INVESTIGATION ON THE RELATIONSHIP BETWEEN NURSE STAFFING RATIOS AND PATIENT OUTCOMES IN EMERGENCY WARDS, MAITAMA GENERAL HOSPITAL

CHAPTER ONE

INTRODUCTION

Background to the Study

It a well noted fact that the quality of healthcare delivery is significantly influenced by the staffing ratios in hospitals, particularly in high-demand areas like emergency wards. Nurse staffing ratios—defined as the number of patients assigned to each nurse—play a critical role in determining patient outcomes. A lower nurse-to-patient ratio ensures that nurses can provide better quality care, closely monitor patients, and respond to emergencies more efficiently. According to the World Health Organization (WHO), there is a growing recognition that healthcare systems must prioritize nurse staffing ratios to enhance patient care, especially in emergency departments where patients often require urgent and complex interventions (WHO, 2021). 

Undoubtedly, patients in emergency units require urgent care to stabilize their health. Timeliness of care is feasible with an appropriate staffing-to-patient ratio in emergency units. Ball et al. (2018) found that low staffing levels lead to patient mortality, missed nursing care, nurse burnout, dissatisfaction, and failure-to rescue rates. In emergency units, patient needs are higher than in non-emergency units, and patients depend on the nurses to have their needs met. Aiken (2018) highlighted in emergency wards, the need for prompt, effective medical interventions is paramount, and nurses serve as the frontline workers responsible for delivering this care. Thus inadequate nurse staffing ratios can lead to negative patient outcomes, including increased mortality rates, longer hospital stays, and a higher incidence of medical errors. In a study conducted in the United States, hospitals with higher nurse staffing ratios reported better patient outcomes, including lower mortality rates and fewer preventable complications (Griffiths et al., 2018).  According to Kyung Jin Hong et al., (2021), For the best patient outcomes, healthcare leaders must continually focus on enabling nurses to perform at their best. Nurse staffing levels impact the nurse's ability to improve the patient experience. 

In contrast, hospitals with insufficient nurse staffing often witnessed a decline in patient care quality, which is a growing concern in resource-constrained healthcare systems. Research indicates that nurse burnout is closely associated with suboptimal patient outcomes, such as increased rates of hospital-acquired infections and complications (Kutney-Lee et al., 2016). According to Dall’Ora & Donald (2020), nurses in emergency wards face significant physical and emotional demands due to the fast-paced environment and high patient turnover.  Howbeit, when nurses are overloaded with too many patients, they may experience burnout, fatigue, and job dissatisfaction, which can further impact the quality of care they provide This points to the importance of maintaining optimal staffing levels, particularly in emergency wards where patients’ conditions can deteriorate rapidly without proper care. 

In Nigeria, healthcare facilities face challenges in maintaining adequate staffing levels due to budgetary constraints, workforce shortages, and other systemic issues. Despite these challenges, emergency wards remain critical areas that demand adequate staffing to ensure timely and quality care for patients. The role of nurse staffing in improving healthcare outcomes in Nigerian hospitals remains under-researched, despite its clear relevance to patient care. This study seeks to investigate the relationship between nurse staffing ratios and patient outcomes in the emergency wards of Maitama General Hospital. 

1.2 Statement of the Problem

The increasing demand for healthcare services in emergency wards, coupled with workforce shortages, has heightened concerns about nurse staffing ratios. Especially as evidence by Griffiths et al., (2018) suggests that inadequate nurse staffing leads to understaffed emergency units and likely to have less time to attend to patient requests and educate them. Inadequately qualified nurses in the ED can lead to medication errors, falls, and poor communication with patients, negative patient outcomes, including delayed care, increased medical errors, and patient dissatisfaction

Bizzarely, in a recent assessment of Nigerian healthcare systems by Ogunfowokan, Adeyemi & Afolabi (2021), findings indicated that many public hospitals operate with fewer nurses than needed, especially in high-pressure departments like emergency wards. The impact of these staffing shortages on patient outcomes remains understudied, creating a gap in understanding how staffing challenges affect the quality of emergency care in Nigerian hospitals.  The problem is further compounded by the high patient turnover in emergency wards, where timely interventions are crucial. When nurses are assigned too many patients, they may struggle to provide individualized care, leading to negative outcomes such as prolonged hospital stays, readmissions, and increased mortality rates.

Although existing studies, such as Aiken et al. (2018), have demonstrated the importance of adequate staffing in reducing mortality and improving patient recovery. Aiken et al., (2018) highlighted the negative impact of poor nursing staff ratio on patient outcomes, including poor quality of care, increased mortality, decreased patient satisfaction, and an increase in adverse events such as medication errors, falls, pressure ulcers, infections, and readmission. However, no such comprehensive study has been conducted within the Nigerian context, particularly in the emergency wards of Maitama General Hospital. Additionally, there is a lack of data on how nurse staffing ratios affect the quality of care in specific Nigerian hospitals. While some studies have explored general staffing issues in Nigerian healthcare, none have focused on emergency departments in Maitama General Hospital. This study addresses this gap by examining the correlation between nurse staffing ratios and patient outcomes in the emergency department of Maitama General Hospital.

1.3 Objectives of the Study

The objective of this study is focused on the relationship between nurse staffing ratios and patient outcomes in the emergency department of Maitama General Hospital. Specifically the study seeks to:

To assess the relationship between nurse staffing ratios and patient outcomes in the emergency wards of Maitama General Hospital.

To determine the effect of nurse staffing ratios on patient recovery times and satisfaction in the emergency wards.

To examine the challenges that nurses face in maintaining quality care in under-staffed emergency wards.

To provide recommendations for improving nurse staffing ratios to enhance patient outcomes in emergency wards.

Research Questions

What is the relationship between nurse staffing ratios and patient outcomes in the emergency wards of Maitama General Hospital?

How do nurse staffing ratios affect patient recovery times and satisfaction in the emergency wards?

What challenges do nurses face in providing quality care in under-staffed emergency wards?

What recommendations can be made to improve nurse staffing ratios and patient outcomes in emergency wards?

Research Hypotheses

Ho: There is no significant relationship between nurse staffing ratios and patient outcomes in the emergency wards of Maitama General Hospital.

Hi: There is a significant relationship between nurse staffing ratios and patient outcomes in the emergency wards of Maitama General Hospital.

Significance of the Study

Practically this study has significanct implications for healthcare management, particularly in public hospitals in Nigeria. By identifying the impact of nurse staffing ratios on patient outcomes, hospital administrators can make informed decisions regarding staffing policies, ensuring that emergency wards are adequately staffed. This will improve patient care, reduce hospital-acquired complications, and enhance overall patient satisfaction.

Theoretically the study contributes to the body of knowledge on healthcare staffing and its effect on patient outcomes. It provides empirical evidence on the relationship between nurse staffing ratios and patient care quality in Nigerian hospitals, which has been under-explored in existing literature. The findings will also inform future research on healthcare workforce management in resource-limited settings.

Scope of the Study

The study focuses on the emergency wards of Maitama General Hospital, Abuja. It examines the relationship between nurse staffing ratios and patient outcomes, specifically looking at recovery times, patient satisfaction, and medical complications. The content covers nurse staffing, patient outcomes, and challenges in emergency care within the hospital's emergency wards.

1.8  Limitations of the Study

One limitation of the study is the reliance on self-reported data from nurses and patients, which may introduce bias. Additionally, the study is limited to Maitama General Hospital and may not reflect staffing conditions in other Nigerian hospitals. Furthermore, the study may be constrained by the availability of hospital records and data on patient outcomes. Regardless of this limitation, the study provided insight on administrative path of healthcare managers concerning the cost, relevance, and improvement of quality healthcare services for patients, nurses, and members of the community. It could also improve patient outcomes, nurse staffing to patient ratio, and patient experience in general.

1.9 Definition of Terms

Nurse Staffing Ratios: The number of patients assigned to each nurse in a hospital setting.

Patient Outcomes: The health results experienced by patients, including recovery time, satisfaction, and medical complications.

Emergency Wards: Hospital departments where patients with urgent medical conditions receive immediate treatment.

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