Nurse-to-patient ratios, or the number of patients assigned to each nurse, vary widely, depending on factors such as type of facility and level of care required. While there are some existing regulations that mandate or suggest ratio parameters, many nurse managers must determine appropriate staffing for their facilities without much guidance. An online Master of Science in Nursing Administration (MSN) program introduces methods to optimize nurse-patient ratios while also being mindful of staffing budgets.
Why Are Nurse-to-Patient Ratios Crucial Now?
Nurse staffing has always been a challenge, but it is particularly relevant for administrators now. A 2019 American Nurses Association (ANA) membership survey found that 93% of respondents identified staffing as an “important” issue, and 72% considered it “extremely important.” An aging Baby Boomer population — a group of approximately 73 million individuals anticipated to require more complex care — coupled with the strains created by potential nursing shortages and the COVID-19 pandemic have highlighted the need for safe nurse-to-patient ratios.
Unfortunately, there are very few guidelines to assist administrators in establishing optimal staffing. A federal regulation offers general guidance for Medicare-participating hospitals by requiring them to “have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses and other personnel to provide nursing care to all patients as needed.” This has led some states to enact their own staffing regulations. California and Massachusetts have stratified nurse-to-patient ratio requirements specific to the unit and/or patient stability. As many as seven states, including Texas, require hospitals to form staffing committees that address nurse-to-patient ratio planning.
What If a Nurse Has Too Many Patients?
Appropriate nurse-to-patient ratios are associated with improved outcomes and fewer adverse events, complications and hospital re-admissions. Optimal ratios can also reduce staffing and overhead expenditures. When a nurse is tasked with caring for too many patients at one time, the quality and timeliness of care suffers. A 2017 Annals of Intensive Care study found that higher workloads for nurses correlated with a significant reduction in survival for critically ill patients. Moreover, the stress and burden placed on these nurses can contribute to decreased job satisfaction, burnout and turnover.
How Can Nurse Administrators Improve Ratios in Their Facilities?
Maintaining safe staffing requires nurse administrators to often revisit the topic of nurse-to-patient ratios. ANA supports the use of flexible staffing models that change in response to the needs of the facility or unit and the following factors:
- Severity of patient illness
- Nursing experience
- Unit layout
- Resource availability, including ancillary staff and access to technology
- Number of shift admissions, discharges and transfers
Nurse managers should regularly review schedules to pinpoint areas of concern and encourage staff to contribute to discussions about ideal ratios. For example, if you notice that staff or skill mix has shifted in the ICU — perhaps inexperienced nurses outnumber those with five or more years of experience — then you can quickly make adjustments. You may also notice increases in overtime or patient acuity, which should prompt investigation on the adequacy of staffing ratios for unit needs. Flexible ratios are beneficial for resolving the facilities’ financial concerns also, like unexpected reimbursement decreases or delays.
Nurse-to-patient ratios are an ongoing topic of conversation among healthcare leaders. Nurse administrators must understand how ratios affect the quality of patient care, nursing satisfaction and an organization’s financial stability. Certain segments of the population such as aging Baby Boomers or individuals impacted by evolving public health emergencies are likely to require more intensive care, and having flexibility in your staffing ratios will allow you to safely address these surges and maintain a high level of care.
Learn more about UTA’s MSN in Nursing Administration online program.
Sources:
Nurse.com: Nurse to Patient Ratios – Leaders Have Their Work Cut Out for Them
Nurse.org: ANA Updates Nurse Staffing Guidelines to Support Flexibility
United States Census Bureau: By 2030, All Baby Boomers Will Be Age 65 or Older
Wolters Kluwer Lippincott Nursing Education: The Importance of the Optimal Nurse-to-Patient Ratio
Wolters Kluwer Lippincott Solutions: Update on Nursing Staff Ratios
