Optimal staffing for safe patient care


Can the nursing fraternity really achieve this goal?

By M. Khoza RN, RM, Bcur, Psychology in HIV management, Oncology & Palliative Care, Port Louis, Mauritius

The challenge
For many years now, Nurse Leaders across different countries have been trying to find a solution for an ideal model for nurses to render safe patient care. This remains a top concern globally for registered nurses working in the acute care setting.

There is a growing body of research supporting the relationship between optimal staffing and clinical outcomes. I have been part of the population of nurse leaders looking for a solution at least in three different countries – South Africa, Saudi Arabia and now Mauritius. Each of these countries face different challenges due to their nursing recruitment structure.

Brief comparison

  • South Africa has the union demanding regulated nurse – patient ratios. According to them, this will result in better patient outcomes. However, this is not ideal as it lacks flexibility of staffing the nursing units according to their activities. Furthermore, this notion is not supported by the Nursing Leaders, especially in the private sector.
  • Saudi Arabia, on the other hand, depends mainly on expatriates and have only three categories of nurses, auxiliary nurse, registered nurse and midwives. The ratios are not regulated and not influenced by the unions. Most hospitals are JCI accredited, which assesses the nurse-patient ratios but are not necessarily prescriptive nor do they require any specific staffing model. Nurses are bound by their contract and they are left with no choice than to continue operations even though if they are burned out as a result of being overly stretched.
  • In Mauritius, there is a critical shortage of nurses especially in the private sector. Most qualified nurses prefer to work in State hospitals due to staff privileges and job security. The nurse-patient ratio is not regulated, the nursing units are staffed according to the activity in the units. However, this is still a challenge due to registered-nurse shortage.

    On a concluding note, while taking into consideration the different proposed scenarios, it clearly reflects the fact that the trend is almost the same, i.e.,
    • Shrinking of financial resources,
    • The increasing burden of disease,
    • And the demand for good service.

More and more patients are aware of their rights and therefore this gives patients and relatives the bargaining power to demand a lot from nurses.

So, I ask, should we be looking at mandatory staffing norms? Is it practical? Is there any other solution in addressing this global challenge?

The Nurses perspective
Nurses are in a unique position to exploit their knowledge, skills and abilities to identify a solution to propose a convenient staffing plan that will provide for safe patient care. They should actively participate and drive conversations around nurse-patient ratios. Nurses at operational level should be given the possibility to engage in those kinds of discussions and forums. Their voices must be heard. I have been a nurse for 30 years where I have been dedicating the last 15 years being in the management and leadership positions and I can strongly affirm the fact that we do not have the luxury to exclude the workforce in decision-making process.

If nurses continue to quit their profession due to burnout, understaffing, and bullying, we are no closer to a solution than before. Nurses turnover is expensive, and it also poses a risk to safe patient care and excellent outcomes. Stopping nurses from leaving their jobs prematurely is now a “critical issue” for governments around the world as the problem of staff shortages is escalating, which is a great concern.

The patients
Over the past few years, the DNA/mindset of the patient has changed. Patients are health conscious and they are well versed about different healthcare topics and their rights, which makes them an active participant in the management of their health daily. The high demand for specialised or individualised care is thus increasing pressure with regards to the quality of service offered by nurses bearing in mind that the latter are already giving out their best. It would be highly recommendable to engage patients along with nurses in discussions forums conducted in order to get insights from both ends, which can then be taken up to bring about feasible solutions. The well-being of patients is as important to us as to them. Are we ready to afford the patient of today the space?

The health insurance (private sector)
The medical insurance rates are continuously increasing at a fast pace on a yearly basis. For insurance companies to get more patients, they build up their business cases on the positive patients’ feedback collected and excellent service offered by different hospitals. Monitoring tools that measure patient experience and feedback are being used by the funders and act as motivators for hospitals to perform well and to constantly deliver excellent service, which will hereafter impact on nurses’ activities.

What then?
It is evident that the issue of safe nurse -patient ratio in all the nursing unit is not going away. The questions are:

  • Can it be rigid?
  • Do we need legislation on this?
  • How will this impact on the nurses as we are aware of global shortage?

Optimal staffing for safe patient care should be flexible. There can never be one model suitable for all. Several factors should be taken into consideration including the patient population being cared for, the layout and technology of the hospital, the activity and skill mix (different nursing categories) and most importantly the dangerously high nurses’ turnover in the nursing units. ANA (American Nurses Association) advocates for minimum registered nurse -to- patient ratios that are flexible based on these factors.

What needs to be done
The governments especially Ministers of Health across the world need to hear this outcry.

  • Nursing education must be prioritised and be budgeted for accordingly.
  • Robust Private-Public Hospital partnership must be encouraged in terms of nursing practice in order to fight for a common goal which is to serve our communities better.

As a nurse leader who has a passion for the nursing profession and a duty to care, I would like to leave this platform knowing that there is a clear direction and a solution to this challenge.

References available on request.

Khoza will be discussing ‘Staffing model in Mauritius’, as part of the Nursing Conference on May 28, at the Africa Health Exhibition and Congress.