NURSE TO PATIENT RATIO LEADS TO MALPRACITCE 1

Nurse to Patient Ratio leads to Malpractice

Emily L. Flanagan, SN

James Madison University

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Introduction

The nursing shortage in America is becoming a colossal issue. This growing nursing

shortage in America is largely due to the baby boomer population, who are now reaching the age

group of 65 and over (Bureau of Labor Statistics, 2017). The United States Bauer of Labor

Statistics (2017) reports that healthcare professions are going to be the fastest growing group

during the 2016-2026 period, however because of increased life expectancies, number of chronic

illnesses, and the aging baby boomers, the increased growth does not equate to the demand

(Rosseter, 2017). Despite the growing number of nurses, it is still not enough to meet the

demand. This creates unintentional complications like increased nurse to patient ratio which

leads to neglect, unintentional medical errors, and poorer patient outcomes (Bureau of Labor

Statistics, 2017). Clearly the associated complications due to the understaffing of nurses in

hospital summons a closer look, specifically the nurse to patient ratio.

Background

Ethical situation occur are all around us. Sometimes we may not even be aware that an

ethical situation is occurring until we reflect back on the experience. One ethically difficult

situation that I encountered was the direct result of my nurse’s patient-to nurse ratio. During

clinical, I was following around a nurse who was in charge of seven patients because there were

not enough nurses staffed. At the start of the day we listened to report from one nurse about four

of my nurse’s patients, and then had to find the night nurse for our other two nurses to get their

report. By the time this had been completed it was around 0730. This gave us less than two hours

to give our seven patients their medications. During this particular day, six out of our patients

needed Humalog and fasting blood glucose checks before getting their breakfasts. As a result, we

prioritized them above the patient who did not need insulin. My nurse and I began passing
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medications to each of our patient, however, 0900 rolled around and we still had three patients

who needed their meds passed including the non diabetic patient. By the time we got to our last

patient to pass his medications, it was 1000. One of the medications he was on was Lisinopril for

high blood pressure. When the nurse and I checked his vital signs we saw he had extremely high

blood pressure, and after checking the MAR we realized it had been well over the time he was

suppose to get his medication. Our patient was unable to get his medications on time because our

nurse to patient ratio was extremely high leading to us providing unintentional inadequate care.

One potential response we could implemented to benefit the situation was ask another nurse who

had finished their medication pass for the morning to administer our last patients medications.

This situation caused me moral distress because I knew the right course of action was to

administer our patient’s medications by 0900, however because we had 6 other patients who had

a higher priority we were unable to administer the medications within the allotted time. Both the

nurse and I knew that we were late on administering our patient’s morning medications. We both

knew that because our patient did not get his Lisinopril on time his blood pressure would rise, yet

we were unable to do anything about it. This is because there was an increased nursing-to-

patient ratio for the day directly related to lack of staffing.

Methods/ Findings

James Madison University’s 8 Key questions are used to reflect back on ethical situations

and the decision making process (The 8 Key Questions, 2017). These eight questions feature

vital human values including fairness, outcomes, responsibilities, character, liberty, empathy,

authority, and rights. In this situation, I could have displayed fairness by giving each of our

patients the same amount of time, making sure not too give one patient a majority of our time. In

terms of short term goals, giving the patients with the insulin their medications first would
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decrease the risk of the patients having hyperglycemia and further long term complication.

However, in doing so this lead to an increased risk for the patient who received their medications

last to have complications from their hypertension. As far as responsibility, the duties or

obligations that my nurse and I had was to make sure every patient was given their morning

medications in a timely manner. The action that best reflects who I am is right prioritization of

patient medication administration. It is important to me that my patients feel respected and by

giving their medications on time and I am respecting the patients while reflecting a good moral

character.

In my situation, I do not believe that liberty applies. My patients in the hospital setting do

not have the freedom to administer their medications when ever they want. They also do not

have any autonomy over when their medication administration is. In term of empathy, both my

nurse and I care deeply for all our patients which made it extremely hard to know we let one

patient down. The law and our superiors expect that we administer our medications by 0900;

however, due to the increased number of patients we were unable to complete this task. In this

situation there were some legal rights that applied both to myself and the patient. The patient had

the right to receive their medications in a timely fashion, however I had a right as a nurse to

provide care and prioritize the line of care.

The American Nurses Association nursing ethics, specifically looking at provision 4

which states “the nurse is responsible and accountable for individual nursing practice and

determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide

optimum care” (Code of Ethics, 2001). This provision can guide my decision making in this

situation by figuring out what task to prioritize that will give the patients the optimum care. This

means that when figuring out to prioritize I need to think about if I delay this nursing care, how
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will this affect the optimum care that should be given? This also entails that I am accountable

and responsible for the judgment of prioritizes and actions that I provide or delegate to another

personnel.

Conclusion

From this situation I learned the importance of prioritization of care. I also learned how

important it is for the hospital to be adequately staffed so that the nurse to patient ratio is not

above the number allotted to still provide optimum care. I could have thought about how to

improve my nurses and I efficiency so that we could have completed our task quicker. One thing

I could have done differently is have the courage to speak up and ask if I could help with

medication administration. I could have helped by getting the next patients medications from the

omnicel and having all the necessary supplies needed to administer our next patient’s

medications. In terms of prioritizations, I still would have done the same prioritizing of patients.

I would still give the patients who had insulin their medications first so that they could eat and

we can control their blood glucose. After their medications were administered I would still do the

patient without insulin last.

In future situations I would recommend scheduling more nurses so that the nurses are not

overwhelmed by the amount of patients they are providing care for. Likewise, I would also

recommend that if another nurse has finished their morning medication pass and has extra time,

that the nurse who is running behind asks the nurse who is not busy for help. I believe that this

situation could be avoided if more nurses were staffed, however many hospitals are understaffed

due to the nursing shortage. If we as a country fix the nursing shortage, then we can decrease the

nurse to patient ratio. This can lead to a decrease in the unintended malpractices or ineffective

care and this whole situation could have been avoided.

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References

Rosseter, R. Nursing Shortage Fact Sheet. Retrieved March 19, 2018 from

hhtp://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing Shortage

Registered Nurses. (2017, March 31). Retrieved March 19, 2018 from

http://www.bls.gov/oes/current/oes291141.htm

American Nurses Association (2015). Code of Ethics for Nurses with Interpretive Statements.

Retreived from http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-

Nurses.html

The Eight Key Questions (8KQ). Retrieved March 19, 2018 from http://www.jmu.edu/mc/8-key-

questions.shtml