The Staffing Ratio in a Home Care Setting

Problem or Issue

The staffing ratio is a policy, practice, education, or population problem that coincides with the defined organizational aims. According to Griffiths et al. (2018), nurse staffing levels have been linked to adverse clinical outcomes, such as in-hospital fatalities. Most hospitals in the US are organized into a variety of specializations, including emergency rooms, labor and delivery, post-partum, medical-surgical units, critical care units, telemetry, and so on. Some states became the first to establish legislation requiring a minimum patient-to-nurse ratio for healthcare facilities. Depending on the patient’s complexity of care and clinical requirements, the ratio law dictates how many patients might be allocated to a nurse in a single shift. Overall, a low Registered Nurse (RN) employment rate has been linked to hospital allegations of missed care, which is a potential indication of nursing workload.

The nursing ratio is a vital issue in homecare settings as the number of patients in these facilities increases. For instance, in 2018, people aged 65 and up surpassed children under five globally (Möckli et al., 2021). The current issue caregivers face is that they regularly work beyond their mandated allocation. Most nurses, especially those caring for adults and those with terminal illnesses, exceed their limit to handle the high volume of patients, which increases yearly.

Evidence for the Problem

There are many findings on the nurse-to-patient ratios in hospitals and their link to clinical outcomes. The need to gain a detailed insight into the effect of nurse staffing on healthcare quality is growing due to worldwide estimates of a shortfall of nurses by 2025, driven by a retiree and an elderly population (Griffiths et al., 2018). Nurses frequently failed to document their assessments or follow up with home-based care patients. For other interdisciplinary teams, recording the nursing evaluation creates a clear picture of the patient’s current circumstances. Nonetheless, RNs have become overloaded due to the excessive ratio assignment and have forgotten to chart their report on time.

The Current State of the Situation

The current state of the staffing ratio is devastating and requires urgent intervention. The Bureau of Labor Statistics predicts a 15% rise in demand for RNs between 2016-2026, with 438,000 additional nursing jobs generated during that time (Department for Professional Employees, 2019). Consequently, many nurses are becoming burned out, and as a result, some have resigned from their current position. RNs are frequently understaffed on a single shift, especially during this COVID-19 pandemic, when the patient load is higher than usual. Generally, several RNs have quit and moved away from my existing facility in the previous years due to work overload, further worsening the situation.

The second factor that escalates the state of the situation is that the homecare staffing ratio is a neglected area. Home healthcare is becoming more popular, especially in the US (Clarke & Donaldson, 2008). According to the authors, no studies of home health agency staffing methods, nurse workloads, or skill mix have been conducted to date (Clarke & Donaldson, 2008). Therefore, the critical conclusion is that quality improvement (QI) plans and evidence-based studies should be conducted in this area to improve patient care outcomes.

Solution or Innovation

The most comprehensive effort is standardizing nursing personnel and outcome measures to improve quality. Essentially, this is conducted by the National Quality Forum (NQF). California was the first state to require a minimum patient-to-nurse ratio in hospitals (Clarke & Donaldson, 2008). The NQF aims to promote public health care by establishing consensus-based performance analysis and transparent accountability mechanisms for determining if healthcare services are secure, prompt, helpful, patient-centered, impartial, and practical (Clarke & Donaldson, 2008). Generally, the purpose of this measure is to ensure hospitals are staffed with qualified and enough nurses to provide better patient outcomes.

Another solution to this problem is collaboration with other healthcare workers. Healthcare delivery is hampered in different ways by a lack of care coordination in homecare services (Möckli et al., 2021). Therefore, there is a need to increase teamwork with other professionals to reduce the gap in the staffing ratio. Regarding the percentages of unregistered workers and RNs, staffing patterns fall between acute facilities and long-term care (Clarke & Donaldson, 2008). Generally, the amount of time nurses spend with patients affects the quality and depth of nursing acts and assessments.

