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Nurse Staffing Ratios and Patient Safety

Nurses play a critical role in patient safety by monitoring patients, detecting errors or changes in condition, and communicating with the healthcare team. They spend significantly more time at the bedside than physicians. Several studies have linked higher nurse-to-patient ratios with increased safety risks, morbidity, and mortality. While nurse staffing ratios are one factor, overall nursing workload is also important for patient outcomes. Determining appropriate staffing levels requires consideration of patient acuity, staff skills, and unit characteristics. Staffing guidelines vary by care setting, with intensive care generally having lower ratios than medical-surgical units.

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Melody B. Miguel
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100 views2 pages

Nurse Staffing Ratios and Patient Safety

Nurses play a critical role in patient safety by monitoring patients, detecting errors or changes in condition, and communicating with the healthcare team. They spend significantly more time at the bedside than physicians. Several studies have linked higher nurse-to-patient ratios with increased safety risks, morbidity, and mortality. While nurse staffing ratios are one factor, overall nursing workload is also important for patient outcomes. Determining appropriate staffing levels requires consideration of patient acuity, staff skills, and unit characteristics. Staffing guidelines vary by care setting, with intensive care generally having lower ratios than medical-surgical units.

Uploaded by

Melody B. Miguel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Nurses play a critically important role in ensuring patient safety while providing care directly to patients.

While physicians make diagnostic and treatment decisions, they may only spend 30 to 45 minutes a day
with even a critically ill hospitalized patient, which limits their ability to see changes in a patient’s
condition over time. Nurses are a constant presence at the bedside and regularly interact with
physicians, pharmacists, families, and all other members of the health care team and are crucial to
timely coordination and communication of the patient’s condition to the team. From a patient safety
perspective, a nurse’s role includes monitoring patients for clinical deterioration, detecting errors and
near misses, understanding care processes and weaknesses inherent in some systems, identifying and
communicating changes in patient condition, and performing countless other tasks to ensure patients
receive high-quality care.

Nurse staffing and patient safety

Nurse staffing ratios

Nurses' vigilance at the bedside is essential to their ability to ensure patient safety. It is logical,
therefore, that assigning increasing numbers of patients eventually compromises a nurse’s ability to
provide safe care. There are many key factors that influence nurse staffing such as patient acuity,
admissions numbers, transfers, discharges, staff skill mix and expertise, physical layout of the nursing
unit, and availability of technology and other resources.1,2

Several seminal studies linked in this sentence have demonstrated the association between nurse
staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity, and
even mortality as the number of patients per nurse increases. The strength of these data has led several
states, beginning with California in 2004, to establish legislatively mandated minimum staffing ratios.
According to the American Nurses Association, only 14 states have passed nurse staffing legislation as of
March 2021 and most states do not specify registered-nurse (RN)-to-patient ratios, which vary by state
and are also setting-dependent.

The nurse-to-patient ratio is only one aspect of the relationship between the nursing workload and
patient safety. Overall nursing workload is likely linked to patient outcomes as well. A PSNet Classic 2011
study showed that increased patient turnover was also associated with increased mortality risk, even
when overall nurse staffing was considered adequate. Determining adequate nurse staffing is a very
complex process that changes on a shift-by-shift basis. It requires close coordination between
management and nursing and is based on patient acuity and turnover, availability of support staff and
skill mix, and settings of care. The process of establishing nurse staffing on a unit-by-unit and shift-by-
shift basis is discussed in detail in this WebM&M commentary.

Nurse staffing and settings of care

Acute Care Hospitals: The Centers for Medicare & Medicaid Services (CMS) requires hospitals to ensure
that there are adequate numbers of licensed RNs, licensed vocational (practical) nurses (LVN), and other
staff to provide nursing care to patients as needed (42 Code of Federal Regulations (42CFR
482.23(b)),but does not require specific ratios. Nurse-to-patient ratios are setting-dependent; while five
patients per RN may be appropriate in the acute medical-surgical units, intensive care units have a ratio
of one or two patients per RN, depending on the acuity of the patient. In California, the nurse patient
ratio in the emergency department is one nurse to four patients. In recent years, more states are
acknowledging that better staffing ratios are important to improved patient outcomes. In fact, Dall et al.,
2009, found that there were economic benefits to hospitals with better staffing arising from decreased
hospital length of stay.3

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