NUR4455 Reproductive Health Nursing


Scope and impact of the topic issue:

Nurse staffing or appropriate patient-nurse ratio is an important parameter that determines the patient care quality and safety. It is directly related to outcome of care as adequate nurse-patient ratio promotes efficiency in care delivery, increases job satisfaction and patient satisfaction with care (Frith et al, 2012). However, the issue is that many hospitals fail to maintain adequate nurse staffing level thus contributing to many issues for nurses. Nurses who are forced to work for long shifts are often overworked, stressed and dissatisfied with the job. Due to time constraints and the need to care for a large number of patients than should be required, they may fail to give proper care to individual patients. This may result in high incidence of adverse events like medication errors, fall incidences, hospital-associated infections and injury to patients (Rahman & Shamsudin, 2015). Hence, the nurse staffing issue not only affects performance of nurses, but also has an impact on outcome of care.

Much evidence exists to show the effect of nurse staffing levels on a higher rate of falls and deaths in hospital. Wong, Cummings & Ducharme (2013) proved the impact of nurse staffing on patient outcome by showing that low nurse staffing levels significantly increase the risk of nosocomial infection, patient falls and patient mortality in a clinical setting. Along with the increase in adverse patient events, low nurse staffing levels also increase the length of stay in hospitals and total health expenditure. Another study established link between patient outcome nurse staffing levels by conducting a cross-sectional interview based research with nurses working in surgical and medical wards in 12 private hospitals. The findings of the study revealed that low nurse to patient ratio had negative associations with quality of care and patient safety compared to those hospitals with high staffing levels (Rahman & Shamsudin, 2015).  Zhu et al. (2012) also proved the association between staffing level and patient outcome by showing that when the number of nursing staff per patient is increased, positive patient outcome is achieved. Hence, from this discussion it is understood that taking steps to maintain optimal nurse staffing levels is necessary to obtain positive patient outcomes and promote safety in practice.

Plan to promote quality/safety practice:

As nursing shortages are the main factor that contributes to the nurse staffing issue and poor quality of care, the plan is to promote safety practices in the clinical setting by maintaining workforce flexibility and keeping optimal nurse-patient ratios so that all patients get the proper attention and care from nurses. Nurses working in the hospital for longer hours mostly suffer from burnout and may develop the intention to leave the job because of stress, poor nursing care and high rate of adverse events. To increase the performance of nursing staff and promote patient safety, the nursing workforce should be given flexibility of timing so that they do not feel stressed out. The number of breaks and optimal work hours should be planned and nursing shift hours should be rotated according to those criteria. This would lead to fewer undesirable shifts and enable the nurse to provide optimal care to patient (Kortbeek et al., 2015). Another approach that is needed to prevent adverse events and address staffing level issues is to create positive practice environment in clinical setting. Positive practice environment means giving sufficient resources, greater autonomy, flexible work hours and effective nurse leaders to prevent medication errors. All these factors are strategies to retain nurses, promote excellence in care and the practice environment. Clinical managers should also put forth an effort to keep staffing levels high so that each nurse gets regular breaks from work and consistency in care is maintained (Twigg & McCullough, 2014).



Frith, K. H., Anderson, E. F., Tseng, F., & Fong, E. A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5), 288.

Kortbeek, N., Braaksma, A., Burger, C. A., Bakker, P. J., & Boucherie, R. J. (2015). Flexible nurse staffing based on hourly bed census predictions. International journal of production economics, 161, 167-180.

Rahman, H. A., & Shamsudin, A. S. (2015). The impact of patient to nurse ratio on quality of care and patient safety in the medical and surgical wards in Malaysian private hospitals: a cross-sectional study. Asian Social Science, 11(9), 326.

Twigg, D., & McCullough, K. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International journal of nursing studies, 51(1), 85-92.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.

Zhu, X. W., You, L. M., Zheng, J., Liu, K., Fang, J. B., Hou, S. X., … & Wu, Z. J. (2012). Nurse staffing levels make a difference on patient outcomes: a multisite study in Chinese hospitals. Journal of Nursing Scholarship, 44(3), 266-273.

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