Nurse patient ratio and how it impacts patient care

Nurse patient Ratio and How it impacts patient care



Nursing is one of the most important services in the healthcare system delivered through professional nurses. The nurses play an essential part in patient care, including diagnosis, drug prescription, self-care education, guidance, psychiatric care, and assistance for coordinated care. In delivering the various services for the patient’s wellbeing, the nurse-patient ratio highly impacts the timeliness and quality of care, among other aspects of care.  An increased ratio of nurses to patients reduces the amount of work per nurse and thus provides for timely care and reduced nurse burnout, which is also associated with poor quality of healthcare services (Cho et al., 2017). The research aims to establish the impact of inadequate nurse-patient ratio on the quality of care, which is hypothesized to have an inversely proportional relationship. This paper will review two research articles on the impact of the nurse-patient ratio on the quality of care and the wellbeing of the nurse practitioners.


 The search for the articles was done on the Google Search Engine and the “Google Scholar” database to acquire the relevant research articles for the research. The main search keywords include “patient-nurse ratio,” “impact of a nurse shortage,” and “nurse shortage and quality of care.” The search provided a list of numerous articles relevant to the topic of study on the impact of nurse shortage on the quality of care. The articles included in the literature review are those aged five years and below (From 2017 to 2021). This ensured that the articles chosen were the most recent with relevant content. The articles also included for the literature review are research articles and not personal opinions.

Identified Articles

There are two main articles registered for literature review after the search from the online database. The two articles include Chen et al. (2019) and Driscoll et al. (2018).

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Chen et al. (2019)

The research study aimed to investigate the effects of the patient-nurse ratio on the nurses’ intention to leave and considering the mediation roles of burnout and job dissatisfaction. The authors wanted to establish whether the ratio affects the nurses’ view towards the nursing profession, leads to underlying stress and job dissatisfaction. The quantitative study analyzed cross-sectional surveys on the average daily patient-nurse ratios (ADPNR), personal burnout of the nurses, client-related burnout, intention to leave, and job dissatisfaction, among other aspects. The study conducted for 1409 full-time RNs in the medical and surgical wards indicated a relationship between the ADPNR levels and the intention to leave the nursing job, mediated by the factors of personal burnout, job dissatisfaction, and client-related burnout. According to the results, high ADPNRs predicted high client-related burnout, personal burnout, and job dissatisfaction that contributed to the nurses’ intention to leave the workplace or the nursing profession. The research concluded that an increased patient-nurse ratio induces high levels of personal burnout, dissatisfaction, and client-related burnout that eventually increase the nurses’ intention to leave their job.

Driscoll et al. (2018)

Driscoll et al. (2018) identified the lack of an optimal number of nurses in acute care hospitals for high-quality delivery of services. The purpose of the systematic review and meta-analysis examination was to examine the association between the nurse staffing levels and the nurse-sensitive outcomes in the acute specialist units. The research included articles published between 2006 and 2017 from nine electronic databases. The articles considered for the study were cross-sectional, utilizing large administrative databases. According to the research article, higher staffing levels were associated with reduced medication errors, mortality rates, restraint use, ulcers, hospital-acquired infections, pneumonia, higher use of aspirin, and timeliness in care for the percutaneous coronary complications. These results generally indicated that the increased ratio of nurses to the patients reduced the strains leading to a positive patient outcome. The study concluded that nurse-to-patient ratios highly influence patient outcomes, especially on key quality indicators such as timeliness of care, mortality rates, and risks to HAIs.


The results of the two research articles indicated a positive relationship between the number of nurse practitioners in a healthcare environment, their workload, and the quality of services delivered. Chen et al. (2019) sought to establish the intent to leave among the nurses due to high patient-nurse levels, while Driscoll et al. (2018) sought to establish the impact of nurse-patient ratios on the patient outcome. The two studies focus on establishing the impact of high patient-nurse ratios in the delivery of healthcare services by the nurses, which can be measured on both the healthcare providers and the patients. The two studies conducted meta-analytic reviews on other previous studies for the quality conclusion. The quantitative studies obtained cross-sectional articles, which are effective for analyzing the situation of the nursing environment. The studies had limitations that would affect their reliability. Driscoll et al. (2018) established that some studies combined patients from special units and those from non-special units, thus weakening the findings. Chen et al. (2019) cited limitations of the study, such as the unidentified worker-survival effect since even on standardized ADPNR, the nurses indicated different responses to burnout, work dissatisfaction, and intention to leave, thus affecting the conclusively of the findings.


In conclusion, the two articles are relevant and provide conclusive findings supporting the reduction of nurse shortage in increasing the nurse-patient ratio, which is associated with poor quality of services. Apart from the low nurse-patient ratio causing poor patient outcomes, the issue also affects the wellbeing of the nurses, who should be emotionally, physically, and psychologically stable while delivering patient care. Healthcare institutions should thus consider increasing the ratio of nurses to patients to increase the patient care outcome and reduce adverse effects such as high rates of nurse burnout, work dissatisfaction, untimely care, and intention to leave.


Chen, Y. C., Guo, Y. L., Chin, W. S., Cheng, N. Y., Ho, J. J., & Shiao, J. S. (2019). Patient-Nurse Ratio is Related to Nurses’ Intention to Leave Their Job through Mediating Factors of Burnout and Job Dissatisfaction. International journal of environmental research and public health, 16(23), 4801.

Cho, S. H., Mark, B. A., Knafl, G., Chang, H. E., & Yoon, H. J. (2017). Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care. Journal of Nursing Scholarship, 49(3), 347-355

Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2018). The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: a systematic review and meta-analysis. European journal of cardiovascular nursing: journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 17(1), 6–22.

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