How Inadequate Medical Staffing Ratios Hurt Patient Care

Improving the ratio of healthcare providers to patients at medical facilities does not only benefit the patients but also the people treating them.

Studies estimate a primary care provider has an average patient load of 1,000 to 3,000 people. On average, doctors work 51 hours a week and see 20 patients per day, with nearly 25% of their time devoted to non-clinical paperwork, according to a 2018 survey by the Physicians Foundation.

The American Association for Physician Leadership (AAPL) found that a doctor would need to work 17 hours each day, every day of the year, without a break, to provide "the recommended preventive, chronic and acute care services" to 3,000 typical patients.

To improve the physician-to-patient ratio, doctors have reduced the time spent with patients, hired more staff and delegated some of their duties to others.

"To see more patients, most primary care and specialty providers shortened their face time with patients to about 8 to 12 minutes," explained UHC Solutions, a healthcare placement firm.

Physicians in private offices may want to take a closer look at staff level benchmarks and their office's layout, practice management system and patient demographics – all of which can affect staff efficiency, noted the AAPL.

"The well-organized physician who sees patients on schedule and completes paperwork in a timely manner will probably require fewer support staff than one who is less organized," the association added.

A 2012 study by the University of California at San Francisco’s Center for Excellence in Primary Care (UCSF) found that up to 77% of a doctor’s time spent on preventive services could safely be given to non-clinician coworkers. And 47% of the hours a doctor spends managing patients' common chronic conditions could go to "registered nurses, pharmacists, health educators and medical assistants – aided by health information technology and working under standing physician orders," UCSF found.

Increasing inadequate nurse staffing levels

Delegating certain duties to other healthcare providers might not always help, however. Nurses in particular have stepped up in recent years to publicly voice their concerns about nurse-to-patient ratios and their impact on patient care.

A 2016 study of more than 11,000 hospital patients around the country found that "the likelihood of survival was 16% lower for patients cared for in hospitals with poor nursing work environments. In addition, the odds of survival were 5% lower for each additional patient per nurse on medical-surgical units.”

“Inadequate nurse staffing levels by experienced RNs are linked to higher rates of patient falls, infections, medication errors and even death," noted RNAction.org, an American Nurses Association (ANA) advocacy website. "As a result of massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage, fewer nurses work longer hours and care for sicker patients. This situation compromises care and contributes to the nursing shortage by creating an environment that drives nurses from the bedside."

According to National Nurses United (NNU), a union and professional association of registered nurses, "unsafe staffing levels contribute to higher RN burnout rates and job dissatisfaction." Better nurse-to-patient ratios can reduce RN turnover and therefore cut back the amount of money facilities spend on overtime and temporary RNs, the NNU noted.

"A 2009 study estimated that adding 133,000 RNs (the number of RNs needed to increase nursing staff to the 75th percentile) to the U.S. hospital workforce would result in medical savings of $6.1 billion on healthcare spending, not including the value of increased productivity when RNs help patients recover more quickly," the NNU added.

A bill introduced to Congress in May 2021 – the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act – would put safety limits on the number of patients a registered nurse could care for in each hospital unit, and also give whistleblower protection to nurses who want to speak out about staffing.

“Safe staffing levels are critically important to ensure patients are properly and safely taken care of at a healthcare facility,” Jean Ross, a registered nurse and the NNU president, said in a statement. “Evidence has demonstrated that RN staffing ratios prevent avoidable infections, injuries and deaths.”

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