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Nurses- to- Patient Ratio in Hospitals

Nurses-to- Patient Ratio in Hospitals

Nurses-to- Patient Ratio in Hospitals

Nursesare very essential in hospitals as they assist patients in manydifferent ways. Some of their duties include proper medicalprescription as authorized by the doctor, consultancy, and in somecases, they control the machines used in treatments. Thenurses-to-patient ratio is very critical and should be addressedproperly, to ensure security to patient`s life. It is unfortunatethat the Hawaii Resolution Bill is still pending as it addressesHawaii’s nurse- to- patient ratio problems. Advocating for approvalof the Hawaii Senate Resolution 5 bill, which campaigns for minimumdirect care register of nurse- to- patient ratios and the staffingratio, proposed in H.R.1602, might see the situation improve. Thisseems easy when mentioning, but it is a difficult task for thegovernment to implement. This bill will bring a great change inHawaii in different fields, firstly in medical institutions,secondly, treatment of patients and in the whole economy. This levelof change may sound less but it is very important in the state ofHawaii. Adoption of the policies included in the bill may see nurse-to- patient ratio reach a level of 1:2 or 1:3. The policy maker whocan see the state attain this level of change is the government. Thebill is supposed to be passed by senate then will be implementedlater. A number of factors, either directly or indirectly related,hinder this policy. They include work environment, financialproblems, and patient`s satisfaction with regard to their expectationfrom the service offered.


Themain points in this paper are that nurse-to-patient ratio incrementis a paramount necessity to all hospitals, mainly in Hawaii, toensure patient satisfaction. However, the policy needs to be tiedwith a healthy working environment and checked spending to ensurehigh quality service delivery due to the developments and saving ofresources. The paper mainly supports the bill due to the advantagesit will bring into the Hawaii’s health sector. The billacknowledges that the number of nurses needs to be increased, asinadequate number of nurses results to medical errors and dangerouspatient infections. Further, apart from encouraging a rise in thenumber of nurses, it insists that they be monitored to protectpatients in hospitals, outpatient emergency, or in surgical centers.The bill will also help in improving the overall standards ofhealthcare in Hawaii hospitals, to ensure public safety throughdelivery of high quality healthcare. It also acknowledges thatoverworking of nurses due to understaffing is a threat to the healthof patients and to the wellbeing of the nurses.


Patientsatisfaction and service offered according to their expectations

Accordingto Kupfer (2012), in the research he conducted about the relationshipof the patient satisfaction and the service rendered, the patientwill only be satisfied if the services offered are good and areaccording to the individual’s expectations. If the service offeredis good, then that will be a high-quality service. Otherwise, if theservice is poor according to their expectations, then that service isof low quality. For the nurses to be able to offer high-qualityservices, they need to be enough. That is, the ratio of nurse- to-the patient should be fair. Whenever there are fewer nurses thanexpected, it means that the task handled by one nurse is more thanher capability. For this reason, nurses spend less time than expectedwhen attending to a patient in order to take care of all patients(Alexander, 2016). As a result, the patients end up being improperlytreated or served, with some dying or experiencing deterioration intheir conditions, due to under treatment.


Apositive work environment is recommended in the hospitals, to ensuregood nurse- to- patient relationship. Sometimes, the ratio is not anissue but rather the environment one is working in. Patient`ssatisfaction greatly depends on the environment where the nursethrives. If the environment is not good or appealing enough to thenurse, the services offered to the patient are not good and viceversa. For example, exposure to surgical smoke is a threat to nursesand doctors’ lives (Ilce, 2016). This is a clear indication thatbefore considering the nurse- to- patient ratio, the work environmentis supposed to be perfected, to ensure the happiness of the nurses,to motivate them to offer good services to their patients. Despitethe government’s effort to ensure good working condition of thenurses, if the nurses themselves are not willing to work, the outcomeends up being poor. Therefore, nurses should always maintain a highspirit, to put hope on the patients’ faces.


InHawaii, the nurse- to- patient ratio is about 1:8. This means thatfor every one nurse, she has around eight patients to take care of.This is a large number of patients compared to only one nurse. Due tothis, the number of nurses needs a raise to reduce work overloadamong some of the nurses and to ensure efficient work delivery. As aresult, when a nurse is added in the employment list, extra resourcesand finance are required for payment of wages, work equipment,housing, among others (Duvall &amp Ferraro, 2010). The governmentmust generate all this money, and so in adding quite a large numberof trained nurses, it requires a lot of money and government andother financial stakeholders must be prepared. Nevertheless,sometimes the population of nurses is accepted the way it is, sinceincreasing their number require more capital and resources, and thusthe rapid increase of nurses in the hospitals might not be possible.It needs to be a step-by-step processes to ensure implementation ofthe policy does not add more problems to the hospital.

Burnoutof nurses.

