Why Nurse-to-Patient Ratios are Important

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As a nursing professional, you’re likely well aware that nurse-to-patient ratios have become a hot topic within the health care industry – and an increasingly important one. Numerous aspects of patient care are impacted – for better or worse – by how many patients are in your direct care.

With something that holds this much significance, you might assume that this ratio would be regulated by the federal government. It’s not. The Code of Federal Regulations only requires that facilities that accept Medicare patients “have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed.”

This doesn’t provide any clarity or concrete guidelines for medical staff and administrators to identify and maintain the appropriate number and mix of nursing staff – even though doing so is critical for you to be able to deliver the best patient care. 

This leaves states to address this issue on their own through legislation or regulations. And for states that don’t regulate staffing, medical facilities need to fend for themselves when figuring out a suitable ratio.

Dangers of Insufficient Staffing

If there are more patients than nurses available at your place of employment, your patients are at a higher risk of being hurt or having complications. RNAction.org, an American Nurses Association (ANA) website, states that insufficient nurse staffing levels by experienced RNs are linked to higher rates of patient falls, infections, medication errors and even death.

Unfortunately, factors such as reductions in nursing budgets and a growing shortage of nurses, have resulted in it becoming more common for health care facilities to operate with fewer nurses who are working longer hours. These factors exacerbate the existing nurse-to-patient ratios issue, further compromising patient care – and putting you at risk of fatigue and burnout.

Benefits of Nurse-to-Patient Ratios

Numerous studies reveal an association between higher levels of experienced RN staffing and lower rates of adverse patient outcomes. These studies have shown that appropriate nurse staffing provides numerous benefits for your patients, and for you as a professional. Some of these benefits include:

  • Improved overall patient safety due to less medical and medication errors and fewer incidents of falls, pressure ulcers and health-care associated infections (HAIs)
  • Reduced length of stay and readmissions, which leads to lower patient care costs
  • Lower patient mortality rates
  • Improved patient satisfaction and HCAHPS scores
  • Increased nurse retention rates due to higher job satisfaction and less burnout

Factors Involved in Creating Staffing Standards

Although most healthcare providers recognize that having appropriate nurse-to-patient ratios can significantly impact the safety and quality of patient care, there are many factors that need to be considered when it comes to mandating these ratios.

Nurse.org states that any nurse-to-patient ratio and staffing plan must include certain recommendations. Some of these recommendations include:

  • Establishing adjustable minimum numbers of RNs, based on the level of education, training and experience of the RNs providing care, as well as the specific needs of each unit (e.g. the number of patients and the variable intensity of care needed)
  • Considering the staffing levels and services provided by other health care personnel associated with nursing care
  • Taking into account other factors impacting the delivery of care, including unit layout and available technology
  • Ensuring that RNs are not forced to work in units where they are not trained or experienced

While it is extremely difficult to account for such a variety of factors, you’ll probably agree that these are all considerations that would lead to optimal staffing.

Potential Solutions to the Lack of Regulation in Nurse-to-Patient Ratios

Given that creating and maintaining an appropriate nurse-to-patient ratio is one of the top ways to ensure the you are able to provide quality care to your patients, the American Nurses Association is working to offer solutions to improve patient care across the United States.

One of the potential solutions to this existing staffing issue is to allow health care facilities to determine their own staffing levels through a nursing committee. The committee would have the ability to adjust the nurse-to-patient ratio based on each unit, depending on the unit’s specific needs. Doing so would allow hospitals to create flexible staffing levels that can account for changes such as:

  • The number of admissions, discharges and transfers during a shift
  • The intensity of patients’ needs
  • Level of experience of the nursing staff
  • Availability of resources like ancillary staff and technology

Other suggestions the association has proposed include asking the government to mandate certain requirements and requiring that health care facilities make their nurse-to-patient ratios available to the public. The purpose of public reporting of staffing data would be to promote transparency and penalize facilities that aren’t in compliance with the minimal safe staffing standards set forth.

There is a lot of work ahead in this area, but policies surrounding optimal nurse-to-patient ratios are essential for making positive changes in health care. In the end, safe staffing standards will enable you to provide optimal patient care, while creating a healthier working environment for you and your colleagues.

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