Nurse-to-Patient Ratios and How it Affects You

On June 12, I joined hundreds of other nurses from across the country on the lawn of the U.S. Capitol for a rally and spoke with staffers from my state's representatives offices about the need for nationally regulated patient ratios. I also recently became a member of National Nurses United, the largest union and professional association of registered nurses in U.S. history. 

Why is this significant? If nurses are saying that there are issues with staffing practices at hospitals and longterm care facilities then the general public who receives this medical care, should be worried too. Nurses are concerned because the ongoing focus on profit by corporate healthcare organizations is impeding our ability to provide safe and effective care to you and your loved ones.

In previous posts, I have shared how feeling like I was being expected to care for too many patients affected my ability to provide holistic care and incorporate integrative therapies at the bedside. But being holistic and getting to know their patients is the least of many nurses concerns around the country. They want to know they didn't cause harm to any of their 8+ patients on a medical surgical unit, 5+ patients on the stepdown/progressive care unit, or in some places 4+ patients in the intensive care.

I can relate as I too have worked in a for-profit hospital where nurses were routinely understaffed and continuously expected to do more. More charting, more rounding, more medication administering...more more more...with less nurses and less nursing assistants and unit secretaries to help. Why? Because if they can make us provide care for more patients with less staff then the corporation will make more profit. Pretty simple answer, right? But instead, we are providing less real care and causing more harm to our patients and ourselves.

Numerous studies have demonstrated the increased risks that our loved ones are subjected to when receiving care at a facility with inadequate staffing practices. Increased risk of developing pressure ulcers, hospital-acquired pneumonia, falls, medication errors, respiratory failure, cardiac arrest, readmission, and death are a few examples. *see references listed at bottom of this page*

Nurses are selfless creatures by nature. We work extra hours, stay late, skip lunch breaks, take the rare bathroom break with the ASCOM phone attached to our hip, and join committees. Not because we have nothing else to do, but rather because we don't want to leave our nursing colleagues short-staffed or put our patients at risk of further complications due to short-staffing. But nurses are humans too. I have previously written about the importance of self-care to avoid burnout and caregiver fatigue. Some of the main risk factors for nurse burnout is unsafe staffing practices and increased stress from their job related to these expectations. In one study, 83.7% of nurse participants reported that the number of nurses working on their departments is not sufficient for the amount of work (Obradovic, Obradovic, Cesir-Skoro, 2013). Nurses leave the career they worked so hard for and felt called to because of these issues, leaving us with even fewer nurses at the bedside and perpetuating this cycle. According to Twibell & St. Pierre, roughly 30% of new graduate nurses leave their roles within the first year and 57% within two years, citing heavy workloads, inability to ensure patient safety, and insufficient time with patients as reasons for leaving. The cost of replacing a nurse who leaves is more than $80,000 (2012). 

The view of corporate healthcare in America is too short-sighted to see the simple solution. By providing better staffing ratios we would be providing safer and more comprehensive care to our patients, improving staff job satisfaction and reducing nurse burnout, and ultimately saving billions of dollars by preventing readmissions, reducing errors, and shortening length of hospital stays.

Nurses are organizing and have been for several years on this matter. In 2004, California passed the only government regulated nurse-patient ratios after nurses and patients united to demand safer practices. Why is it now, 12 years later, we cannot have those same regulations in hospitals and longterm care facilities all across America? Greed! Corporate healthcare is not in the business of keeping you healthy. They are in the business of making money like the rest of corporate America, and their practices are self-serving and putting you and your loved ones in danger. 

Would you want your mother or grandfather to be my third patient in the ICU? Or the 8th patient for a nurse on the medical surgical floor? Trust me, you don't. When nurses are expected to provide care beyond safe levels patients suffer: mistakes are made, tiny changes that could save your loved ones life are missed, and they miss out on the potential caring moments that we nurses long to cherish with them. We are rushed, flustered, stressed out, and afraid that we will bring harm to those we work so hard to help. So, what can we do? We need to be active in our government and let our voices be heard. Nurses can join movements and organizations such as National Nurses United or Nurses for National Patient Ratios Facebook Group. Non-nurses who want to be involved and spread the word about safe staffing can find more information on the National Campaign for Safe RN-to-Patient Staffing Ratios. 

Please feel free to share this information and contact me directly at nurseapril@holisticheartrn.com for more literature and conversation on this very important issue.  And continue to follow me as progress is made on this matter. 



Resource list
Aiken L, Clarke S, Sloane D, Sochalski J, Silber J. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama [serial online]. October 23, 2002;288(16):1987-1993. Available from: MEDLINE Complete, Ipswich, MA. Accessed May 27, 2016.
Cho, Eunhee,PhD., R.N., Chin, Dal Lae,PhD., R.N., Kim, Sinhye,M.S.N., R.N., & Hong, OiSaeng, PhD, RN,F.A.A.N., F.A.A.O.H.N. (2016). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82. doi:http://dx.doi.org/10.1111/jnu.12183
Harless D.W. & Mark B.A. (2006) Addressing measurement error bias in nurse staffing research. Health Services Research 41 (5), 2006-2024.
Harless D.W. & Mark B.A. (2010) Nurse staffing and quality of care with direct measurement of inpatient staffing. Medical Care 48 (7), 659-663.
McHugh MD, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51:52–59. 