Resources to Implement the Solution

One primary resource that can help reduce the problem is employing many caregivers and RN for homecare and other nursing settings. Recruiting and retaining more RNs is cost-effective since it can lower healthcare costs (Jeranji, 2021). Another tool that can be used is encouraging teamwork and collaboration through training the nurses on evidence-based care. Carers’ technical skills can also be improved using QI plans, especially when introducing new information technology. As a result of digital improvements, electronic devices now assist in various medical treatments. Generally, the benefits incurred after the in-service initiatives, such as reduced medication errors and mortalities, outweigh the expenditures of educating the staff.

Timeline for Implementation

The recruitment and interview process takes two weeks to complete. Once an applicant has been hired, they will have one week to work with human resources to clear their history and pass the drug test. Upon recruitment, the new employee will generally get a one-week orientation to the institution, training on the present policies and procedures, and an orientation to the existing electronic health medical record. Finally, in the next 30 days, they will undergo evidence-based learning on collaboration and safety measures.

Value of Key Stakeholders/Partners

Clinical managers (CM), charge nurses, and the HR director agreed that more staff is needed, particularly during this pandemic season. CMs are vital stakeholders because it is their job to advocate for current staffing shortages. The HR department is also critical to the success of this project since they can deliver the cost-benefit analysis to the recruitment. Additionally, charge nurses are essential to this endeavor since they oversee the department’s day-to-day operations. I have also met with RNs, non-managerial employees, and numerous nurses who work in direct patient homecare and have since felt burnout. Generally, they agreed that recruiting more staff is best done now rather than later, so our current staffing will have a lower fatigue rate and a more productive working atmosphere.

I intend to collaborate with those critical stakeholders by conducting a department-wide survey on nurse burnout due to understaffing. I will collect information mainly on the state of the situation, the impact, and what or how it needs to be addressed. The data should be measurable and generalizable to improve the validity. Finally, after gathering and analyzing this information, I will provide senior management with my current plan to expand staffing.

Implementation and Measurement of Proposed Solution

The current proposed approach can be adopted quickly and easily. The nursing department, particularly homecare, is always short staffed for every shift, and patient demand is higher during this flu season. New employment can be advertised online on the corporate website or at a job fair conducted at the hospital once the chairman and board members have approved the suggested solution. The clinical management, charge staff, and the HR director can conduct the interviews and recruit. Finally, after these new nurses have completed their orientation, they will be paired with a seasoned nurse in the facilities and those responding to homecare to undergo evidence-based learning.

A survey administered before new hires and again two months after newcomers have been working can assess recruitment success. Data collected before and after this can be utilized to evaluate the performance of the acceptable staffing ratio and nurse burnout. The number of hours worked and the number of hours set aside for employees and their families is two examples of statistics that can be analyzed. The time worked will be reduced, but the total period set aside for themselves and their families will be enhanced. Clinical managers and department directors can evaluate the success of new personnel within two months to avoid burnout by looking at the current retention trend. The number of workers retiring or being transferred to another department will drop after the installation of recruits. Overall, the staffing pattern can also be utilized to determine whether or not a project is successful.

Process of Investigation

  1. Scientist: During this project, I fulfilled this role by meeting with clinical managers, RNs, charge nurses, and HRM to identify and develop a solution to the present staffing ratio problem.
  2. Detective: I played the role of an investigator by identifying the most pressing issues and determining what might be done to address them.
  3. Manager of the healing environment: When it comes to this function, many nurses experience workload and fatigue. Therefore, the request to employ extra staff can benefit the department, but it will also assist the team in recovering from burnout.


Clarke, S. P., & Donaldson, N. E. (2008). Nurse staffing and patient care quality and safety. In Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality. Web.

Department for Professional Employees. (2019). Safe staffing: Critical for patients and nurses. Web.

Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., Smith, G. B., & Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487. Web.

Jeranji, T. (2021). Employing more nurses can reduce total health costs, study suggests. Spotlight. Web.

Möckli, N., Simon, M., Meyer-Massetti, C., Pihet, S., Fischer, R., Wächter, M., Serdaly, C., & Zúñiga, F. (2021). Factors associated with homecare coordination and quality of care: A research protocol for a national multi-center cross-sectional study. BMC Health Services Research, 21(1), 1-14. Web.

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