Adding LPN Personnel to Manage the Imbalance in Nurse Patient Ratios

Nursing research requires a profound understanding of current problems in the public health sector as well as specific analytic skills (Burns & Grove, 2011). As it was identified, the problem of understaffing is one of the current prevalent issues in the health care system. The problem is formulated in the form of the following PICO question: “in a hospital with an imbalance in nurse-patient ratios, can hiring more nurses per room compare with adding LPN personnel increase on quality of care, reduce nursing stress and medical errors, and increase patient safety?” The purpose of this paper is to critically analyze a particular study on the topic as well as to discuss related ethical considerations.

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Background of the Study

The issue of understaffing has been the area of major concern within the contemporary healthcare system over the past few years. As a rule, the nurse-to-patient ratio (NPR) is used to determine the presence of nurse shortage (Burns & Grove, 2011). Currently, there has been a downward trend for the NPR globally, which has affected the quality of nursing significantly, simultaneously increasing workplace burnout levels (Burns & Grove, 2011).

In their qualitative research, MacKinnon, Butcher, and Bruce (2018) prove the significance of their study by asserting that the introduction of licensed practical nurses (LPN) into the healthcare environment will improve the quality of care. The goal of the study is to explore the experiences of nurses working in multidisciplinary teams including both registered nurses (RN) and LPN. Therefore, the research question can be defined as “How can the Care Delivery Model Redesign (CDMR) framework contribute to the promotion of interdisciplinary cooperation between RN and LPN?”

Methods of the Study

To gain a deep insight into the nature of the LPN-RN collaboration, the authors of the analysis chose the qualitative method and adopted the institutional ethnographic (IE) design (MacKinnon et al., 2018). Since the research question was rooted in the analysis of interpersonal relationships, the specified approach can be regarded as legitimate. The authors stress that the research was conducted from the perspectives of LPN and RN, particularly, the difficulties that they face when managing patients’ needs and interactions in the workplace.

MacKinnon et al. (2018) have provided extensive support for the choice of their methodology, rendering the notion of discourse and citing several crucial scholars such as Campbell and Gregor (2008) and Bisaillon and Rankin (2013) (as cited in MacKinnon et al., 2018).

Apart from articles in NPR and LPN, the authors include a range of studies that focus on social interactions. Despite some of the references being not current, as the example above shows, they provide credible information that serves as the basis for further analysis. Although the authors do not assess the strengths and weaknesses of the studies that they reference, they include the information that is sufficient for a coherent logical argument. While MacKinnon et al. (2018) do not use the grounded theory as their research method, a diagram is provided in the Methodology Section based on the literature review.

Results of the Study

According to the results of the analysis, the collaboration between RN and LPN can be enhanced through the use of the CDMR tool once the existing communication strategies and the relevant values are reconsidered. With the active promotion of cooperation and the focus on teamwork in the specified setting, the discourse within the specified environment changed significantly. Among the key themes that were located after the integration of the CMDR tool and the enhancement of communication between RN and LPN, a rapid positive change was observed. Specifically, the nature of collaboration was defined as “workful” (MacKinnon et al., 2018, p. 5).

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The specified outcomes have a tremendous effect on nursing. Particularly, they offer the tool that will help integrate LPN into the environment that used to be comprised predominantly of RN. As a result, a range of conflicts are avoided, and the quality of care rises impressively. Furthermore, nurses no longer experience the pressure of an increasingly heavy workload since the total number of responsibilities is divided between NP and LPN (MacKinnon et al., 2018). Consequently, the problem of understaffing caused by RN’s inability to manage their workload is resolved.

The findings also contribute to the promotion of nursing knowledge. The article shows that a significant change can be made once the system of workplace values is revisited and the CMDR tool is used to encourage cooperation. Therefore, the outcomes of the analysis will guide one toward more successful administration choices regarding assigning nurses with roles and responsibilities and distributing the workload.

Similarly, the area of practice will experience gradual alterations since nurses will be relieved of a significant amount of pressure and, thus provide better services to patients. Medical errors will be prevented, and all patients will receive the amount of attention and care that they need to recover (MacKinnon et al., 2018). Finally, the solution provided by the authors will encourage nurse and patient education, causing a gradual rise in the quality of patient-nurse communication and building the rates of patient awareness.

Ethical Considerations

MacKinnon et al. (2018) received the approval of the Health Research Ethics Board (“University of Victoria HREB Approval No. J2014-041)” (MacKinnon et al., 2018)) to start their research. Thus, the paper by MacKinnon et al. (2018) complies with the essential ethical standards. In addition, the researchers ensured that none of the data provided by the participants could be disclosed to the public. All data obtained from RN and LPN in the selected setting was regarded as personal and treated with due care. MacKinnon et al. (2018) considered the issue of treatment very briefly since it was not the focus of their study.


The thesis statement of this paper, which was formulated in the form of the PICO question was used as a guide for the development of this paper. Therefore, it is essential to emphasize the importance of it in the context of the conducted critical analysis. The thesis statement is congruent with the performed analysis since such a critical investigation was conducted to provide evidence for the PICO question. The most important and practically useful finding of the analysis is that the negative impact of understaffing could be efficiently facilitated by hiring additional nursing professionals.

The utility and applicability of the findings to nursing practice are also evident. The credibility of the study’s findings is determined by the use of reliable peer-reviewed sources. Therefore, the results of the article under consideration, especially about the assessment of specific characteristics of hospital settings, are highly applicable to the nursing practice. Considering the knowledge learned from this analysis, it is possible to observe that the synthesis of the information from a vast variety of quantitative studies has extended my understanding of the problem of understaffing.


Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier.

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MacKinnon, K., Butcher, D. L., & Bruce, A. (2018). Working to full scope: The reorganization of nursing work in two Canadian community hospitals. Global Qualitative Nursing Research, 5(1), pp. 1-14. Web.

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StudyCorgi. (2021) 'Adding LPN Personnel to Manage the Imbalance in Nurse Patient Ratios'. 13 July.

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