HealthMarch 07, 2016

Best practices for nurse/patient staff ratios

Healthcare facilities have a tough balancing act when it comes to being clinically effective as well as financially solvent.

Identifying and maintaining the appropriate number of nursing staff is critical to the delivery of quality patient care, but facilities are also being pressured to trim costs wherever possible. Having sufficient nursing staff is absolutely critical, as numerous studies reveal an association between higher levels of experienced RN staffing and lower rates of adverse patient outcomes.

Federal & state laws

Maintaining appropriate nurse staffing levels is not just a good idea, in most cases, it's the law.

A Federal regulation has been in place for some time (42CFR 482.23b) which 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.”

Several states have taken action to ensure there is optimal nurse staffing appropriate to patients’ needs. State staffing laws generally take one of the following approaches.

  1. Require hospitals to have a nurse-driven staffing committee to create staffing plans that reflect the needs of the patient population and match the skills and experience of the staff.

  2. For legislators to mandate specific nurse to patient ratios in legislation or regulation.

  3. Requiring facilities to disclose staffing levels to the public and /or a regulatory body.

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 intensity of patient's 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 legally requires for minimum nurse to patient ratios to be maintained at all times by nursing units. 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, as indicated by California laws.

Although California is the only state requiring specific nurse/patient ratios, there are numerous other states that either have specific laws and regulations pertaining to nursing staffing, require staffing committees to make the necessary arrangements, or require some form of disclosure or public reporting.

Benefits of effective RN staffing

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

  • Enhancement of patient satisfaction and health-related quality of life.
  • Reduction in medication errors, patient mortality, hospital readmissions, and length of stay.
  • Decrease in number of preventable events and ‘hospital-acquired conditions’ such as patient falls, pressure ulcers, central line infections, healthcare-associated infections (HAIs), and other complications related to hospitalizations.
  • Reduced patient care costs through avoidance of unplanned readmissions.
  • Prevention of nurse fatigue, thus promoting nursing safety, nurse retention, and job satisfaction, which all contribute to safer patient care.

In addition to promoting flexible staffing plans, the ANA and like-minded groups support public reporting of staffing data to promote transparency and penalizing institutions that fail to comply with minimal safe staffing standards.

The ANA supports a model in which nurses themselves are empowered to create staffing plans.  Further, RNs nationwide are actively working with National Nurses United, the largest union and professional association of registered nurses in the U.S., to win their own mandated direct-care RN-to-patient staffing ratios.

Establishing minimum upwardly adjustable staffing levels is proven to be a good foundation for achieving safe and appropriate staffing plans.

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