Problem Statement and the Literature Review

ProblemStatement and the Literature Review

Problem Statement


In this assignment, I will analyze the Student Learning Outcome (SLO)#5 that insists how a nurse should “apply practice guidelines toimprove practice and the care environment.” The care environmentoften faces multiple challenges that might interfere with the servicedelivery. For instance, the lower nurse-to-patient ratio is a problemthat has affected most hospitals since it undermines the quality ofcare. Some of the nurses even keep complaining about the stress,burnout, dissatisfaction and the low quality of care. Theconsequences show that the nurses will be unable to implementrational and evidence-based decisions while treating the patients.Hence, this research will reveal how the fifth SLO supports thepresence of enough nurses to treat the patients based on the practiceguidelines.


Aiken et al. (2012) engage in research that evaluates the issue ofstaffing ratios in hospitals in twelve European nations as well asthe US. The approach provides a wide range of information thatreveals how different hospitals in Europe are dealing with the issueof nurse-to-patient ratio. The research reveals that the efficiencyin a hospital setting relies on the staffing ratios since itinfluences the decision-making process and how the nurses shouldhandle their problems. In fact, a hospital will have a problem if aspecific number of the nurses are unable to deal with the challengesthat the patients are facing. Aiken et al. (2012) even urge varioushospitals to consider the proper staffing ratios to improve thepatients’ outcome.

Description of theProblem

Needleman et al. (2011) reveal that a lower staffing ratio willresult in a higher rate of the inpatient hospital mortality since thepatients will lack enough nurses to treat them. Apart from that, theburnout and stress might lead the few nurses to make irrationaldecisions that will even cause the death of some patients. Shekelle(2013) shows how a few Registered Nurses in a shift will underminethe patient outcome since the decisions will be full of human errorsarising from the poor decision making. Lastly, Aiken et al. (2011)praise the better staffing ratios since it helps in reducing cases ofburnout and stress, and focus on the efficient service deliveryinstead.

Problem and CourseStudent Learning Outcomes

The lower nurse-to-patient ratio meets the objectives that the SLO #5“apply practice guidelines to improve practice and the careenvironment” illustrates. In this case, the lower staffing ratiowill undermine the practice and the care environment too. Hence, thesolution will need the hospital management to observe the practiceguidelines and make sure that the nurses are able to work favorablywithout any pressures. The practice guidelines will help in promotinga higher nurse-to-patient ratio to improve the patients’ outcomes.The scenario will improve the care environment since the nurses willbe able to handle the pressure and tackle the interests of thepatients effectively.


In conclusion, the lower staffing ratio is a problem that willundermine the service delivery and patients’ outcome in the end.The scholarly journals have analyzed the issue effectively andrevealed how the staffing ratios often lead to burnout anddissatisfaction among the nurses. On the other hand, the problemclearly affects the care environment since the patients will not getthe appropriate treatment plan since the nurses will not makerational and ethical decisions. Hence, the practice guidelines insiston each shift having enough nurses to deal with the patients andprioritize the patients’ safety.

Reviewof the Literature

Various scholars have looked into the issue of the staffing ratios inthe nursing area. More importantly, they have highlighted thechallenges that arise from the lower staffing ratios and the benefitsthat a hospital will get if they have the required staffing ratio.Ball et al. (2013) reveal that the nurses should seek the help of thepractice guidelines when they are faced with ethical dilemmas.However, the article also explains how the staffing ratio influencesthe decisions that the nurses makes. For instance, the lower staffingratios might lead to the nurses being stressed, and they might evensuffer from burnout. In the process, they might make unethicaldecisions that will affect the safety of the patients. In fact, thearticle relates to the second SLO since it highlights the ethicalchallenges that the nurses undergo in a setting where they do notmatch the number of the patients in that particular shift. However,they will overcome all those challenges if the hospital managementcomplies with the practice guidelines suggested by the fifth SLO andincrease the number of nurses. A considerable number of the nursesmean that they will share the responsibilities and ensure that theymake rational and ethical decisions while implementing the treatmentplan.

