Look Beyond Nurse-Patient Ratios

Nurses who advocate for patient safety often cite nurse staffing ratios as a top concern. Evidence suggests more education for nurses, not a mandated, one-size-fits-all approach to staffing, is a better way forward.

5 comments on "Look Beyond Nurse-Patient Ratios"
Deb (4/17/2014 at 11:05 PM)

I have worked in nursing for a long time. I have seen administrative nurses counted as staff caring for patients who were not on the floor providing care. Hospitals who show two sets of scheduled staff. The reality based unsafe numbers and the perfect overstaffed numbers of patient care assignments Hospitals have notoriously taken the cheaper way out since they began using unpaid nursing students as regular staff, then the nuring assistants, then the certified nursing assistant,psychiatric care specialists. Most of these people with a high school graduation at the most. Then came the contingent nurses with no benefits. Too many part time nuses resulting in no continuity of care. Use of the acuity scale is manipulated to make the patients less sick than they are. Very few hospitals consider the physical layout of the units and time required to reach areas to provide care. Nurses have been instructed to delegate nursing duties to non-licensed poorly educated staff and then are required to sign their name that all is done. Nursing schools do not teach how to delegate your job away, nor do they teach the reality of caring for 22 patients with one nurse and 2 patient care tech's. Until a federally mandated nurse patient ratio is established nurse burnout will continue, poor nursing care will be provided, nursing shortages will continue and the system will remain the same. Those who can afford the private high cost insurance will receive good quality care and those who need it the most will not have access to it. So yes the education is needed of the administration that poor care results in higher cost and fewer good quality nurses.
Nancy Ballard (4/17/2014 at 2:53 PM)

Good points were made in the article to which I would add the importance of the work environment. When structures and processes (nurse leadership; trust; teamwork, shared decision making, etc.)are good then workload is better managed. Leadership from the CNO to the frontline manager set the tone and expectations that are crucial to providing the work environment where care is provided which has an impact on how well nurses manage in the complex, fluctuating environment in which nurses practice. Static numbers are not the answer.
mary pat teschler (4/17/2014 at 8:29 AM)

Your article states "...study after study.." shows the higher the education of the nurses the better the outcomes. What studies are you talking about? Could you referednce these? I assume that the outcomes you are talking about are concerning staffing ratios, not patient outcomes, is this correct? Thank you
JVoss (4/16/2014 at 1:01 PM)

We used to do staffing by acuity but when they found they needed to hire more nurses it was more "economical" to go by numbers - nurse to patient ratio. Luckily I now work in an area where we have to be 1:2 ratio and we help each other if something comes in that is a 1:1. If there was a way to standardize patient acuity with staffing it would work and I think more nurses would be happy with their assignments.
Ruth Hansten RN PhD FACHE (4/16/2014 at 12:57 PM)

In addition to the points made in this article, a full staffing plan that matches the right nursing competencies (and numbers) to the patient/family's needs must include optimal numbers and skills of the assistive personnel (UAPs, patient care technicians, nursing assistants). The way in which NAPs (nurse assistive personnel) are utilized, assigned, supervised, and evaluated in the care delivery model can make the difference between missed care and world class clinical outcomes. Best staffing plans including NAPs can set the stage for avoiding reimbursement penalties for poor care or surveillance that culminates in falls w/injury, pressure ulcers, CAUTIs, pneumonia, infections, readmissions, patients requiring higher acuity care post-hospitalization. The full complement of patient care staff, their education and experience, and the way in which they are assigned and supervised, are all crucial to best clinical outcomes.


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