Improving Nurse-to-Patient Ratios Through Leadership

BSN Leadership & Quality Improvement

Assessment 3: Nurse-to-Patient Ratios and Safe Patient Care

(1,200–1,500 words)

Course and Assessment Context

Institution (model): BSN program, North American university (Leadership and Management in Nursing course)
Course code: NURS 432 – Leadership, Quality and Safety in Nursing Practice
Assessment name: Assessment 3 – Nurse-to-Patient Ratios and Patient Safety Position Paper
Length: 1,200–1,500-word individual written essay (excluding title page and references)
Weighting: 25% of overall course grade
Submission format: Typed, double-spaced, 12-point Times New Roman, APA 7th edition, submitted as a Word document via the learning management system

Assessment Overview

Safe nurse staffing is a core leadership responsibility and a persistent patient safety concern in acute and community healthcare settings. Appropriate nurse-to-patient ratios have been consistently linked to lower mortality, fewer adverse events, improved patient satisfaction, and better nurse retention. In contrast, inadequate staffing contributes to missed care, burnout, moral distress, and compromised quality outcomes.

For this assessment, you will write a position paper that critically analyzes how nurse-to-patient ratios influence patient outcomes in a specific practice context and proposes realistic leadership actions to improve staffing and patient safety.

Task Description

Write a 1,200–1,500-word position paper from the perspective of a BSN-prepared nurse leader, such as a charge nurse, unit-based quality champion, or emerging nurse manager. The paper should focus on nurse-to-patient ratios in one clearly defined practice setting, such as an adult medical-surgical unit, step-down unit, emergency department, pediatric ward, or long-term care facility.

Required Components

1. Practice Setting and Current Staffing Situation

• Describe the chosen clinical setting and the typical patient population, including acuity or complexity where relevant.

• Summarize a realistic current staffing pattern, such as usual RN-to-patient ratios on day, evening, and night shifts, skill mix, and use of float or agency staff.

• Identify at least two patient safety risks or quality concerns that arise from the current nurse-to-patient ratios, supported by current evidence.

2. Evidence Linking Nurse-to-Patient Ratios to Patient Outcomes

• Explain how nurse-to-patient ratios influence specific patient outcomes, such as mortality, falls, healthcare-associated infections, missed nursing care, medication errors, readmissions, or patient satisfaction.

• Refer to at least one study or authoritative report examining staffing ratios and outcomes in a setting similar to the one selected.

• Discuss how nurse workload, skill mix, and working conditions interact with staffing ratios to affect patient safety and quality of care.

3. Leadership, Policy, and Ethical Responsibilities

• Discuss the professional and ethical responsibilities of nurse leaders in advocating for safe staffing, drawing on relevant professional standards, guidelines, or position statements issued by national nursing organizations.

• Identify existing legislation, organizational policies, or workload measurement tools that influence staffing decisions in your context, such as mandated minimum ratios, acuity-based staffing models, or collective agreements.

• Reflect on how inadequate staffing contributes to moral distress, burnout, and nurse turnover, and explain how these issues further impact patient safety and care quality.

4. Proposed Leadership Actions for Safer Staffing

• Propose at least three specific and feasible leadership actions that a BSN-prepared nurse can implement at the unit or organizational level to improve nurse-to-patient ratios or reduce their negative impact on safety.

• Examples may include unit-level staffing plans, formal escalation procedures when staffing is unsafe, quality improvement initiatives addressing missed care, staff-led advocacy efforts, or participation in staffing committees and policy discussions.

• For each proposed action, explain how it could improve patient outcomes and nurse well-being, and identify potential barriers and enablers to implementation.

5. Evaluation and Use of Data

• Identify at least three measurable indicators that could be used to evaluate the impact of the proposed leadership actions, such as falls per 1,000 patient days, medication error reports, patient satisfaction scores, nurse turnover rates, or overtime hours.

• Describe practical strategies for collecting, analyzing, and presenting these data to nursing staff and organizational leaders to support continuous improvement.

• Discuss how frontline nurses can be involved in interpreting data and co-designing further changes to staffing practices.

---

6. Integration of Evidence and Academic Writing

• Support your position with a minimum of four recent, peer-reviewed sources or authoritative reports published between 2018 and 2026.

• Paraphrase evidence in your own words and integrate it logically into the discussion, avoiding excessive direct quotations.

