The Issue with Nurse-to-Patient Staffing Ratios

The debate over nurse-to-patient staffing ratios has raged for years. No one can deny that patients receive better care when there are sufficient nurses on staff. However, how many nurses are enough? Is there an ideal ratio between nurses and patients to ensure adequate care? Perhaps most importantly, should there be laws that mandate specific ratios?

A shortage of experienced nurses is firing this debate. Budget cuts have forced many hospitals to slash the number of nurses they employ, which causes the remaining nurses to work long, arduous shifts. Though they work lengthy hours, nurses say they have less time to spend with patients because there simply aren’t enough of them.

Recognizing that this problem was likely to continue, California instituted a law in 2004 to address the issue. The law specified how many patients nurses could treat, limiting operating room nurses to one patient at a time while nurses in other settings could be responsible for more patients at a given time. Limits were set by researchers at the Davis Medical Center of the University of California and the California Department of Health Services using extensive survey information from hospitals across the state.

Many nurses hailed the change as being an incredibly positive transformation. Instead of providing care for 10 or more patients in a shift, they could now concentrate their efforts on between four and six patients. The results were nearly miraculous. Nurses stopped feeling overworked, they had more time to devote to patients and the number of patient errors declined.

However, the news hasn’t all been good. It is not possible to improve nurse-to-patient ratios without hiring additional staff. This has led to budgetary headaches for hospital administrators and executives. The headaches are compounded by salary raises to nurses in hopes of encouraging them to remain in an existing job.

This is not the only argument against staffing ratio laws. Hospital executives reason that the nurse’s workplace is a dynamic one that is subject to constant, and sometimes sudden, changes. A major collision on a nearby highway or a natural disaster can make the number of patients requiring care increase by an unexpectedly high amount. Staffing as if such an event will happen in every shift is wasteful, yet a hospital could easily run afoul of the law if they are not constantly prepared for such an eventuality.

Similarly, administrators say that a law that specifies nurse-to-patient ratios might significantly increase wait times in places like emergency rooms. If a nurse is limited to caring for only three or four patients at a time, she is not permitted to take on another patient in the waiting room even if none of her current patients require care. Accordingly, new patients have to keep waiting until the nurse signs of responsibility for at least one of her patients.

Despite the potential drawbacks, more states are considering instituting nurse staffing ratio laws. The transition, if it happens, is likely to be a slow one as health care service providers continue to deal with the changes brought about by the Patient Protection and Affordable Care Act of 2010. As hospitals, patients and care givers grow increasingly comfortable with these alterations, they are likely to become even more focused on the quality of care and nurse staffing ratios.

Some experts feel that the answer to the riddle may be offering better educational opportunities to nurses. When more nurses hold at least bachelor’s degrees, they will be better prepared to offer more quality care. Additionally, giving nurses the power to make decisions on the job will similarly make their jobs much more manageable.