Inadequate Staffing: Patient Safety in Today's Healthcare Marketplace- A Four Part Series

In part one of this four part patient safety series, we will discuss the major patient safety concern of inadequate staffing ratios and offer nursing lead initiatives that will help to bring patient safety back to the forefront of our healthcare system.

Updated: Feb 24, 2023

Inadequate Staffing: Patient Safety in Today's Healthcare Marketplace- A Four Part Series

"We are short again today" - A daily phrase used by nursing staff that summarizes the consistent inadequate nursing staff ratios that healthcare facilities seem to continue to support. Inadequate nursing staffing ratios greatly diminish the likelihood of achieving positive patient health outcomes, as well as significantly decreases nursing staff job satisfaction and retention across our nation. Having an upwards of eight or more patients per Registered Nurse, and 15 or more patients per Nursing Assistant in an acute healthcare setting, such as a hospital, has been the norm for far too long now. As our healthcare marketplace expands and becomes more demanding of nursing staff by offering more treatment options, more medications, more technology, longer working hours, more complex patient illnesses, more computerized documentation, etc., healthcare facility staffing procedures should be reconfigured to include more nursing staff resources, rather than remaining unsafe.

According to an article posted in The American Nurse - an official publication of the American Nurses Association, when it comes to achieving high standards of care, optimal patient outcomes and institutional financial growth, adequate nursing staffing ratios should be considered as a necessity. Unfortunately, many healthcare facilities have not set standards for adequate nursing staff ratios. Instead, they continue to base their nursing staff to patient ratios off of a grid that only reflects patient body count - not taking into consideration RN experience levels, patient acuity, or available resources.

In a nursing led effort to provide adequate nursing staff ratios across our country, the American Nurses Association, each individual State's Nursing Association, and Nurses Take DC, have introduced Bills to improve staffing in a variety of care settings. The ANA proposed The Safe Staffing for Nurse and Patient Safety Act (S. 2446, H.R. 5052) to the House and Senate for consideration. According to the American Nurses Association (2018), this proposed legislation would require Medicare-participating hospitals to create a committee, composed of at least 55% direct care nurses, to develop nurse staffing plans that are specific to each patient care unit. The idea of having these committees is to utilize the expertise of the direct care nurses, who are best equipped to determine the adequate staffing levels to safely meet the needs of their patients.

For example, many charge nurses get report from the bedside nurses regarding how much care their patients need. Someone who is completely bed bound, incontinent, has multiple wounds, IV lines, oxygen, and may be confused, would require the assistance of three nursing staff members. This could be a combination of nurses and nursing assistants. The unfortunate reality is that the charge nurse currently collects this information so that they do not assign five of these high acuity patients to the same nurse. Instead of getting additional nursing staff to help with the increased acuity, they try their best to split up the acuity among the nurses and nursing assistants - which rarely works in regards to maintaining adequate and safe nursing staff ratios. However, if the charge nurse were able to bring on an additional nurse, or nursing assistant to help manage the increased acuity, then patient safety and nursing staff job satisfaction would improve significantly.

The ANA states that to date, seven states have enacted nursing staff ratios legislation that closely resembles the American Nurses Association's recommended approach to ensure safe staffing, by utilizing hospital-wide staffing committees, where direct care nurses have a voice in creating appropriate staffing levels. A total of 14 states have implemented laws that address nursing staffing ratios. These states include: CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT and WA. For more information on these efforts, you can visit the Nurse Staffing page on the American Nurses Association website.

Nurses Take DC have proposed the RN Ratio Bill S. 1063/HR 2392, which goes further by mandating that each nursing speciality has their own mandated patient to nurse ratio, and places great consideration on other staffing issues such as mandatory overtime, averaging, video monitoring, and keeping nursing administration, such as charge nurses, out of the direct patient care staffing numbers. To see a side by side comparison of the differences among the ANA's Bill and the Nurses Take DC Bill, you can click here.

As of this very moment the fight for adequate nursing staff ratios continues. With all of our continued dedication and service to improving nursing care and standards of practice, I am certain that we will prevail in obtaining legislation for adequate nursing staff ratios.

For articles in this series, go to: