Jump to content

Mandated Nurse-Patient Ratios

Nurses Article   (142,456 Views | 122 Replies | 1,073 Words)
by Nurse Beth Nurse Beth, MSN (Columnist) Educator Writer Innovator Expert Nurse

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

18 Followers; 104 Articles; 236,089 Profile Views; 2,097 Posts

Why the disparity in nurse-patient ratios?

Every nurse has to decide whether to support mandated nurse-patient ratios or support the status quo. It's time to speak up for patient safety and nurse sanity.

Mandated Nurse-Patient Ratios
Share Article

Ashley sank into a chair in the breakroom on her MedSurg unit in a large hospital in Florida. It was 0330, 8 ½ hours into her shift. She had not yet taken a break of any sort, including a bathroom or hydration break. In staff meetings, it was repeatedly emphasized never to miss a lunch break or stay overtime, but in the moment, it was hard to manage. Right now her stress was so high that as soon as she sat down, she struggled to keep back the tears.

Of her 7 patients, she had had two rapid responses (RRTs) and one patient was sent to ICU with sepsis. She was pretty sure she had missed the early signs of sepsis in her post-op patient, with an increased heart rate and infected wound. It's just that there was too much information and she was cognitively overloaded.

Her phone buzzed in her scrub pocket. Wearily she picked up the call. It was Laura, the charge nurse, sounding stressed out. "Ashley, I need you to take an ED admit in Room 4123. Is the room clean? Can you take report now, please?"

Across the country in California, Lindsay works on a similar MedSurg unit. Because she works in California, she can never be assigned more than 5 patients. Her day was busy and at times crazy. She knew that adding on 2 more patients would make it unmanageable. Thank goodness it was 5 patients, and not 7. During lunch breaks her patients were covered by break nurses and she did not take her phone into the breakroom.

Why is there such disparity? How is it that a patient with exacerbated CHF on Tele in Alabama has a nurse with five other patients and a patient with exacerbated CHF on Tele in California has a nurse with only 3 other patients?

The reason is that California has mandated nurse-patient ratios in every hospital unit. ICU is 1:2, SDU 1:3, Tele 1:4, Med Surg 1:5.

Patient Perspective

If you were a patient and could choose, would you choose a nurse who has 4 patients or 7 patients? If your baby was in NICU, would you want your child to have a nurse with 1 other infant, or 2 other infants?

There is abundant evidence to show that patients suffer when nurses have too many patients. The following is a quote from Ruth Neese's Talking Points for Safe Staffing.

  • Cost to replace a single nurse burned out by overwork from understaffing was in excess of $80,000/nurse in 2012 (Twibell & St. Pierre, 2012).
  • The difference between 4:1 and 8:1 patient-to-nurse staffing ratios is approximately 1,000 patient deaths (Aiken, Clarke, Sloan et al., 2002).
  • Patients on understaffed nursing units have a 6% higher mortality rate (Needleman et al., 2011). This risk is higher within the first 5 days of admission (Needleman et al).
  • An increase of one RN FTE per 1000 patient days has been associated with a statistically significant 4.3% reduction in patient mortality (Harless & Mark, 2010).
  • Adding one patient to a nurse's workload increases the odds for readmission for heart attack by 9%, for heart failure by 7%, and for pneumonia by 6% (McHugh, 2013).
  • Lower patient-to-nurse staffing ratios have been significantly associated with lower rates of:
    • Hospital mortality;
    • Failure to rescue;
    • Cardiac arrest;
    • Hospital-acquired pneumonia
    • Respiratory failure;
    • Patient falls (with and without injury); and
    • Pressure ulcers (Aiken, Sloane, et al., 2011; Cho et al., 2015; Kane et al., 2007; Needleman, Buerhaus, Stewart, Zelevinsky & Mattke, 2006; Rafferty et al., 2007: Stalpers et al., 2015)
  • Higher numbers of patients per nurse was strongly associated with administration of the wrong medication or dose, pressure ulcers, and patient falls with injury (Cho, Chin, Kim, & Hong, 2016).
  • Rising patient volumes, higher patient acuity, and reduced resources lead to nurse burnout and fatigue, resulting in first year nurse turnover rates of approximately 30% and second year rates up to 57% (Twibell & St. Pierre, 2012)."

Action

Mandated nurse-patient ratios are a matter of public safety. There are regulated practice safeguards in place for airline pilots and truck drivers and other industries. Why not nursing?

Historically nurses are a silent workforce who have allowed employers to determine clinical practice. But that is changing. The time for change is now. On April 25th and 26th 2018, nurses around the country will gather in Washington D.C. for the 3rd annual rally to urge lawmakers to enact safe staffing ratios. In numbers, we have strength and will be acknowledged.

Come join allnurses in Washington DC! Meet up with the allnurses team who will be filming and interviewing, and myself, Nurse Beth! Dr. Laura Gasparis, whose conferences many of us ICU nurses have attended, is the lead speaker.

By standing together, we can bring about needed reform. Will you be a part and bring about change as the nurses did in California?

Be sure and read Male Nurse Disgusted by Female Nurses for a unique point of view on working conditions and ratios.

What else can you do? So many things!

Easily find out who your legislators are and make a call.

Write a letter to support H.R. 2392 and S. 1063 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 legislative bills. Legislators respond to topics based on the number of phone calls and mail from their constituents.

