Management and Leadership Approaches to Nursing Staffing Ratios

Management and Leadership Approaches to Nursing Staffing Ratios


Health care organizations are having difficulty in delivering quality patient care because of the issue with the identification and maintenance of appropriate numbers of nursing staff. In the recent years, the medical community has engaged in nurse-to-patient ratios debate, and some individuals have argued for government involvement in minimum staffing laws. The states of California and Massachusetts are the only one in the country that have passed legislation regarding mandatory nurse-to-patient ratios (Mark, Harless, & Spetz, 2009). On the same note, California is the only state that has implemented the law. Conversely, nursing unions in other states are busy fighting for their rights. However, since the successfulness of California, other states have failed to implement nurse-staffing laws because most hospitals refused to participate. Nursing shortages in the country would lead to nurses experiencing stress, job burnout and as a result, patients’ lives would be in danger. The leadership and management approaches to the nurse staffing ratios can help to provide a nursing environment conducive to everyone and eliminate the adverse effects of inappropriate nurse staffing ratios.

The Approaches by Nursing Leaders and Managers on the Nurse Staffing Ratios

Management in a medical profession is something that requires adequate skills and determination to perform the tasks. The managers have an obligation to run the healthcare institutions by ensuring that the workers play their roles. Similarly, in situations of poorly performed tasks, the blame will fall to the same managers; therefore, it is important for the managers to ensure the nurses carry out their duties with minimal errors. With the nurse staffing ratios issue, managers in medical institutions are affected because nursing shortages have high chances of increasing errors in the healthcare facilities (Wong, Cummings, & Ducharme, 2013). Patients have the opportunity to experience improper treatment while the nurses endure burnout. Health care facilities with low nurse-to-patient ratios are worse-off compared to those with high nurse-to-patient ratios. Apart from the problems that patients receive, nurses have trouble to deliver their services (Marquis & Huston, 2009). They feel discouraged and overworked because they have to attend to a larger number of patients. The managers have the responsibility to assess the working environment and determine how they can assign and manage the nurses. For instance, to reduce burnout, the managers can decide to recreate the working schedules. Moreover, in situations when nurses attend to a large number of patients, the manager of a medical institution should ensure that the nurses get enough recovery time before they embark to another shift.

In a nursing profession, the role played by leadership is different compared to the management. For instance, in a health care organization, managers are assigned to their positions, but leadership is found within the personnel despite the position they hold (Marquis & Huston, 2009). Leaders have the task to motivate and inspire people around them to attain both the personal and organization’s goals. Studies by various authors on the relationship between nursing leadership and patient outcome are quite fascinating. The results show that there is a definite link between nursing leadership and patient outcome. For example, the studies associated transformational leadership with reduced medication errors. Transformational leadership encompasses a leadership style whereby people get inspired to change for the better because of the behavior of their leaders (O’Neill, 2013). Leaders perform beyond their expectations; they do not put their interest first because they prioritize what is best for the people. Transformational leaders portray the ability to inspire and motivate their followers; hence, creating high-performance workforces (O’Neill, 2013). They instill vision and motivate their staff. When leaders take this approach, it means that things inside the hospital will be done much more carefully. In addition, the leadership style relates to the nurse staffing strategy that focuses on empowering and valuing nurses and this will result in the hiring of additional and more experienced nurses. Patients have the chance to get better care and treatment if nurse leaders develop their technology literacy skills and enhance their emotional intelligence (O’Neill, 2013).

Wong, Cummings, and Ducharme (2013) conducted research on the relationship between nursing leadership model and patient outcome by performing qualitative analysis. Besides, the group determined the individual nurse motivation. After the quality assessment on the method used, the author concluded that there exist a positive relationship between the two subjects. In an environment where nursing staffing ratios are the problems, it is ideal for a leader to use the relational leadership approach. Relational leadership style includes transformation and collaborative styles. Precisely, the approach accepts all viewpoints and background. With this method, nurse leaders can gather information concerning nursing staff ratios. For instance, if leaders can incorporate ideas from their employees, they have a high chance of improving the working environment (Manz, 2005).

Personal Approach to the Issue

I will prefer to use a relational leadership approach to handling this problem because from my past leadership experiences; I love to involve everyone in my decision-making processes. I encourage people to provide their feedbacks and criticism about my leadership style. Moreover, I came to realize that I perform well when I am inclusive of suggestions and ideas from other people. My approach that would solve the low nurse-to-patient ratios would involve gathering information from nurses regarding the areas they enjoy and feel oppressed. I would assign nurses the longest shifts or most patients in areas they enjoy most. Conversely, concerning areas they dislike, I would assign nurses the least number of shifts or patients. In addition to creating a favorable working environment for nurses, I will try to mix the schedules after every three weeks. As a leader, I will employ my leadership skills and keep my nurses motivated.

In conclusion, the existence of low nurse-to-patient ratio in a medical institution can create an adverse environment for both the patients and the nurses. Leaders and managers often make varied approaches that would ensure successful health care facilities. The different leadership styles and management strategies are critical in creating a favorable environment. My approach would focus on the interests of the nurses. The approach will ensure that the nurses are motivated, and they work in an environment that is conducive to them. Moreover, since nurses have enough knowledge about the problem, I will ensure that they are fully involved in the decision-making process. Lastly, in situations of low nurse-to-patient ratios, healthcare organizations should make sure that they do their best to motivate nurses.



Manz, C.C. (2005). The leadership wisdom of Jesus: Practical lessons for today. San Francisco: Berrett-Koehler.

Mark, B., Harless, D. W., & Spetz, J. (2009). California’s minimum-nurse-staffing legislation and nurses’ wages. Health Affairs, 28(2), w326-w334.

Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application. Lippincott Williams & Wilkins.

O’Neill, J. A. (2013). Advancing the nursing profession begins with leadership. Journal of Nursing Administration, 43(4), 179-181.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.



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