• Maintain a clear structure with appropriate headings and an academic tone that is precise, coherent, and readable.

---

Formatting and Submission Requirements

• Word count: 1,200–1,500 words, excluding title page and reference list.

• Title page must include course code, course title, assessment title, student name, student ID, instructor name, and submission date.

• Use headings aligned with the required components.

• Double-spaced text with 2.5 cm (1-inch) margins.

• Use APA 7th edition for in-text citations and reference list.

• Submit as a Microsoft Word document (.doc or .docx) via the LMS by the specified deadline.

---

Academic Integrity

All submitted work must be original and represent the student’s own analysis and writing. All sources, including journal articles, policy documents, and reports, must be appropriately acknowledged. Plagiarism, purchasing or sharing essays, or other forms of academic misconduct will be managed in accordance with institutional policy and may result in significant penalties.

---

Marking Rubric (100 Points)

1. Practice Context and Problem Definition (15 points)

• High distinction (13–15): Clear and specific description of the clinical setting and staffing situation, with strong linkage to patient safety risks supported by recent evidence.

• Credit–Distinction (10–12): Accurate description of the setting and staffing pattern with some supporting evidence; connections between context and risk may lack depth.

• Pass (7–9): General description of setting and ratios with limited evidence or analysis of safety issues.

• Fail (0–6): Context and staffing poorly described; safety concerns unclear or unsupported.

---

2. Use of Evidence on Ratios and Outcomes (20 points)

• High distinction (17–20): Integrates high-quality, current research to clearly explain the relationship between staffing ratios and patient outcomes.

• Credit–Distinction (14–16): Uses appropriate evidence with generally accurate interpretation.

• Pass (10–13): Limited synthesis of evidence; links to context are underdeveloped.

• Fail (0–9): Minimal, outdated, or inaccurate use of evidence.

---

3. Leadership, Policy, and Ethics (20 points)

• High distinction (17–20): Insightful discussion of leadership, ethical responsibilities, and policy frameworks with clear links to advocacy and professional standards.

• Credit–Distinction (14–16): Addresses leadership and ethics with some reference to policy or regulation.

• Pass (10–13): Basic discussion of leadership or ethics with minimal analysis.

• Fail (0–9): Leadership, ethical, or policy considerations largely absent.

---

4. Proposed Actions and Evaluation Plan (25 points)

• High distinction (22–25): Specific, feasible actions supported by a coherent evaluation plan and meaningful outcome measures.

• Credit–Distinction (18–21): Relevant actions and indicators identified, though connections may lack detail.

• Pass (13–17): Actions and evaluation measures are present but limited in depth or feasibility.

• Fail (0–12): Actions vague or unrealistic; evaluation plan missing or inappropriate.

---

5. Organization, Style, and Referencing (20 points)

• High distinction (17–20): Clear, well-structured writing with accurate and consistent APA referencing.

• Credit–Distinction (14–16): Generally clear and well organized with minor APA errors.

• Pass (10–13): Adequate structure but noticeable writing or referencing issues.

• Fail (0–9): Disorganized writing with frequent errors and incorrect referencing.

Nurse-to-patient ratios determine the extent of patient surveillance, timely intervention, and therapeutic communication that nurses can provide on a busy medical-surgical unit. When ratios exceed safe levels, adverse events such as falls, medication errors, and delayed responses to deterioration become more frequent. A BSN-prepared charge nurse who actively monitors daily assignments, escalates unsafe staffing through formal channels, and contributes to staffing committee discussions can help shift the unit culture toward proactive, evidence-informed decision making. Tracking unit-level indicators such as falls, medication errors, and nurse overtime, alongside qualitative feedback from staff, provides leaders with actionable data to advocate for additional resources and refine acuity-based staffing models.

 References

Agency for Healthcare Research and Quality (AHRQ) (2020). Nursing and patient safety. Patient Safety Network (PSNet).

American Nurses Association (2019). Safe nurse staffing and patient outcomes. ANA Position Resources.

Chau, J.P.C., Lee, K.K.Y., Choi, K.C., Lo, S.H.S. and Fung, W. (2025). Associations between nurse-to-patient ratio, nurse qualifications and patient outcomes in acute care wards. Journal of Advanced Nursing, 81(2), 412–423.

Twigg, D.E., Myers, H., Duffield, C., Pugh, J.D. and Evans, G. (2021). The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review. Journal of Advanced Nursing, 77(3), 1182–1203.