Running head: WHITE PAPER ON NURSE-PATIENT STAFFING RATIOS

White Paper on Nurse-Patient Staffing Ratios

Kaytlyn Stephens
Dixie State University

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White Paper on Nurse-Patient Staffing Ratios
As a nurse, have you ever had too many patients assigned to you? As you look back, do
you think you provided the best care possible when caring for all those patients? Do you think it
was safe to care for that many patients? You are not the only nurse who feels this way; nursepatient staffing ratios have been debated for many years. The question is now how many patients
is safe for one nurse to take? What are to consequences of having to high of a nurse-patient ratio?
Nursing is a very intense and detailed oriented field. How are nurses supposed to do their job
properly and safely if they have too many patients to care for? When nurses have too many
patients to care for the quality of care decreases and patient outcomes and safety are at risk. By
setting up a policy that mandates nurse-patient staffing ratios, nurses would benefit, but
ultimately the most benefit would come to the patients.
The Problem
There are many ways that high nurse-patient ratios can hurt the patient. High staff to
patient ratios risks patient safety. In a study about nurse- patient ratios in California the authors
concluded that each additional patient per nurse was associated with a 7% increase in the
likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-torescue (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002, p. 16). Caring for patients is an
aspect of nursing that is very crucial, when nurses have high nurse-patient ratio, patient outcomes
suffer. Another way high nurse-patient ratios can hurt patients is by how much attention can be
given. When you have to care for more patients, your time with each patient gets shorter. Nursing
is about caring, you cannot care for patients properly if you have too many of them, each patient
needs a certain amount of time with the nurse to ensure that they are headed down the right path
of healing. In an article about dangerous staffing levels, Ford (2014) concluded that as units get

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understaffed, nurses are needed to take on a heavier patient load. This problem results in
decreased time each nurse has to spend with each of their patients (Ford, 2014). Policies about
nurse-patient staffing ratios should be set to ensure that the main focus is on the patients, not on
the money.
Policy One
A policy that would help nurse-patient staffing ratios would be mandating nurse-patient
staffing ratios in different areas in the hospital and in nursing homes. The Intensive Care Unit
would not have the same staffing needs as a nursing home. Nursing ratios need to be based on
how much care the patient in that unit needs. Starting July 1, 2016 Queensland, Australia will
have mandated nurse-to-patient ratios. This comes across the legislation to promote safer
workloads for nurses (Anonymous, 2016). With this new mandate, the author estimates more
than 250 nurses will need to be hired to fill the increased needs. The mandate that was set for
hospitals reads, to maintain a minimum of one nurse to four patients for morning and afternoon
shifts, and one nurse to seven patients for night shifts (Anonymous, 2016, p. 11). By mandating
nurse-patient rations, the nurses will be care for his or her patients for effectively and also open
up more jobs for nurses. By implementing these rules about nurse-patient ratio, this will solve
the problem of nurses being under staffed and ensure that the best care possible is given to every
patient. With this policy, there will need to be a raise in money going towards nursing, this may
be a concern to some people but there is a fine line that nurses can have the right nurse-patient
ratio and a lot of money will not have to be spent to do so.
Policy Two
Another policy that would help nurse-patient staffing ratios is staff by acuity. Acuity is
how much care and attention a patient needs during a shift. There are many factors that can be

