Safe Staffing: How Does Your Workplace Stack Up?

[tnbutterfly - Mary, BSN]

Salary is a definite factor for those looking for a job. It also plays a big factor in retaining nurses. But there are other factors that impact retention rates even more. Work environment and nurse-patient staffing ratios are more important to the nurse who is trying to decide whether or not to leave.

Nurses and the public have felt the effects of Unsafe Nurse Staffing. Nurses are exhausted from working more and more shifts with heavier patient loads, missing meal breaks and bathroom breaks. After staying over to finish charting, they go home after their shifts feeling guilty for not providing the quality care they want to but instead are forced to work in unsafe conditions. Nurses are burning out and leaving the bedside due to the stresses caused by understaffing.

Patients and their families experience the effects of inappropriate nurse-patient staffing ratios from the other side of the bed rails. They seldom see "their nurse", call bells go unanswered, pain meds are delayed. Families are afraid to leave their loved ones.

The research shows that nurse-patient ratios directly affect patient outcomes. According to the Journal of the American Medical Association (2002) the odds of patient deaths increase by 7% for each additional patient a nurse is given.

Although 14 states (CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA) have legislation that addresses nurse staffing to some degree, only California has mandated minimum nurse-patient ratios that are to be maintained in all units at all times (since 2004).

Currently, there are 2 sets of Federal legislation that are circulating in the House and Senate. One supported by the Nurses Take DC grassroots movement is based on Mandated Nurse-Patient Ratios and Acuity (Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 - [s. 1063/HR 2392]), the other supported by the ANA and AHA (The Safe Staffing for Nurse and Patient Safety Act [s. 2446, H.R. 5052]) is based on Acuity and Staffing Committees. For a side-by-side comparison, see Federal Nurse Staffing Bill Comparison.

Below is a listing of recommended Nurse-Patient ratios by unit and acuity proposed by the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017 - [s. 1063/HR 2392]

Because staffing issues are a big factor in job satisfaction as well as quality care, we decided to poll our readers to see how the ratios differ across the country. Below are the results from the 2018 allnurses Salary Survey based on responses from more than 12,000 nurses to two questions regarding nurse-patient ratios.

If you work in a clinical setting, what is the nurse-patient ratio in your primary unit of employment?

What unit do you primarily work on?

The interactive results can be customized to allow you to see how your state and workplace stack up to the proposed recommendations. Are you surprised by what you see? Would you like to see changes made? Please post your comments below. This is great information to use when you talk to your legislators about the unsafe staffing ratios.

For more information on Safer Nurse-Patient Ratios, go to:

Mandated Nurse-Patient Ratios

Nurse Beth and Keith Carlson Talk About Staffing Ratios & NurseTakeDC

Safe Nurse Staffing FB Live Video #2 - How to Influence Your Legislators

Nurses Advocate for Safer Staffing, Patient Safety, and Quality Care

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

For the rest of the salary survey, see:

2018 Nursing Salary Survey Results Part 1 - Demographics

When and Why Nurses Are Leaving the Workforce - 2018 allnurses Salary Survey Results Part 3

How Much Do Nurses Make? - 2018 allnurses Salary Survey Results Part 4

[klone, MSN, RN]

Why does it say "Salary Survey"? Is the title supposed to say something else?

[tnbutterfly - Mary, BSN]

Why does it say "Salary Survey"? Is the title supposed to say something else?

This is the second of four articles that will be published with results from the 2018 salary survey. There were 2 questions that had to do with nurse staffing and the responses are shown in this article. There is a link at the end of this article that goes to the first article.

[Daisy4RN]

I totally agree that all states should provide for safe staffing ratios. I have work in Ca with those ratios but there is still much room for improvement as the hospitals have learned to play with numbers and undercut those ratios to save money; such as eliminating ancillary staff (CNA's secretary etc), changing the description of patient acuity, removing tele from pt's in order to fit the numbers needed etc. So even with the "ratios" you end up with the same problems!

[anon456, BSN, RN]

I'm not able to complete the survey-- the format is messed up on both Google Chrome and Firefox

[K8TRN, RN]

I'm an LPN and I work in Massachusetts in a skilled nursing facility. I am per diem so I float to all units and I primarily work 3-11. On the locked dementia unit there is one nurse to 32 patients, on the LTC unit one nurse to 32 patients or two nurses for half the shift then one leaves at 7pm, and on the LTC/sub acute it depends on admissions (if they are being nice) you might have two nurses until 7pm or if they are short staffed one nurse. I just got another per diem job because the staffing is dangerous and I can't give my patients the care they deserve.

[tnbutterfly - Mary, BSN]

I'm an LPN and I work in Massachusetts in a skilled nursing facility. I am per diem so I float to all units and I primarily work 3-11. On the locked dementia unit there is one nurse to 32 patients, on the LTC unit one nurse to 32 patients or two nurses for half the shift then one leaves at 7pm, and on the LTC/sub acute it depends on admissions (if they are being nice) you might have two nurses until 7pm or if they are short staffed one nurse. I just got another per diem job because the staffing is dangerous and I can't give my patients the care they deserve.

Thank you for sharing this. This is a prime example of a dangerous situation and definitley one that needs to be changed.

[cutiepie2012, ASN, BSN, MSN, LPN, RN, APRN, NP]

I work at 2 hospitals in the Nashville TN area. At one of my jobs the ratio is 1:6 on a busy med/surg floor and we rarely have techs. The other job does a ratio of 1:5 on an obs unit. I don't think these ratios are safe. But it used to be worse cause we used to max out at 7 patients on the med/surg floor.

[pandabearLPNsoontobeRN]

I'm an LPN working night shift in LTC. Dayshift has 30/1 ratio and after 11pm its 60/1 ratio. Most of my residents are dementia care with the others being rehab and skilled nursing care.

[RKCNA]

I'm still a CNA (going to be starting school in August with hopes of getting into the nursing program) but I've worked in two separate hospitals in FL and both had insane ratios. At my first all nurses were required to max out at 7 patients no matter what floor (the only exceptions were ICU, CCU and PCU), and like it was mentioned above the hospital was always trying to mix and match their wording to get patients on floors and sometimes even on floors they shouldn't have been on (active and rising troponin levels on a non Cardiac floor for example). My second, while somewhat better about where patients are placed, still requires the nurses to max out at six on my current floor (Med surg with GI focus). I've seen my nurses suffering burn out quickly and most are planning on leaving the floor within the coming months. Heavier units /need/ to set a lower patient ratio if they want to keep their nurses, otherwise they risk constant staff changes and always having brand new nurses on the floor with no experienced hands helping

[neuron]

When I had 30 patients and 4 hospice, and in their end stages all on morphine, bleeding foleys, my DON was hounding at me at the med cart, and family members were asking for their morphine, busted colostomies, vomiting G- tube, and 5 breathing treatments to give, I walked out of there and never looked back. This is the way corporate CEO's treat you, not to your face, but passive-aggressively.

[Raj777]

I worked my first shift as a nurse in Canada in dementia care unit, in the evening shift, I cared for 38 clients alone that was not safe.

I quitted my job.