated with increased errors in care. In some cases, medication errors occur, and in others, some treatments may be omitted or overlooked. Additionally, poor nurse-to-patient ratios are also associated with increased mortality rates. This consequence is perhaps one of the worst associated with poor nurse-patient ratios.
What are the Most Common Consequences of Unsafe Nurse-to-Patient Ratios for Nurses?
(The following are the 5 most common consequences of unsafe nurse-to-patient ratios for nurses.)
CONSEQUENCE #1: Increased Workload
A main consequence of unsafe nurse-to-patient ratios is that nurses experience increased workloads. When nurse-to-patient ratios are off, nurses are assigned additional patients for whom they must provide care. Additional patients mean increased work. This consequence is especially troubling because with a greater workload comes the risk of other consequences, which could have negative effects on patients, staff, and organizations.
CONSEQUENCE #2: Workplace Stress
Unsafe nurse-to-patient ratios are one of the main contributing factors to workplace stress for nurses. I remember many days in bedside nursing when our nurse-to-patient ratios were off either because of an influx of several patients or because of being short-staffed. There is so much that goes into nursing care, and when the nurse-to-patient ratio is off, it throws everything else out of balance. To say it creates a stressful workplace environment is really an understatement!
CONSEQUENCE #3: Decreased Job Satisfaction
Among the many consequences of unsafe nurse-to-patient ratios is decreased job satisfaction. As a nurse with both clinical and administrative experience, I have worked in settings where there were inadequate numbers of nurses to provide the care we felt was appropriate for our patients. I have also seen what it is like from a manager’s perspective when you have so many patients and not enough nurses to even out the workload and make it more bearable. In both clinical and administrative roles, when we did not have enough staff, I experienced a decrease in the satisfaction I felt in my job.
Bear in mind that I am not saying that working short-staffed from time to time makes all nurses hate their jobs. I am saying, however, that it has been my experience that when nurse-to-patient ratios are inadequate, the stress and extra work nurses must contend with can lead to feelings of dissatisfaction.
CONSEQUENCE #4: Nurse Burnout
High nurse-to-patient ratios are a major cause of
nurse burnout. One thing I have noticed in my experience is that nurse burnout does not happen suddenly. Instead, it occurs over a period of time when nurses are exposed to increased workplace stress. Nurse burnout causes physical, mental, and emotional exhaustion and has the potential to affect not only nurses but the patients we care for and the organizations for which we work. As a nurse and healthcare educator, I believe it is crucial for all nurses to recognize the symptoms of burnout in themselves and coworkers and to be proactive about taking steps to prevent long-term consequences.
For example, if you feel overwhelmed by work, talk to your manager or supervisor. If your facility is large enough, rotating to a different department, even temporarily, may help relieve some of your stress. Also, if you need a day off work, do not be afraid to tell your supervisor and discuss why. Having worked as a nurse leader, I can tell you that I would much prefer my team members to come to me and discuss their feelings so we can work together instead of risking losing good nurses to burnout.
CONSEQUENCE #5: Increased Chance of Workplace Injury
Adequate nurse-to-patient ratios are not only essential for providing patient safety, but also to protect nurse safety, as well. One of the consequences of having too few nurses is that nurses become mentally and physically tired, which leaves them more prone to injuries and accidents when caring for patients.
While maintaining proper staffing ratios is something the administration typically handles, it is important to understand that you are responsible for your own actions or inaction. So, if you are tired or overworked, speak up! Do not take on assignments that you know you cannot handle, which could put you and your patients at risk. Something I cannot stress enough is that it is impossible to take diligent care of others if you are not caring for yourself, and part of that is protecting yourself from the risks of injuries and accidents when it is within your power to do so.
What are the Most Common Consequences of Unsafe Nurse-to-Patient Ratios for Organizations?
(The following are the 5 most common consequences of unsafe nurse-to-patient ratios for organizations.)
CONSEQUENCE #1: Risk of Legal Ramifications
I have been a nurse for more than 20 years, and I can honestly say I have never seen more lawsuits in healthcare than we see today. While some lawsuits may seem frivolous or seem to have no substance or just cause, others do have merit. In cases where there are not enough nursing staff to cover the number of patients, errors, injuries, and poor patient care often result, which can lead to lawsuits.
Although administrators and managers cannot control who comes to work and does not, the responsibility of having adequate staff remains with leadership. If nurse-to-patient ratios fall in an unsafe category and a patient or nurse experiences an injury or if a patient does not receive care or receives inadequate care, there is usually grounds for some kind of legal standing, putting the organization at risk of being sued.