While you are in Washington, make an appointment to see your legislator.

Share this article on social media. Use hashtags #NursesTakeDC and #allnursesSTRONG

Please watch the following video for more information on NursesTakeDC 2018. Like this article if it spoke to you, and comment below. Thanks much.

[video=youtube_share;jkWGHNB9gik]

Neese, R (2016). Talking points for Safe Staffing. Retrieved January 12018. Nurse Patient Ratios | Talking Points for Safe Nurse Staffing

Nurse Beth blogs at nursecode.com

18 Followers; 104 Articles; 236,089 Profile Views; 2,097 Posts

Share this post


Link to post
Share on other sites

ICUman has 5 years experience and specializes in Cardiac Cath Lab.

1,660 Posts; 54,147 Profile Views

With all the expenses lost in replacing burnt out nurses, fines for hospital acquired pressure ulcers, medication errors, and everything else listed above, etc., how come hospitals haven't realized reducing nurse to patient ratios will actually *save* the hospital money?

Is it more expensive really just to hire a few extra nurses? All the hospital scores and safety numbers would rise, including HCAHPS.

It would be a win-win for everyone. What am I missing?

Share this post


Link to post
Share on other sites

Axgrinder specializes in Adult MICU/SICU.

256 Posts; 5,776 Profile Views

We have been consistently under staffed on evening shift since October ... management says "the call volume doesn't indicate higher staffing ratios" than 1.5 nurses for this shift - but calls come in clusters, and many are very involved and/or behavioral health patients ... am I (present - not the number crunchers) missing something?

Dreading my shift tonight (as per usual lately) ...

Feeling stressed, irritable and burned out to the Nth degree ...

Share this post


Link to post
Share on other sites

Daisy4RN has 20 years experience and specializes in Travel, Home Health, Med-Surg.

1 Follower; 1 Article; 1,196 Posts; 7,278 Profile Views

I have worked in California in the past and can tell you even with ratios it is too much. It has become worse over the years because of gov. regulations, hospital p/p, and the push for pt. satisfaction, and higher pt acuity. I can not even imagine having 7 med-surg patients, this is crazy and unsafe.

Share this post


Link to post
Share on other sites

1 Post; 443 Profile Views

Staffing ratios are a must., but it must include other areas such as long term care. I would like to hear what everyone's opinion is for appropriate ratios for long term care, assisted living, and rehabilitation,

Share this post


Link to post
Share on other sites

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

18 Followers; 104 Articles; 2,097 Posts; 236,089 Profile Views

ICUman said:
With all the expenses lost in replacing burnt out nurses, fines for hospital acquired pressure ulcers, medication errors, and everything else listed above, etc., how come hospitals haven't realized reducing nurse to patient ratios will actually *save* the hospital money?

Is it more expensive really just to hire a few extra nurses? All the hospital scores and safety numbers would rise, including HCAHPS.

It would be a win-win for everyone. What am I missing?

I don't know because I'm missing the same thing! Baffled

Share this post


Link to post
Share on other sites

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

18 Followers; 104 Articles; 2,097 Posts; 236,089 Profile Views

ROSE BSN said:
Staffing ratios are a must., but it must include other areas such as long term care. I would like to hear what everyone's opinion is for appropriate ratios for long term care, assisted living, and rehabilitation,

Yes. I think it will spread if we stay strong.

Share this post


Link to post
Share on other sites

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

18 Followers; 104 Articles; 2,097 Posts; 236,089 Profile Views

Daisy4RN said:
I have worked in California in the past and can tell you even with ratios it is too much. It has become worse over the years because of gov. regulations, hospital p/p, and the push for pt. satisfaction, and higher pt acuity. I can not even imagine having 7 med-surg patients, this is crazy and unsafe.

I completely agree. The proposed legislation calls for 1:3 Tele, 1:4 MedSurg!

Share this post


Link to post
Share on other sites

428 Posts; 7,630 Profile Views

Also needs to include correctional facilities! Try delivering safe care with a ratio of 1:850!

Share this post


Link to post
Share on other sites

73 Posts; 4,264 Profile Views

AngelKissed857 said:
Also needs to include correctional facilities! Try delivering safe care with a ratio of 1:850!

YIKES! :nailbiting:

Share this post


Link to post
Share on other sites

111 Posts; 2,387 Profile Views

Just reading this sounds like a dream come true. I would LOVE to have a 1:4 ratio! What good care I could give my patients...

I work on an oncology/telemetry unit. We have 1:6 ratios and as a 1st year nurse I can tell you I can constantly overwhelmed. I have taken a lunch break 2x in my 7 months (both times cut short by calls from the floor). Everyone is expected to eat at their desk while charting (and not let patients see of course). I usually only get to go pee 1 or 2x in 12 hours.

I love my job and my floor, but we need more nurses and a lower ratio, for safety's sake.

Share this post


Link to post
Share on other sites

1 Follower; 786 Posts; 7,360 Profile Views

And let's not forget the nursing assistants. If we get these types of ratios, they'll cut the NAs and we'll be responsible for total care. With the acuity levels we see, that's neither safe nor reasonable.

Share this post


Link to post
Share on other sites
×

This site uses cookies. By using this site, you consent to the placement of these cookies. Read our Privacy, Cookies, and Terms of Service Policies to learn more.