The Cycle of Low Nurse To Patient Ratios, Burnout, and the Nursing Shortage

May 17

Is there anything more common knowledge in the healthcare community than the nursing shortage? Water is wet, the sky is blue, and the U.S. is poised to experience one of the worst nursing crises it’s ever faced.

According to a recent article in the New Yorker, titled “Why Is The U.S. Perpetually Short of Nurses?” James Ledbetter writes that unlike other professions that operate according to a supply and demand model, nursing is perpetually short staffed. Often the reason for the shortage is attributed to one specific factor, usually burnout, or the fact that more nurses are leaving the profession than are starting.

However, these issues are not only related, but are inextricably linked.

The high ratio of patients to nurses contributes to burnout, which in turn causes nurses to leave the workplace. We’ve broken down exactly how this happens below:

How Nurse to Patient Ratios Impact Burnout

One of the most prominent factors affecting nurse burnout is the issue of nurse staffing ratios. Ideally, the nurse to patient ratio varies based on unit, but typically should not exceed 1:5, especially in the acute care fields, where the ratio should be closer to 1:2 or 1:3. However, in many hospitals, the ratio is closer to 1:6, 1:8, or more on the night shift.

When nurses are constantly juggling a high patient load, it becomes difficult to find time to rest while at work.

Further, being pressured into caring for so many patients likely leads to poorer care overall. In fact, according to the article “Proposed Federal RN Regulations — What You Can Do About It,” author Amy Blitchok writes “Unsafe and stressful working conditions have caused 1 out of 5 new nurses leave the profession completely within just 12 months of earning their licensure...In addition, 1 out of 3 nurses leave within two years of starting work.”

These sobering statistics indicate that stress is a definite precursor to burnout, and that the more patients a nurse cares for, the more likely he or she is to be stressed.

While there is an ongoing push to put legislation in place to limit the numbers of patients to nurses, as of 2017 California is the only state to have done so. While other states are considering what constitutes a safe nurse to patient ratio, these high volume days result in greater feelings of frustration and contribute to more nurses experiencing burnout in their professions.


How Burnout Exacerbates the Nursing Shortage

When nurses burn out, it’s much more serious than just feeling dissatisfied in a job. While most people have moments where they aren’t thrilled with their position, but in healthcare, nurse burnout can be literally deadly.

While many people think that nurse burnout means working too long in high stress conditions, according to Rasmussen College’s article “Nursing Burnout: What It Is and How to Avoid It,” there are significant differences between stress and burnout.

They write, “while stress is defined by over-engagement, burnout is defined by disengagement. Burnout can lead to dulled emotions and detachment. It undermines motivation, leaving a sense of hopelessness. For those experiencing burnout, every day is a bad day.” This leads to nurses becoming resentful of their fellow nurses, their patients, and even of the significant relationships in their lives.

Seun Ross, a former intensive-care nurse who is now director of nursing practice and work environment at the American Nurses Association, echoes this thought. She states in a Huffington Post article that, “A burnt-out nurse doesn’t care. She’s cynical. She’s irritable. She’s angry. She’s running out of the hospital before the end of her shift.” This kind of dulling of the emotions leads to a significant decline in the quality of patient care, since a burnt out nurse will likely not care about his or her patients.

The high likelihood of nurse burnout has contributed significantly to the nursing shortage. A recent survey by RN Network asked 600 nurses about the nursing shortage, work/life balance, and general working conditions. Of these nurses, who averaged between 25 and 55, 49% were considering leaving the nursing professional altogether. Further, 46% reported that workloads have gone up in their facilities, and 43% said their workplaces didn’t support a healthy work/life balance.

When combined with the massive number of nurses leaving the workplace to retire (in fact, n a survey conducted in 2013, the American Association of Colleges of Nursing reported that 55% of the RN workforce is 50 or older) , the number of nurses leaving the workplace due to burnout becomes troubling. Here are some nursing shortage statistics by state:

Chapter One

How the Nursing Shortage Leads To Low Nurse To Patient Ratios

Similarly, the demand for more nurses has a tangible impact on the nurse to patient ratio. Because facilities are so desperate for nurses, they offer higher salaries and more benefits. The downside is that higher salaries lead to hospitals staffing fewer nurses, which in turn leads to higher ratios of patients to nurses.

There have been strides within individual facilities to make changes, but ultimately they can’t control the number of patients who need care.

While it may seem that the cycle of nurse to patient ratios, nurse burnout, and the nursing shortage is too entwined for a solution to emerge, innovations in technology are creating new ways to approach these issues.

Will Technology Bring A Disruption To Healthcare Delivery?

In some ways, the solution to the nursing shortage is already being addressed with technology.

For example, telemedicine has become an increasingly popular option for nurses, since it allows them the freedom to work from anywhere, and nurses can potentially toggle between locations and facilities with the press of a button. In fact, there have been rumors that companies like Google and Amazon are considering developing telenursing solutions, which emphasizes that this trend isn’t going anywhere anytime soon.

Additionally, technology is bringing more flexibility to the nursing profession, including the option to work from home, to work on a contract, and more. As technology evolves, we’ll continue to develop more solutions that will improve patient ratios and will take significant steps toward creating nursing shortage solutions.

One that technology is solving the nursing shortage is by using the power of crowdsourcing to find new talent. This technology uses the power of social relationships to expand networks and connect healthcare professionals to jobs that aren’t necessarily in their area or that they might not have heard about otherwise.

Final Thoughts

Despite the cycle of nurse to patient ratios/nurse burnout/the nursing shortage, solutions are emerging every day. While some of these may be “band-aid” fixes, rather than permanent solutions, it’s refreshing to see innovators actively working to make changes to the current landscape.

Whether it is nurses leading the way to support each other in stressful situations, or companies creating new technology to address staffing shortages, hopefully we will see some movement toward a solution that’s good for facilities, and for the nurses that help them succeed.

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Molly Powers