Nurses worldwide are continually discussing the subject of nurse-patient ratios and what is safe. Nurses realize they have high patient workloads and safe staffing should be a significant priority. What do nurses mean by “safe staffing”?
The website dedicated to advocacy and political action, RNAction.org, is part of the American Nurses Association (ANA) explains safe staffing:
“Inadequate nurse staffing levels by experienced RNs are linked to higher rates of patient falls, infections, medication errors and even death. As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside. ANA and its Constituent & State Nurses Associations (C/SNAs) in the states are promoting legislation to hold hospitals accountable for the development and implementation of valid, reliable, unit-by-unit nurse staffing plans. These staffing plans, based upon ANA's Principles for Nurse Staffing (member login required), are not mandated ratios. They are created in coordination with direct care registered nurses (RNs) themselves and based on each unit’s unique circumstances and changing needs.”
Healthcare professionals realize that safe staffing is vital for the quality of patient care and their safety. Unfortunately, many different factors mandate what nurse-patient ratios will be. These factors (budget, nurse availability, doctors preferences) fight against any changes.
10 ways nurses can make a difference
To keep their jobs safe, nurses might consider acting and being part of the conversations by:
- Becoming an active member of state nursing associations.
- Attending training and days related to lobbying your legislators regarding issues of interest and importance to nurses.
- Gaining an understanding of the legislative processes in your state.
- Becoming familiar with current nurse-patient legislation enacted in your state.
- Joining workplace committees and groups who are talking about nurse-patient ratio issues.
- Discussing ratios and nurse staff with colleagues and leaders.
- Documenting situations that prove the challenges faced by nurses in working situations.
- Meeting with legislators and voicing your concerns.
- Meeting with the leadership in your nursing department, healthcare organization or hospital to discuss your concerns.
- Making your voice heard. Share your knowledge on social media and within networks.
Circumstances to be considered
Staffing ratios are the responsibility of legislative sessions in state or federal congresses. There are many different considerations to be explored, however. The ANA recommends hospital committees making staffing decisions include at least 55% direct care nurses on their boards. Who knows better what nurse-patient ratios should be than the nurses themselves?
The ANA mandates that staffing and nurse-patient ratios think about:
- The adjustable minimum number of RNs in a medical situation.
- Listen to input from direct care nurses or their representatives.
- Staffing numbers based on patient numbers and the intensity of the care needed.
- The training, experience, and level of education of the nurses providing care.
- Staffing levels and services provided by other health re personnel
- Listen to staffing level recommendations put forth by specialty nursing organizations.
- Taking into consideration the facility and unit level of staff, patient data, and the quality of care. Compare these to national data when available.
- Considering unit geography, available technology, and other factors that impact care delivery.
- Not forcing nurses to work in areas where they are not experienced or trained.
Legislators do have the power to pass legislation concerning patient safety and nurse staffing orders, but nurses who have the most to lose in these decisions must be part of the solution.
In 2017, nurse workloads and nurse-patient ratios came to the attention of the Ohio state legislature. State Senator Mike Skindell reestablished the Ohio Patient Protection Act (Senate Bill 55), a legislative effort to enforce limits on the nurse-patient ratios to gain a handle on how many patients can be safely taken care of by Ohio nurses.
The bill specified that one-to-one nurse-patient ratios be utilized for patients in the OR, trauma, critical care, ICU, plus patients who are unstable, neonates, and patients who need resuscitation. A provision in the bill suggests a one-to-three nurse-patient ratio for pediatrics and pregnant patients.
The bill requires hospitals to publicly post nurse-patient ratios. The bill also denies imposing obligatory overtime to meet staffing requirements. In the legislation are provisions preventing hospitals from using video surveillance as replacements for face-to-face nursing care.
The Ohio bill stipulates that nurses have the right to refuse to perform certain types of patient care if the nurse feels that such actions are not in the best interests of the patients.
The National Nurses United worked with Sen. Skindell to put the bill together. Unfortunately, the Ohio Nurses Association does not support passage of the bill that advocates nurse-patient ratios.
Those who propose that there be obligatory inpatient nurse to patient staffing ratios are continuously lobbying the U.S. Congress and respective state legislatures to ratify laws to advance working environments in hospitals. Projected minimum nurse-patient staffing ratios need to be explored in all states. California has addressed the recommended minimums and published studies stating that implementing nurse-to-patient ratios has improved the health and welfare of nurses by up to 33.6%. Also, it has been proposed that inadequate staffing has resulted in patients being harmed and care substantially lowered.
It is not only the United States who is concerned with nurse-patient ratios, but there are ongoing debates in the UK. The proper ratios indicate that a nurse needs to care for no more than eight medical patients. In neonatal and intensive care units the ratio should be one to one. The NHS or National Health Service trust chief executives do not believe they have staffed adequately with nurses who have high skills and quality education to deliver high-quality healthcare to their patients. A sadder commentary, most of these executives do not believe they will have sufficient staffing levels even in six months. This scenario is a mirror image of what is going on in the US.
Nurses are leaving the nursing profession in droves. The reasons are burnout, understaffing, incivility, bullying, and abuse. The Robert Wood Johnson Foundation stated a statistic that claims one out of five new nurses leave the profession within the first year of licensure. Additionally, one out of three will leave the profession within two years of their nursing careers.
Mandating nurse-patient rations and outlawing mandatory overtime is right and will help stem the tide of nurses leaving the medical environment. Medical institutions also need to consider that nurse turnover is expensive. They need to adopt nurse-patient ratios, overtime, and abuse must be addressed.
Nurse burnout, violence and other demeaning factors impacting nurse’s effectiveness and job satisfaction are imperative to consider when examining the retention of qualified nurses in the healthcare workplace.
Staffing and nurse-patient ratios problem are ongoing problems for the medical profession. As a nurse or a potential nurse, stay informed, get involved, and share your professional opinion. Your opinions are crucial and will empower you in making a difference. Everyone deserves a safe healthcare environment, and if patient-nurse ratios are the problem, a change needs to be made quickly or we all will suffer.