Mandated Nurse-to-Patient Staffing Ratios: Benefits at the Bedside and Beyond

Safe patient care ratios have been a widely discussed topic with current legislation to address tight budgets and a shortage of qualified medical professionals, especially in nursing. A mandated nurse-to-patient ratio to control the maximum amount of patients a nurse can care for during a shift promotes quality care for patients and benefits the nursing staff.

Adequate nurse staffing can reduce medical errors, patient mortality, length of stay, preventable events such as patient falls, healthcare-associated infections (HAIs), pressure ulcers and central line infections. It also may reduce patient care costs by avoiding readmissions. Lu Crowder, Director of Clinical Quality at Advanced Medical Reviews (AMR), adds “Even the more administrative hospital nursing roles, such as case management and discharge planning, when adequately staffed, help to ensure effective planning for equipment and supplies that support a safe and timely discharge home.”

A survey from the American Nurses Association (ANA) reported more than half of the nurse respondents said they didn’t have sufficient time to spend on each patient. In another survey with Massachusetts Nurses Association, 90 percent said they don’t have the time to provide adequate comfort and emotional support to patients and their family members, while 86 percent say they can’t spend as much time on patient education as would be ideal.

There are states—Connecticut, California, Illinois, Massachusetts, Minnesota, Nevada, New Jersey, New York, Ohio, Oregon, Rhode Island, Texas, Vermont and Washington—that utilize official regulations to address nurse staffing, but only California has a law which mandates nurse-to-patient ratios in hospitals.

Research has shown nurses are able to adequately respond to the needs of each patient if they have fewer patients during their shift and the administration of intermediate nursing interventions results in shortened inpatient stays.

The biggest benefits derived from safe nurse-to-patient ratios in healthcare are improved patient outcomes, lower mortality, patient and staff satisfaction and nurse retention. Let’s review the data that reinforces each of these.

Patient Outcomes

• Enhanced patient outcomes are associated with a safe staffing ratio. - Journal of Nursing Regulation
• Nurse-to-patient ratios influence many patient outcomes, most markedly in hospital mortality. - European Journal of Cardiovascular Nursing
• Mandated nurse staffing levels that facilitate safe, competent, therapeutic and effective care are vital to the safety of patients in U.S. hospitals. - XVI Pan American Nursing Research Colloquium
• Nurse staffing ratios are tied to a higher chance of patient survival. Patients were 95 percent more likely to survive when nurses followed a hospital-mandated nurse-to-patient ratio. - Annals of Intensive Care
• Lower staffing of registered nurses and higher levels of patient admissions per nurse are associated with increased risk of patient death. - BMJ Quality & Safet

Patient and Staff Satisfaction

• Higher patient satisfaction is associated with a mandated nurse-to-patient ratio. - Journal of Nursing Regulation
• Safe staffing ratios equal greater job satisfaction, and decreased nurse turnover. - ADVANCE Healthcare Network: Nursing
• Appropriate nurse staffing helps decrease nurse fatigue, thus promoting increased safety as well as job satisfaction. - American Nurses Association

Nurse Retention

• Mandated nurse-to-patient ratios are associated with lower nurse burnout and better nurse retention. - XVI Pan American Nursing Research Colloquium
• Nurses' intention to leave was increased 1.05 times when a nurse-to-patient ratio was increased by 1. - Nursing Outlook
• A safe nurse-to-patient ratio decreases nurse burnout, including chronic fatigue, irritability, insomnia, depression, weight gain and other potential health risks that come from being overworked in a stressful environment. - Department for Professional Employees, AFL-CIO (DPE)

The benefits of legislation to mandate safe nurse-to-patient ratios speak for themselves. Increased nurse staffing can provide a competitive advantage to hospitals, and, as a result, better financial performance, particularly in more competitive markets.