Muller-Juge et al. (2013) reveal how the interprofessionalcollaboration works in the nursing setting. In particular, thearticle reveals that the collaboration is all about handlingdifferent roles that aim at improving the patient’s outcome. Thepresence of interprofessional collaboration in a particular settingmeans that the nurses will work effectively even if they are facedwith a lower staffing ratio. In fact, they will use the spirit ofteamwork to enhance the service delivery and make sure that they meetthe interests of each patient. The article also aligns with theobjective of the fourth SLO that is improving the patient’s outcomein the hospital setting. The lack of collaboration will clearly be aproblem since a nurse will want to handle concerns that anutritionist should deal with. In the process, the hospital willreceive various cases of human error and poor decision-making.However, the fifth SLO will urge the management to have enough nursesthat will nurture interprofessional collaboration and improve thepatient outcome.

McHugh et al. (2011) illustrate that the lower nurse-to-patient ratiowill often be a problem to the service delivery. In particular, thearticle outlines the reduced satisfaction, burnout, and frustrationas some of the issues that will affect the nurses. Hence, they shouldcreate ways to avoid the burnout and focus on improving the ways theyuse in treating their patients. More importantly, it aligns with theobjectives of the third SLO that insists on the credible,evidence-based decisions that support the treatment plans. It focusesmore on improving the patients’ outcome and ensuring that theyundergo the positive changes needed. It also matches with the fifthSLO that wants to improve the care environment and prioritize thesafety of the patients too.

Lastly, Wong et al. (2013) talk about the efficiency of relationalleadership in handling the pressure that the hospital faces when theyhave a lower staffing ratio. In some cases, the management mightspecify a lower number of nurses to handle a shift regardless of thehigher number of patients. In most cases, a relational leader oftenhelps the nurses in handling the pressures that they will face inthat shift. For instance, a relational leader will make sure a nursewith a shorter shift has more patients while the one with a longershift has fewer patients. The arrangement will motivate the nurses,and they will prioritize the patients’ outcome regardless of thestaffing ratio. The article uses the relational leadership theory tohandle the inadequate nurses, which meets the objectives of the firstSLO. It also creates a safer care environment for the patients sincethey will get the quality care they want.


Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn,L., &amp Neff, D. F. (2011). The effects of nurse staffing and nurseeducation on patient deaths in hospitals with different nurse workenvironments. Medical care, 49(12), 1047.

Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse,R., McKee, M., … &amp Tishelman, C. (2012). Patient safety,satisfaction, and quality of hospital care: cross sectional surveysof nurses and patients in 12 countries in Europe and the UnitedStates. Bmj, 344, e1717.

Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., &ampGriffiths, P. (2013). ‘Care left Undone’ during Nursing Shifts:Associations with Workload and Perceived Quality of Care. BMJquality &amp safety, bmjqs-2012.

McHugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., &ampAiken, L. H. (2011). Nurses’ Widespread Job Dissatisfaction,Burnout, and Frustration with Health Benefits Signal Problems forPatient Care. Health Affairs, 30(2), 202-210.

Muller-Juge, V., Cullati, S., Blondon, K. S., Hudelson, P., Maître,F., Vu, N. V., … &amp Nendaz, M. R. (2013). InterprofessionalCollaboration on an Internal Medicine Ward: Role Perceptions andExpectations among Nurses and Residents. PloS one, 8(2),e57570.

Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L.,Stevens, S. R., &amp Harris, M. (2011). Nurse staffing and inpatienthospital mortality. New England Journal of Medicine, 364(11),1037-1045.

Shekelle, P. G. (2013). Nurse–patient ratios as a patient safetystrategy: a systematic review. Annals of internal medicine,158(5_Part_2), 404-409.

Wong, C. A., Cummings, G. G., &amp Ducharme, L. (2013). TheRelationship between Nursing Leadership and Patient Outcomes: ASystematic Review Update. Journal of nursing management,21(5), 709-724.