Unsafe Nurse-to-Patient Ratio

Nurses General Nursing


From Lippincott Manual of Nursing Practice 8th edition

"Unsafe Nurse-to-Patient Ratio

  • A pattern of unsafe nurse-to-patient ratio can be caused by staffing problems, be they temporary or longer term.

    A series of actions to best resolve the problem includes:
    • Address this unsafe situation verbally and in writing to the nurse unit charge nurse with copies to the nursing supervisor and director of nursing.
    • This will likely prompt action by the hospital, such as creating an as-needed pool of nurses to call for such situations, hiring more staff or, in the interim, securing contracts with outside nursing agencies and utilizing agency nursing personnel.

    Tolerance by staff nurses employed under such circumstances will preclude appropriate resolution and will leave the nurse open to unsafe practice and unmet patient needs, potentially increasing the risk of liability.

    [*]Although the employer is liable for the acts of the employee performed within the scope of employment, the nurse will not be exonerated should a patient's care be compromised in a setting of an unsafe nurse-to-patient ratio."

Stood out like a sore thumb while perusing chapter 2

My summary " If you tolerate poor ratios and don't say anything, YOU ARE PART OF THE PROBLEM! :trout:

I noticed it stops far short of suggesting ratios.

Tweety, BSN, RN

34,113 Posts

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I agree....we get as much crap as we're willing to take.

Remember however, we need to be understanding of one another while motivating others to action. Playing the blame game isn't part of the solution either.


112 Posts

Specializes in Med/Surg; aged care; OH&S.

Well it would be great if this article stated what a good patient/nurse ratio was ... for example only 1 ICU patient if unstable, 2 ICU if stable, 4 in acute general wards on an early shift, no more than 20 patients in aged care etc. (forgive me if my ratios are a bit out, it's been a while since I did the bedside thing). :mad:

I do agree in theory that nurses need to start sticking up for themselves and not back down from unreasonable workloads but ..

It's a bit difficult to stick up for yourself in terms of reasonable patient ratios when you don't have anything formal or legislative to back you up (in my experience). I've had nurse managers tell me that 'everyone else' seems to be able to handle things so why can't I? I learned early on not to complain TBH, it only seems to backfire on me and sadly, that seems to be the culture of nursing in Australia - take it on the chin, don't complain and for god's sake don't show any weakness.

That said, back in the day when I started nursing (in the 90s) we had 6 patients on early shifts in the public hospital wards and now apparently nurses have no more than 4, so I guess somebody took some notice. I'm of the opinion that it was the nurses strike a few years back that brought that about though :twocents:. It caused a fuss at the time in terms of the public's opinion of nurses but it seemed to bring about some change.


385 Posts

Specializes in Derm/Wound Care/OP Surgery/LTC.

I think the most challenging nurse to patient ratio comes in LTC facilities. They are hugely understaffed. I have seen nurses have 40+ patients on their wing with no help. That's a good way for mistakes to occur and for patient care to be lacking.

But it is true that if you don't speak up, then you are part of the problem. I agree with that wholeheartedly.

Specializes in Hospital Education Coordinator.

assigning numbers is an arbitrary method and does not consider the variations from one patient to another. One patient can be a job and two sometimes are a breeze depending on acuity. I hope the new law in Texas will help solve this issue. It calls for every hospital (don't know about other facilities) to have a team of nurses help decide staffing.

there should be a policy in place that outlines the appropriate actions for a nurse to take when declining an unsafe assignment. the safest recourse is to refuse the assignment and then take these steps, carefully documenting each step of the way. the alternative, taking report and accepting the assignment, places the nurse's license in jeopardy. management and administration will not be considered at fault if an error occurs or if a patient is injured under these circumstances, because the nurse accepted the assignment.

if there is not a policy in place for nurses to decline an unsafe patient assignment, there should be an immediate discussion with administration to see that one is outlined as soon as possible. this policy should include a formal means for the nurse to document his or her concerns.

working toward a solution through policy implementation and documentation is not easy, and there is always a concern of possible repercussions from management. working with state legislators to obtain laws for safe staffing ratios is an alternate option, but one that could take a considerable length of time to come to pass, particularly considering that each state must act individually. if, however, we do nothing and continue to accept unsafe patient assignments, both the nursing profession and the community for whom we provide care will be the ultimate casualties.

allnurses Guide

herring_RN, ASN, BSN

3,651 Posts

Specializes in Critical care, tele, Medical-Surgical.

I think a law can help. Some LTAC hospitals especially have a history of unsafe staffing. This bill applies to them too!

It requires staffing by acuity with a ratio setting the maximum number of patients that may be assigned to an RN.

Text of S.1031 as Introduced in Senate

A bill to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes



11 Posts

At the two hospitals here where I live..med-surg floors have between 8-10 patients during days..more at night. ICU has 3-4. IMO..unsafe!!! This is why I'm not working at either of the hospitals and right now still looking for a job after graduating a month ago.


224 Posts

Specializes in LTC, geriatric, psych, rehab.

The last time I worked at a hospital (15 yrs ago), the staffing became really bad. I was the charge nurse for the telemetry floor. Then they decided to take the end of the hall and make it into a peds floor. I was to be charge over that as well. That is where I drew the line. I was happy to be charge over either one, but not both. There was not staffing for that, so I was told. So I just quit. I recognize that with the shortage of nurses in certain areas, you can't always find the help you need. But I am not willing to put my license at risk either.


213 Posts

Specializes in Trauma & Emergency.

People need jobs right now and the very few things out there seem to be the jobs that others didn't want to take. I currently have a position with a 60 patient med pass. There is a charge nurse if things head south but for the most part I'm it. It's not safe nor is it where I imagined myself after graduation, but guess what? Sometimes there's just NOTHING else. LTC DEFINETELY has the biggest safety issue.


985 Posts

Specializes in Med/Surg, ICU, educator.

LTC, then med surg are bad on staffing. These 2 areas are chronically known for short staffing. Right now, we have new grads begging for jobs in med surg, whereas a year or 2 ago, we had 10-15 open positions at any given time. I wish the ANA would take a defined position on this, classify facilities, THEN give a breakdown of each type of facility. I think it would be easier for facilities to know how to do it. Manangement will pile on the work unless they are pursuaded to do otherwise. Remember, no 2 facilities are remotely alike, some better/worse than others.


10 Posts

Sometimes on my unit people can get up to 13-14 patients. So far the max I'v had is 12 which is still ridiculously overwhelming! I hate when that happens! I can have up to 8 and be comfortable, any more than 8 and it's hard for me to handle.

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