CONSEQUENCE #2: Poor Patient Satisfaction Scores
Another consequence of unsafe nurse-to-patient ratios is that they can result in poor patient satisfaction scores. Patient satisfaction can have serious implications for healthcare organizations. For example, poor patient experiences may lead to complaints, negative news coverage, and poor patient outcomes, all of which may lead patients to seek healthcare services elsewhere. Another concern associated with poor patient satisfaction scores is that patient satisfaction is a contributing factor to how organizations are reimbursed for services. If an organization constantly gets poor patient reviews, third-party payers, such as Medicare, may scrutinize bills or even deny funding for some services.
CONSEQUENCE #3: Lost Revenue
One of the main consequences of unsafe nurse-to-patient ratios for organizations is lost revenue. Lost revenue may be linked to several factors. For example, approximately 60% of patients leave online reviews of healthcare providers, and nearly
90% of new patients check online reviews before going to a new provider, which means if patients leave poor reviews because of inadequate nurse-to-patient ratios, it could lead to patients seeking care elsewhere. As a result, the organization’s bottom line can be negatively impacted.
CONSEQUENCE #4: Increased Nursing Staff Turnover Rate
The only way healthcare organizations can provide high-quality, effective care is to have enough nursing staff to do so. Unfortunately, one of the consequences of unsafe nurse-to-patient ratios that many organizations face is that nurse turnover rates tend to increase. It is not so much that nurses want to leave their jobs, but more so that nurses desire jobs where they are not overworked and they feel as though they can provide safe, quality care, which requires having enough staff to get their jobs done.
A friend of mine was the administrator of a long-term care facility that struggled to get and keep good nurses. For a time, the nurse-to-patient ratio fluctuated, and nursing staff were faced with caring for more patients than was reasonable. The shortage of nurses led to other nurses getting burned out and leaving their jobs for new ones. In time, the facility hired and trained new nurses and built up a strong staff with enough nurses to safely care for patients. However, in cases where organizations do not make changes and get enough staff, the increased nurse turnover rate typically continues.
CONSEQUENCE #5: Difficulty Recruiting New Staff
One thing that anyone in nursing will tell you is that nurses do not mind sharing their opinions about where you can find a good job, and which places you should avoid! I have worked in places that I loved and would encourage any of my nursing friends to work there if they asked, but I have also worked at places I hope never to return. Anyone who has been a nurse for any length of time will probably tell you the same.
Nurses know what it takes to provide quality care to patients when the nurse-to-patient ratio is within a safe range, and we also know the consequences that could occur if we have too many patients. That's why, when it comes to organizations with unsafe nurse-to-patient ratios, if a nurse knows beforehand that this is an issue, they are likely to look elsewhere for a job. If unsafe nurse-patient ratios continue, organizations may find it challenging to recruit new staff. Unfortunately, this can be a difficult cycle to break, especially when nurses shy away from taking jobs at places where they feel they may be overworked.
My Final Thoughts
Providing high-quality, safe patient care should be the goal of every nurse. One of the best ways to ensure safe patient care is to have enough staff to cover the number of patients who need nursing services. Unfortunately, there are times when staff numbers are less than adequate, which can lead to problems for patients, nurses, and organizations. If you are a nurse, you may wonder, “What are the most common consequences of unsafe nurse-to-patient ratios?”
In this article, I answered that question by sharing the 15 most common consequences of unsafe nurse-to-patient ratios for patients, nurses, and organizations. At times, inadequate nurse-patient ratios may be unavoidable but, whenever possible, we all should do our part to ensure patient and nurse safety by showing up and doing our part.
List Of Sources Used For This Article
1. National Institute of Nursing Research
2.
“Nurse Burnout: Risks, Causes, and Precautions for Nurses” (
University of St. Augustine for Health Sciences)
3.
“Best Practices for Responding to Online Patient Reviews” (
healthgrades.com)
Darby Faubion, RN, BSN, MBA
Darby Faubion is a nurse and allied health instructor with over 20 years of clinical experience. Her work history includes clinical experience in pediatrics, mental health, addiction and behavioral disorders, geriatrics, wound management, and communicable disease. Darby has worked in hospitals, long-term care facilities, and home health and hospice agencies. Darby also has experience as a nursing and allied health educator at both community college and university levels. Her love for nursing and nursing education led to her becoming a test-taking strategist and NCLEX prep coach.