Needleman, J., PhD., Buerhaus, Peter,PhD., R.N., Pankratz, V. S., Leibson, C. L., PhD., Stevens, S. R., M.S., & Harris, Marcelline,PhD., R.N. (2011). Nurse staffing and inpatient hospital mortality. The New England Journal of Medicine, 364(11), 1037-45. doi:http://dx.doi.org/10.1056/NEJMsa1001025
Twibell, R., & St. Pierre, J. (2012, June). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today, 7(16). https://americannursetoday.com/tripping-over-the-welcome-mat-why-new-nurses-dont-stay-and-what-the-evidence-says-we-can-do-about-it/
Obradovic, Z., Obradovic, A., & Skoro, I. C. (2013). Nurses and burnout syndrome.Journal of Health Sciences, 3(1) Retrieved from http://search.proquest.com/docview/1660377054?accountid=458

Are you nourishing your body?

I frequently write about nourishing ourselves through self-care: meditation, yoga, aromatherapy, nature. But what I most often find myself counseling others about is nutrition. We know that what we eat influences our health. I certainly can tell when I've been eating well and when I haven't. Hippocrates said, "Let food be thy medicine and medicine be thy food." As a nurse, I provide nutrition education to patients following strokes, heart attacks, receiving antibiotic therapy, and suffering from constipation. But I also recognize that it's not just the patients who need nutrition education. My peers and our society as a whole need a diet revolution. We live in a time where the fast food drive thru and boxed "foods" are the norm. Numerous studies link this type of diet to chronic illnesses and obesity. I enjoy preparing nutrient dense meals with fresh and quality ingredients. I don't think food should have ingredients, but should be ingredients.  

My husband manages our community's online farmers market, and we are both heavily involved in educating customers and community members about whole foods nutrition. I am also the co-founder of the soon-to-be Greenbrier Valley Chapter of the Weston A Price Foundation. If you are not familiar with the Weston A Price Foundation or Dr. Price's work, check it out at www.westonaprice.org.  The foundation's dietary teachings center around the preparation of traditional and whole foods to promote health. Many of the recent clean eating diet fads share similar ideals: less processed foods, more fresh ingredients, smaller serving sizes. All of which are important factors in promoting health through nutrition. 

However, a key element missing from these other diets is fermented foods. People have been fermenting foods since the beginning of humanity. It is a traditional method of food preservation. Fermentation also makes food more digestible and nutritious. Fermented foods such as kimchi, milk kefir, sauerkraut, natural picked, and yogurt are imperative in providing our body with important probiotics. I bet you have heard about probiotics before, but do you really understand and appreciate their role? 

Probiotics are edible products containing the helpful bacteria such as Lactobacillus or Bifidobacterium that normally inhabit the human digestive tract.  These bacteria help to digest food, helping to keep the digestive system in balance and functioning properly. They are also extremely helpful in supporting the immune system, particularly when taking antibiotics, which can wipe out intestinal bacteria indiscriminately, including those that help keep the intestinal tract healthy. I have worked at hospitals where supplemental probiotics are added to the patient's medication list as part of an order set when antibiotics are prescribed to help prevent complications from antibiotics. And yes, you can take a probiotic supplement, but isn't it much more fun to consume your probiotics?

Basic vegetable ferments are quite easy and can be accomplished in your home kitchen. Give this easy recipe a try to promote microbial diversity within your body and expand your food horizons.

Quick Kimchi

adapted from Nourishing Traditions

1 head pak choi, chopped or shredded

1 bunch green onions, chopped

2 carrots, finely grated

4-6 French Breakfast radishes, grated and some of the greens

4 cloves garlic, peeled and minced

1 tablespoon freshly grated ginger

½ teaspoon (or more if you like spicy) dried chile flakes or red pepper flakes

2 tablespoons Himalayan Pink Sea Salt (or other quality salt)

4 tablespoons whey (from whole fat organic yogurt or from your fresh cheese, milk kefir, or yogurt making)

*You can omit whey if you need a dairy free recipe but use an additional 1 tablespoon salt. This will result in a slightly saltier kimchi and may need a longer fermentation.

Add salt to pak choi in a large bowl and use hands to massage. This draws out the moisture in the pak choi, creating the brine which will ferment your kimchi. Let rest while you chop and grate the remaining ingredients.

Add remaining ingredients to salted pak choi and mix again with your hands.

Transfer your kimchi to a quart jar or other fermentation vessel. Use a pounder or meat hammer to press down until the brine comes to the top of the kimchi. If your brine doesn’t quite cover your kimchi you can add a little extra water.

Seal with a lid and keep at room temperature for 3-5 days then enjoy! If your kimchi is still a little salty for your liking you can continue to ferment at room temperature or in a root cellar or basement until it meets your taste preferences. Kimchi and other fermented vegetables will keep for several months in cold storage.

Try your homemade probiotic filled kimchi on a fish taco, as a salad or soup topping, or as a simple flavorful side with any meal. It is also very tasty on your farm fresh breakfast eggs.

The ingredients for kimchi are very flexible. You can use summer cabbage, Napa cabbage, pak choi, or even beet or broccoli greens. Any type of radish will do, but the traditional radish is the Daikon, a long white radish that looks somewhat like a very large white carrot. The same is true for onions. If you don’t have green onions use some fresh chopped white or yellow onions.

Make the recipe your own and use what you have. The whole idea of fermentation is to store your fresh and healthy vegetables for future use. You shouldn’t have to make a special trip to the grocery store for a special type of onion, radish, or cabbage. I was able to use garlic from a friend's fall harvest, pak choi, onions, and radishes from the Monroe Farm Market (shameless plug for our local online farmers market) and only purchased the carrots and ginger from a grocery store because they are not available locally.

For further information on fermentation check out Wild Fermentation by Sandor Ellix Katz and Nourishing Traditions by Sallon Fallon.