Academic journal article Asian Social Science

The Impact of Patient to Nurse Ratio on Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-Sectional Study

Academic journal article Asian Social Science

The Impact of Patient to Nurse Ratio on Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-Sectional Study

Article excerpt

Abstract

Background and objective: Nursing shortage and inadequate hospital nursing jeopardized quality of care and patient safety. This study aims to predict the impact of patient to nurse ratio on quality of care and patient safety in medical and surgical wards in Malaysian private hospitals.

Methods: Cross-sectional data collected by questionnaire from 652 nurses working in the medical and surgical wards in 12 private hospitals participated in the study. Stratified simple random sampling performed to invite small size (less than 100 beds), medium size (100-199 beds) and large size (over than 200) hospitals' nurse to participate in the study, which allow also nurses from all shift to participate in the study from the participated hospitals.

Results: Nurses with higher ratio of patients have greater negative association on quality of care and patient safety. However, this negative association significantly associated with patient safety, whereas insignificantly associated with quality of care.

Conclusions: Staffing level inconsistently associated with quality of care and patient safety, so there is at least one intervening process factor mitigate the negative impact of nursing shortage on quality of care in Malaysian hospitals. However, nurses delivering care for 11-15 patients and nurses delivering care for more than 15 patients had significant negative impact on both quality of care and patient safety at a p<0.05 significance level compared with those caring for less than 5 patients.

Keywords: patient to nurse ratio, nurse adequacy, hospital size, staffing level, quality of care, patient safety

1. Introduction

To 'Err Is Human' report by an Institute of Medicine (IOM), stated that 98,000 deaths occurred annually as result of medical errors in United States (IOM, 2000). Adverse events occurred for 17% of all admitted patients in Australia (Wilson et al., 1995). In European countries there are inadequate hospital nursing to fulfill the rising demand in the health care facilities which in turn associated negatively with quality of care and patient safety (Hinno, Partanen, & Vehviläinen-Julkunen, 2011). However, in Malaysia increasing demand and cost of care with lack of resources threaten the performance of Malaysian health system (Country health plan MOH, 2011). Whereas, the mismatch between patient flow and staffing level lead to increase workload which in turn threatens the performance of care (Boyer et al., 2012). Furthermore, according to the Annual Report of Ministry of Health (MOH) Malaysia (2011) the performance of nurses working in private hospitals lower than nurses working in public hospitals (MOH, 2011). Thus, the main purpose of the study is to explore the effect of staffing adequacy on quality of care and patient safety in Malaysian private hospitals.

Adequate staffing is important to sustain quality of patient care (Aiken, Clarke, & Sloane, 2002; Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002; Newhouse, Himmelfarb, & Morlock, 2013). Study conducted in 12 European country and US found that, better working environment and low patient to nurse ratio improve quality of care, patient safety and patient satisfaction (Aiken et al., 2012). Furthermore, higher nursing ratio in the department increase their time spending with patients which in turn affect the outcome of patients care (Brooten, Youngblut, Kutcher, & Bobo, 2004). Thus, adequate staffing level is required to improve quality of patient care (Newhouse et al., 2013). However, one study conducted in China found that high patient nurse ratio negatively associated with quality of care and job outcome but not associated with patient care outcome (You et al., 2013). This, finding raise the interest of investigating the impact of patient to nurse ratio in one more East Asian country like Malaysia. However, , it is difficult to identify the causal relationship between high workload and quality of patient care, and should consider patients and providers related factors which affecting the treatment process and outcome (Hillner, Smith, & Desch, 2000). …

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