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measured when assessing acuity, like medication, treatments, teaching and emotional support. I
developed a patient acuity chart that I believe will help nurse-patient rations. I developed this
chart to help the rehabilitation center I am currently employed at start staffing more efficiently
and effectively. The patients raged from one to four, four being the hardest. Patient acuity per
nurse would not exceed thirty five for my current employer. We have seen improvement in our
staffing and also better patient outcomes when the nurse-patient ratio is managed by an acuity
rating system. In 2002, Charlene Fullam developed an acuity based staffing system for an
emergency room. This author goes on to show the steps she took in developing this system and
the results are that the acuity system helped with nurse-patient ratios in the emergency room, this
increased patient safety and patient outcome (Fullam, 2002). The only issues with this policy is
that nurse-patient ratio will change by the day depending on how much care the patients need;
there would be no consistency with staffing. By staffing by acuity you enable your nurses to
have a safe nurse-patient ratio which will let them spend for time caring and helping each
patient.
Policy Three
The last policy that would benefit nurse-patient ratios would be mandating the amount of
money spent on the nursing department. Hospitals and nursing facility should have regulations to
set aside a certain portion of the budget to staff nurses. This money would be set aside so that the
hospital or facility had enough money to run a manageable nurse-patient ratio. A key reason why
nurse-patient ratios are so high is because of budgets. Having a percentage of money set aside to
ensure nurses had a manageable patient ratios would help ensure patient safety and promote
nurses to spend more time with each patient. In a study of nurse-ratios the authors concluded that
hospitals are cutting back on nurses on the floor because of a tight budget (Evans, 2006). It also

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went on to say that it would cost millions of dollars to do this but it would improve nurse-patient
ratios and this means better patient outcomes.( Evans. 2006). By increasing the nursing, it will
enable hospitals and nursing facility to put more nurses on the floor which in turn will decrease
the nurses patient load.
My Stance
As a nurse, I have experienced these issues for myself. I have worked in a nursing
facility where I have had high-nurse patient ratios. By having too many patients, I was not able
to provide the best care I could have because of the many patients I need to care for. I believe
that by having a policy of staffing by unit in the hospital and nursing home would ensure safer
nurse-patient ratios. The best course of action is to regulate nursing staffing by facility or unit;
this will be able to regulate how many a patients a nurse will have depending on their need of
care. If there is a set number for each unit, this will help decrease high nurse-patient ratios and
help with patient safety and better patient outcomes. I think this is the best course because this
will have minimal effects on the hospital and nursing facilitys compared to the other policies I
brought up. If this is regulated at a state level then it will make it so no matter where you work,
you can know how many patients you will be taking.
Conclusion
The nurse-patient staffing ratio has been a problem that seems to always be around.
Having a high nurse to patient ratio ultimately hurts patient outcomes. Nurses should have fair
ratios so they can care for their patients properly without worrying what so many other patients.
Having high nurse-patient ratios may save money but in the end patient outcome and safety will
suffer. The policy that I believe would solve this complex issue would be mandating patient
ratios by setting. Nurses in the Intensive Care Unit need to give their patients more detailed

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attention than a nurse who works in a rehabilitation center, thus basing the staffing rations by
unit or setting will ultimately provide the nurses the best patient ratio possible. With this policy
solution, I hope to see mandating of nurse-patient staffing be regulated by unit or setting. This
will help with patient care and safety because the ratios are based on how much care patients
need.

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References
Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J., & Silber J.H. (2002). Hospital Nurse Staffing
and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 2002;
288(16):1987-1993. doi:10.1001/jama.288.16.1987.
Anonymous. (2016). Queensland cements mandated nurse-to-patient ratios in law. Australian
Nursing and Midwifery Journal, 23(7), 11. Retrieved from
http://search.proquest.com/docview/1761653672?accountid=27045
Evans, M. (2006). Nurse-ratio fight goes national. Modern Healthcare, 36(11), 20. Retrieved
from http://search.proquest.com/docview/211920892?accountid=27045
Ford, S. (2014). Staffing levels still "dangerous". Nursing Times, 110, 2-3. Retrieved from
http://search.proquest.com/docview/1500946887?accountid=27045
Fullam, C. (2002). Acuity-based ED nurse staffing: A successful 5-year experience. Journal of
Emergency Nursing , Volume 28 , Issue 2 , 138 140. DOI:
http://dx.doi.org/10.1067/men.2002.122219
Please see comments on your paper.
Carole Grady