The Nurse Patient Ratio: Implications for Quality of Care

NursingJanuary 27, 2014

The nurse patient ratio is an important calculation in health care. How many patients are in a single nurse's care directly affects many aspects of patient care. Although you may have already known or assumed this, did you know that the federal government does not set this ratio?  The Code of Federal Regulations simply requires that facilities that accept Medicare patients "have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed." Some states have addressed this nurse patient ratio issue by enacting legislation or regulations, but in states that do not regulate staffing, health care entities are able to decide this for themselves.

According to the American Nurses Association's website "Nursing World," sufficient staffing helps lower medical and medication errors, reduce patient complications, decrease mortality, improve patient satisfaction and enhance nurse retention rates and job satisfaction. Because of the lack of federal oversight on this issue, the association is working to offer solutions that will improve patient care across the country. One possible remedy to this problem is to allow facilities to determine their own staffing levels through a nursing committee, who would be able to adjust the nurse patient ratio depending on the unit. This solution seems plausible, given that more acute patients will require more of a nurse's attention. Other suggestions by the American Nurses Association include asking the government to mandate certain requirements, or to require that health care facilities make their nurse-to-patient ratios public knowledge. Some states, but very few, already abide by some of these suggestions. 

California, which is the only state that has set required nurse-to-patient ratios, has very specific regulations. For instance, only 50 percent of the nurses may be licensed vocational nurses, as opposed to RNs. The state also specifies when an RN must be assigned, and not a vocational nurse. The health care entity must always have the proper ratio of staffing. Some examples of their staffing ratios are one nurse per two patients in critical care areas, one nurse per patient in surgical units and one nurse per two patients who are being managed in active labor.

In the current climate of rising health care costs, and the possible influx of previously uninsured patients into the system, the nurse patient ratio is becoming increasingly worrisome. Not only facilities with limited resources, but all health care facilities may be forced to make tough decisions about staffing in order to deal with budget shortfalls. Organizations, such as the American Nurses Association, are working to ensure that these facilities are able to deal with rising costs, without sacrificing quality of care, by working within acceptable guidelines that will benefit patients as well as the nurses and other staff who care for them.