Evaluate several scholarly sources to compare and contrast between the impact of a high nurse to patient ratio on the quality of care and a low nurse to patient ratio on the quality of care within a care environment.

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Evaluate several scholarly sources to compare and contrast between the impact of a high nurse to patient ratio on the quality of care and a low nurse to patient ratio on the quality of care within a care environment.

Introduction: This should be the title of your paper. The heading introduction should not be included.

The quality of effective care delivery within a healthcare setting is largely determined by the optimum nurse to patient ratio. It should be noted in this context that the ability of a nursing professional to deliver effective care to the patients is dependent on the number of patients the RN has been assigned to attend for the day. An optimum nurse to patient ratio within a care unit helps in the smooth distribution of workload and renders effective decision making (Gnanlet & Gilland, 2014). It can be stated in this context, that a care environment that is not equipped with ample care professionals but has a huge patient load is bound to cultivate poor job satisfaction and excessive workload among the existing workforce. Further, as mentioned by Knudson (2013), stretched shift hours, excessive workload and poor job satisfaction serve as the major reasons that lead to nurse’s burnout. Also, according to Watson et al. (2016), maintenance of an optimum nurse to patient ratio can help in rendering quality care services within the elderly and the neonatal care unit. It has further been stated in this regard, that effective nurse to patient ratio can play an integral role in the prevention of the high rates of morbidity and mortality among a specific care setting. This paper intends to compare the available literatures that are relatable to the research question and establish a discussion based on the findings.

Nice introduction.

Discussion: Remove colon

Several researchers have laid emphasis upon the fact that maintenance of an optimal nurse to patient ratio within a care setting can help in improving patient outcome. This paper intends to evaluate several scholarly sources to compare and contrast between the impact of a high nurse to patient ratio on the quality of care and a low nurse to patient ratio on the quality of care within a care environment.

The below section should be multiple paragraphs.

Eunhee et al. (2016) conducted a quantitative cross-sectional study in order to examine the relationship between the work environment and nurse staffing level to the incidence of medical adverse events. The researchers used a combination of the patient discharge data, facility data as well as the nurse survey data to conduct the research. The sample size considered by the researchers for the study included a total of 4864 nurses and 113426 patients and the data was collected from 58 hospitals of South Korea (Eunhee et al., 2016). The collected data was analyzed using the descriptive statistics and the elements of Nurse staffing level, work environment and adverse events and characteristics of the patients and nurses was also evaluated. The results showed that less patients allotted to each nurse reduced the frequency of adverse events. Therefore, it can be mentioned that the research study included a huge sample size and therefore the findings can be generalized. According to Driscoll et al. (2018), a higher nurse staffing could help in reducing the mortality rate of the patients within the care environment by 14%. The researchers conducted a systematic review and included a total of 35 articles (Driscoll et al., 2018). The collected data was analyzed using the meta-analysis. Therefore, it can be said that the research offers a multiple range of data from different care settings, but the number of articles included in the study is considerably minimal to generalize the results. Another research study conducted by Debra et al. (2014), investigated the relationship between nurse staffing and job satisfaction. The researchers conducted a quantitative co-relational study and included nurses who had been working for at least a period of 6 months. The sample size included 70 nurses and a combination of NWI-R (Reversed nursing work index) and Survey was used to understand the job experience of the nurses (Debra et al., 2014). The collected responses were evaluated using statistical analysis. The findings critically evaluated that the nurses experienced low level of job satisfaction due to heavy workload and were unhappy with the extensive patient load. The researchers conducted a primary study and validated the finding aligned to the research question. However, the does not shed light on the ethical considerations or the biases that could have influenced nurse’s opinion. Jeong et al. (2016) conducted a quantitative study to evaluate the relationship between workload and adverse patient outcome. A sample size of 1816 nurses was considered from 23 hospitals in South Korea. The collected data was evaluated using the logistic regression model and the findings suggested that workload was increased by non-nursing tasks and that led to adverse medical events. The study considered a sufficiently large sample size and hence the findings can be generalized. However, the study did not mention recommendation to improve practice.  Leigh et al. (2015), conducted a quantitative differential research study to investigate the impact of state ordered minimum nurse staffing on occupational health hazards. The findings suggested that post implementation of the nurse staffing law in California, the occupational injury dropped a significant 55.7 per 10,000 RN. Staplers et al. (2015), conducted a systematic review to evaluate the impact of nurse staffing on work environment and nurse outcomes. A total of 29 articles were included, which were analyzed through meta-analysis and the findings revealed a positive relationship between work environment and nurse outcomes in association to appropriate staffing. Watson et al. (2016), conducted a quantitative longitudinal study to estimate the impact of one on one nurse and patient ratio within the neonatal care unit. The data of 43 neonatal tertiary units were observed and the data was analyzed through logistic regression model. The findings revealed that mortality rates decreased with one to one nursing care in neonatal units.  West et al. (2014) conducted a quantitative-observational study and considered the secondary data of 36,168 patients. The collected data was evaluated by logistic regression model. The findings critically established that higher nursing staff prevented mortality rate within ICU setting.

It would have been nice if you had used headings and discussed each section separately.

Research questions in one paragraph, sample populations in one paragraph, limitations of the studies in one paragraph followed by the conclusion below.


Therefore, to conclude, it can be said that the studies included in the paper have shed light on the importance of maintaining an appropriate nurse staffing ratio so as to promote positive patient outcome. Therefore, healthcare policy makers must make optimal nurse staffing a mandatory criterion so as to prevent the incidence of adverse events within care setting and at the same time induce higher level of job satisfaction among nurses.

References: Center and remove the colon.

Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., … & 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 17 (1), 6-22.

Gnanlet, A., & Gilland, W. G. (2014). Impact of productivity on cross-training configurations and optimal staffing decisions in hospitals. European Journal of Operational Research 238 (1), 254-269.

Hairr, D. C., Salisbury, H., Johannsson, M., & Redfern-Vance, N. (2014). Nurse staffing and the relationship to job satisfaction and retention. Nursing Economics 32 (3), 142-148.

Kang, J. H., Kim, C. W., & Lee, S. Y. (2016). Nurse-perceived patient adverse events depend on nursing workload. Osong public health and research perspectives (1), 56-62.

Knudson, L. (2013). Nurse staffing levels linked to patient outcomes, nurse retention. Nurse Staffing Levels linked Patient Outcomes Nurse Retent 97 (1), C1.

Leigh, J. P., Markis, C. A., Iosif, A. M., & Romano, P. S. (2015). California’s nurse-to-patient ratio law and occupational injury. International archives of occupational and environmental health 88 (4), 477-484.

Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature. International Journal of Nursing Studies 52 (4), 817-835.

Watson, S. I., Arulampalam, W., Petrou, S., Marlow, N., Morgan, A. S., Draper, E. S., & Modi, N. (2016). The effects of a one-to-one nurse-to-patient ratio on the mortality rate in neonatal intensive care: a retrospective, longitudinal, population-based study. Archives of Disease in Childhood-Fetal and Neonatal Edition 101 (3), F195-F200.

West, E., Barron, D. N., Harrison, D., Rafferty, A. M., Rowan, K., & Sanderson, C. (2014). Nurse staffing, medical staffing and mortality in intensive care: an observational study. International journal of nursing studies 51 (5), 781-794.


Excellent literature review.  You provided a thorough comparison of research questions, sample population, and limitations of the studies.  I did not find where you incorporated recommendations for further research in your conclusion.


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