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Thoughts on Nurse-to-Patient Ratios

By Jenny Palmgren, BSN, RN, Clinical Nurse Manager, MSSI

One of the hot topics across the US is the debate of nurse-to-patient ratios. As any healthcare professional would know, one of the reasons this topic is so appealing is due to the ever-increasing needs of the patients related to their healthcare.

Many RNs throughout the country have been fighting to have a consistent law nationwide as the only state that has a law in place is California. (Which states that for most inpatient units, the nurse-to-patient ratio is 1:5. However, it is 1:2 in critical care units.) In the most extreme settings, some hospitals have upwards of 1:8 nurse-to-patient ratios. Unsurprisingly, when the ratio is this extreme, the staff feels it is a safety issue for the patients, as well as their licenses.

Both budget cuts in hospitals and bedside care have caused these ratios to increase over the years. Some say this has played a factor into the increasing errors made during patient care. This may be true in some cases; however, it is not the only reason. At times, nurses also make choices to take shortcuts and bypass the warnings set in place. These warnings are designed to decrease patient care errors. Even when there are safe and appropriate nurse-to-patient ratios, errors can still be made. We are all human, and as I have stated before, we have patients and families’ loved ones in our hands. We need to be aware of our every move to prevent these mistakes. As much as I am in support of changing the law to make it safe, I am also realistic to the fact that this is not going to make it perfect and prevent these errors.

As we progress through more difficult times ahead with the continuous budget cuts and RN shortages, we need to be clearer in how we complete patient care, so it is safe for all parties. Some examples to assist in safe care are:

  • Nurse Input: Bring the nurses from the bedside to the table to assist with ideas on improving safe care/staffing levels.
  • Patient Intensity/Acuity: Take both into consideration when looking at staffing numbers.
  • Proper Training: Ensure staff are properly trained before working in an unfamiliar area.
  • Importance of Teamwork: Having a well-oiled team will help get the job done effectively and safely.

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