Nurse-to-patient ratios have been heavily debated in the healthcare arena for decades, but the most important aspect of the conversation should be remembered: the right providers need to be in place to deliver the best patient care.
Study after study shows that when registered nurses are working in environments where they have a reasonable patient load, are adequately trained for the job, and are given the proper tools to perform their duties, they provide high-quality care to their patients. Contrarily, when the patient staffing ratio is too high, or nurses do not have adequate experience to manage the acuity of certain patients, the safety of patients can be compromised.
Every patient deserves the opportunity to receive quality care. Nurses can only provide that level of patient care when they are given what they need to do the job well. The future success of the U.S. healthcare system relies on solving the complex issue of nurse staffing.
Nurses play a critically important role in ensuring patient safety while providing care. Because they monitor patients for clinical deterioration, detect and report medication errors, identify changes in a patient’s condition, and perform several other tasks, it is essential for them to be responsible for the right number and mix of patients. However, it is a complicated process to determine the proper nurse-to-patient ratio for any given shift or care unit. It requires coordination between nurses and managers, and it is based on numerous factors, including the care setting, patient acuity, and the mix of nurse skills available.
For example, while five patients per nurse may be appropriate in an acute medical-surgical unit, only one or two patients per nurse may be advisable in an intensive care unit (ICU), depending on the acuity of the patient, as noted by the Agency for Healthcare Research and Quality.
Accurately assessing factors such as patient acuity is a key consideration when balancing patient safety, nurse workloads, and equitable staff assignments. Patient acuity systems can help maintain fair nursing assignments by equitably distributing the workload, thereby reducing patient safety risks and improving satisfaction among nurses and patients. Patient acuity also needs to match the competency of the nurse in order to protect patients.
“To close the experience-complexity gap, staffing models should consider nursing competency, patient severity of illness, and safe patient-to-nurse ratios,” stated an article published by Wolters Kluwer. “It is crucial that scheduling and staffing technology solutions have access to patient acuity and nurse competency data in order to recommend safe staffing levels.”
Nurses have a desire to show up for their patients and provide them with the best care possible. Depending on where they are employed, nurses will be required to adhere to a different standard of safe nurse staffing, which will have to do with more than nurse staffing ratios.
Members of the American Nurses Association’s (ANA) Nurse Staffing Task Force defined appropriate nurse staffing as a dynamic process that aligns the number of nurses, their workload, expertise, and resources with patient needs in order to achieve quality patient outcomes within a healthy work environment. Each state and facility manages safe staffing differently, whether it is through legally mandated nurse-to-patient ratios, public reporting systems, or hospital-based staffing committees.
California is the only state that mandates a ratio for all hospital specialties. For example, a nurse in the post-anesthesia care unit may care for two patients at a time. Meanwhile, Massachusetts mandates a ratio of one patient per nurse for ICUs. Exceptions can be made as long as nurses use an acuity tool to determine that a patient is stable enough to be paired. Nine states—Connecticut, Illinois, Minnesota, New York, Nevada, Ohio, Oregon, Texas, and Washington—participate in hospital-based staffing committees to develop staffing plans.
A new regulation drafted by the New York State Department of Health requiring hospitals to assign at least one nurse for every two patients in critical care units was adopted in June 2023 by the department's Public Health and Health Planning Council. It was part of a state law signed in 2021 that mandated hospitals establish clinical staffing committees.
Meanwhile, in August 2020, UI Health of the University of Illinois issued a memo informing its staff of a proposed staffing plan that they submitted to the Illinois Nurses Association. They explained their position that patient acuity‐based staffing plans were the best for patient safety and quality outcomes.
“Staffing by acuity … recognizes the professionalism of our nurses and takes into account each nurse’s education level, expertise, skills, knowledge and experiences,” they wrote in the memo. “It means staffing the right nurse to the right type of patient at the right time. This leads to better health outcomes, more consistent and manageable nursing workloads, higher staff satisfaction and better patient experiences.”
Although each state approaches nurse staffing and ratios differently, the ANA says an increasing body of evidence shows that appropriate nurse staffing contributes to improved patient outcomes and greater patient satisfaction.
Furthermore, researchers from a 2021 study concluded that “improving hospital nurse staffing would likely save thousands of lives per year and that the associated cost would be offset by savings achieved by reducing hospital readmissions and length of hospital stays.” Their analysis found that each additional patient per nurse increased the likelihood of death, length of hospital stays, and chances of being readmitted to the hospital within 30 days.
Ultimately, healthcare facilities must ensure that the most qualified nurses work in the right environment to deliver optimal patient care. If you are eager to improve your staff’s workload while managing rising patient acuity and demand, please contact HealthStream. With our Acuity and Assignment Manager, we can help you use objective clinical charting data to drive staffing decisions and make real-time staffing to demand possible.
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