Inmost of the developing countries, the number of nurses has beenreducing with a higher rate. According to the research which wasconducted, about 820 nurses and 620 patients were involved (Ilce,2016). As a result, it was shown that the number of nurses inhospitals is reducing not because they were never employed butbecause they drop out of their profession after a number of years.Being curious to know the reason behind this, further study was doneand was found that it is because of poor environment and poor workingcondition that triggered their actions. Example the managers beingharsh to them on unnecessary issues, low payments, delayed wagesamong others. As a result, they either dropped out or search forother green pastures or they fail in their duties. That is the dutiesthat they were expected to give to the patients they end up beingpoor. Although this is not the major reason as for why there arefewer nurses in the medical institution but it contributed.

Inspite of having all those concepts related to this policy, it isimportant to note that overworking has no better outcomes, as itbrings fatigue and inaccuracies. That is, there is an importanceattached to the policy of increasing the number of nurses andenhancing quality services in the medical institution. Theseadvantages include economic development and saving of resources amongothers.

Impactand Importance to Nursing

  1. Overall development

Itis important if states will view aspect of employing more nurses inthe medical institutions as a way of growing the hospitals’conditions, but not as a contradictory policy. For example, theHawaii Senate Resolution 5 (HI SR5) bill needs support for thebetterment of the country’s economy and saving of patients.Consequently, the bill will see number of nurses increase, resultingto offload of some tasks, thus enabling these nurses to have adequatesurgery time or to attend to other patients, without any workpressures, which will prevent deterioration of patients’ health.Other results will be increased lifesaving than before.Simultaneously, this will lead to the growth of economy directly orindirectly. That is, people will be treated and go back to theirdaily chores such as production, manufacturing, or distribution. Thedeath rate will also be reduced, hence low number of orphansrequiring government financing (Wise, 2016).

  1. Saving of resources

Somepeople are of the perspective that increasing the number of nurses inthe hospitals means that more capital is required. People mainly donot accept this as a policy of saving the country’s resources.However, if a state such as Hawaii passes the bill, more nurses willbe employed, which will help in smooth service provision to patientsin the hospitals, helping them recover easily and fast. Therefore,instead of increasing the cost, high nurse-to-patient ratio may seeimprovement in nursing performance, thus reducing turnover rates,liabilities, and staffing cost. Further, safe-staffing ratios willhelp in reduction of additional costs that result from addingsupplemental nurses and staffing agencies. These results in thecountry saving the money it could have used to pay the extra salariesfor the additional staff (Falk, 2016). Thus, a safe-staffing ratio isan effective way of saving in the country. Adopting of this policy bythe state of Hawaii through ensuring that the nurse- to- patientsratio is balanced, number of patients who die in labor units willsignificantly reduce.

Safe-staffingratio is a good policy not only to hospitals in Hawaii, but also tothe nursing sector worldwide. However, apart from increasing thenumber of nurses, hospitals need to be stocked with the necessaryequipment, to reduce issues of resource sharing among nurses, as thiscan render safe-staffing ratio useless. Hospitals need to understandthat if patients will be satisfied in the way that they are treated,they will feel free to visit the facility any time they are sick, nomatter the distance or price. This is a clear indication that notonly does the policy of safe staffing solve the situation, but alsonurses have to treat the patients in a good manner to ensure theyalways have a positive mind. Increased staffing and a happyenvironment will improve the level of health care in the state ofHawaii.


Inconclusion, nurse- to- patient ratio is a very important policy thatshould be considered by all state hospitals to ensure patientsreceive adequate care in the hospitals. In Hawaii, having a largeratio is something that needs and has to be done in order to ensuretrauma emergency units, neonatal care units, labor delivery units,and surgical units function smoothly without hindrances or workloads.However, the hospital departments need to be responsible, by alwayssupervising the accountability of nurses in their respectiveworkplaces, to ensure service provision is efficient and of highquality.


Alexander,&nbspM.(2016). It’s good for Patients, Nurses, and Health Care. Journalof Infusion Nursing,39(5),263-264. doi:10.1097/nan.0000000000000191

DuVall,&nbspS.&nbspL.,&amp Ferraro,&nbspJ.&nbspP. (2010). The Role of CoreferenceResolution in Outbreak Reporting and Detection. 201043rd Hawaii International Conference on System Sciences.doi:10.1109/hicss.2010.394

Falk,&nbspA.,&amp Wallin,&nbspE. (2016). Quality of patient care in the criticalcare unit in relation to nurse patient ratio: A descriptive study.Intensiveand Critical Care Nursing,35,74-79. doi:10.1016/j.iccn.2016.01.002

Ilce,&nbspA.,Yuzden,&nbspG.&nbspE., &amp Yavuz van Giersbergen,&nbspM. (2016).The examination of problems experienced by nurses and doctorsassociated with exposure to surgical smoke and the necessaryprecautions. JClin Nurs.doi:10.1111/jocn.13455

Kupfer,&nbspJ.&nbspM.,&amp Bond,&nbspE.&nbspU. (2012). Patient Satisfaction andPatient-Centered Care. JAMA,308(2),139. doi:10.1001/jama.2012.7381

Wise,&nbspJ.(2016). Higher nurse to patient ratio is linked to reduced risk ofinpatient death. BMJ,i797. doi:10.1136/bmj.i797