Two female nurses working together

The Proper Nurse-Patient Ratio and Quality of Care

According to the Journal of Nursing, multiple research studies have demonstrated that an inadequate nurse-patient ratio can increase the chance of adverse outcomes for patients. However, in spite of this data, many hospitals still operate with a shortage of nurses. Until the law mandates a specific nurse-patient ratio for all hospitals, nurses must do everything in their power to ensure that a shortage of qualified nurses does not affect patient safety and the quality of their care.

Understanding the Effect of Nurse-Patient Ratios

Nurse-patient ratios are important for several different reasons:

1. Nurse-Patient Ratios Affect Care

Perhaps most importantly, nurse-patient ratios have a direct effect on the quality of care patients receive on a daily basis. When a nurse is responsible for too many patients at one time, he or she may miss important signs or symptoms of complications among one or more patients. He or she is also more likely to make mistakes that affect patient care, such as inaccurate dosing of medication or forgetting to provide needed treatments altogether.

2. Nurses Suffer When Patient Loads Are Too Cumbersome

According to American Nurse Today, the average nurse lifts a cumulative weight of 1.8 tons during an eight-hour shift, leaving many nurses at risk for musculoskeletal disorders (MSD). When more patients are added to a nurse's list of responsibilities, the weight they must lift throughout the day increases, and the risk of MSDs rises as well. In addition, those with nursing careers are also more likely to become exhausted and burnt out when they are forced to care for an unreasonable number of patients.

3. Hospitals Lose Money

When quality of care decreases, the incidence of adverse outcomes increases. This costs the hospital money in the form of readmissions, additional surgical procedures and much more. Likewise, when nurses develop work-related injuries and illnesses as a result of their workload, the hospital loses even more money to worker's compensation, re-staffing, and other related costs.

Existing Law and Policies

Several states have explored the possibility of mandating a minimum nurse-patient ratio. In fact, California passed a law in 1999 that required medical surgical units to have at least one nurse for every six patients.

In 2005, the minimum ratio was changed to one nurse for every five patients. In Massachusetts, ICU units must maintain a ratio of one nurse to one patient or one nurse to two patients, depending on the patients' conditions. In addition, several other states have passed laws requiring hospitals to form staffing committees and create responsible plans at their discretion.

Unfortunately, publishing a generalized minimum staffing ratio can be somewhat problematic. It doesn't take into account all of the variables nursing units may face, such as the condition of patients, hours worked, or level of responsibility. Because of these variables, a ratio that is appropriate for one nursing unit may not be appropriate for another. Furthermore, nationwide nursing shortages make it difficult for many hospitals to adhere to stringent guidelines without requiring nurses to work unreasonable hours.

Thus, some organizations, such as the American Nurses Association, support legislative models in which specific units can create flexible staffing plans to meet their needs, as opposed to state or federally mandated rules.

Dealing with Shortages

Even when laws are in effect or nursing units come together to create ideal staffing plans, ratios can still fall below desirable levels. Nurses who are forced to work in units with a staffing shortage run the risk of compromising patient care. To ensure quality care for all patients, nurses dealing with staffing issues can follow the tips below.

1. Work as a Team

When a unit is operating without enough nurses, efficient organization of the workload can improve patient care and reduce the burden on individual nurses. One of the best ways to organize tasks is to sit down with all members of the team, make a list of the unit's duties and formulate a plan for carrying them out in the most effective and efficient manner possible.

2. Delegate to Subordinates

Some of a nurse's tasks can be easily delegated to subordinates, such as unlicensed staff working in the unit. Delegating these tasks reduces the nurse's workload, allowing him or her to focus on other duties and provide a better quality of patient care. However, when delegating tasks, nurses must be careful to retain the duties that affect patient care most. For example, while an unlicensed staff member may be sent to the patient's room to record urine output, weight or other stats, the licensed nurse should always interpret them.

3. Prioritize Tasks to Improve Care

When a nurse is overwhelmed with too many duties, he or she should always complete the most important tasks first. For example, preparing one patient for scheduled surgery should typically be handled before discussing an elective medication change with another patient.

Nursing careers can be very rewarding, although sometimes they can be challenging, as well. When nurses are responsible for too many patients at any given time, they must get creative in their pursuit of a high level of patient safety and quality care.