Calling the Shots: Nursing News and Notes

Importance of Optimal Nurse-Patient Ratios

Importance of Optimal Nurse-Patient Ratios

Thursday, November 10, 2016

What is the national benchmark when it comes to nurse-patient staff ratios? Maintaining appropriate nurse staffing levels does not just promote better care, in most cases, it's the law.

But pinning down a specific number is hard to do, given the legal vagaries from state to state.

Federal regulation 42CFR 482.23(b) requires hospitals certified to participate in Medicare to "have adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care to all patients as needed. There must be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient."

Without giving a clear figure, it is left up to each state to determine how to ensure that staffing is appropriate to patients' needs. 

The Right Ratio

The American Nurses Association (ANA) supports a legislative model in which nurses are empowered to create staffing plans specific to each unit. This method allows hospitals to establish staffing levels that are flexible and account for changes including the intensity of patients' needs, the number of admissions, discharges and transfers during a shift, level of experience of nursing staff, layout of the unit, and availability of resources, such as ancillary staff and technology.

California is the only state that has legally defined required minimum nurse-to-patient ratios to be maintained at all times by unit. For example, the nurse-to-patient ratio in a critical care unit must be 1:2 or fewer at all times, and the nurse-to-patient ratio in an emergency department must be 1:4 or fewer at all times that patients are receiving treatment, the law states.

California RN-to-Patient Staffing Ratios

Type of Care

RN-to-Patients

Intensive/Critical Care

1:2

Neo-natal Intensive Care

1:2

Operating Room

1:1

Post-anesthesia Recovery

1:2

Labor and Delivery

1:2

Antepartum

1:4

Postpartum couplets

1:4

Postpartum women only

1:6

Pediatrics

1:4

Emergency Room

1:4

ICU Patients in the ER

1:2

Trauma Patients in the ER

1:1

Step Down, Initial

1:4

Step Down, 2008

1:3

Telemetry, Initial

1:5

Telemetry, 2008

1:4

Medical/Surgical, Initial

1:6

Medical/Surgical, 2008

1:5

Other Specialty Care, Initial

1:5

Other Specialty Care, 2008

1:4

Psychiatric

1:6

Improved Safety

The National Campaign for Safe RN-to-Patient Staffing Ratios is a nationwide effort to ensure safe staffing for nurses and patients across the country.

Studies have shown that appropriate nurse staffing helps achieve clinical and economic improvements in patient care, including:

  • Enhancement of patient satisfaction and HCAHPS scores
  • Reduction in medication errors, patient mortality, hospital readmissions, and length of stay
  • Improved safety outcomes by reducing incidents of falls, pressure ulcers, and healthcare-associated infections (HAIs)
  • Reduced patient care costs through avoidance of unplanned readmissions
  • Prevention of nurse fatigue.

In addition to supporting models where nurses themselves are empowered to create staffing plans and promoting flexible staffing plans, the ANA and like-minded organizations support public reporting of staffing data to promote transparency, and penalizing institutions that fail to comply with minimal safe staffing standards.

Optimal staffing is essential to providing the best care possible and getting the maximum value from RNs. Greater benefit can be derived from staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to account for unit and shift level factors.

Establishing minimum, yet adjustable, staffing levels is a good foundation for achieving safe and appropriate staffing plans.

Do your nurse-patient ratios look similar to the ones established in California? What kinds of things can hospitals be doing to support safer patient care with regards to clinical staffing?  Leave us a comment below!

 

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