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Look Beyond Nurse-Patient Ratios

Alexandra Wilson Pecci, for HealthLeaders Media, April 15, 2014

It's Complicated
Vitello was among those who gave testimony against the proposed Patient Safety Act, which "would set standards for the maximum number of patients that can be safely cared for by hospital nurses at any one time" in Massachusetts. She strongly counters the "unmitigated lie" claim, saying that nurse leaders at Brigham and Women's Hospital are constantly adjusting staffing based on patient needs.

"We do it with a patient acuity system," she says. "That's done on a day-to-day basis." Nurse leaders use a "synergy model" to make daily staffing choices based on factors such as how the needs of patients match up with the skills of the nurses, the number of new grads working on a unit, and even the physical layout of units themselves.

"It is very complex," agrees Patricia M. Noga, PhD, RN, Vice President of Clinical Affairs for the Massachusetts Hospital Association. "Everyone is unique, and you just can't come up with fixed ratios that will be applied everywhere across the board."

Instead of mandated ratios coming from legislation, nurse executives can and should make the business case for hiring more nurses when needed. Vitello says it's something she did successfully when she was CNO of a community hospital.

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5 comments on "Look Beyond Nurse-Patient Ratios"


Deb (4/17/2014 at 11:05 PM)
I have worked in nursing for a long time. I have seen administrative nurses counted as staff caring for patients who were not on the floor providing care. Hospitals who show two sets of scheduled staff. The reality based unsafe numbers and the perfect overstaffed numbers of patient care assignments Hospitals have notoriously taken the cheaper way out since they began using unpaid nursing students as regular staff, then the nuring assistants, then the certified nursing assistant,psychiatric care specialists. Most of these people with a high school graduation at the most. Then came the contingent nurses with no benefits. Too many part time nuses resulting in no continuity of care. Use of the acuity scale is manipulated to make the patients less sick than they are. Very few hospitals consider the physical layout of the units and time required to reach areas to provide care. Nurses have been instructed to delegate nursing duties to non-licensed poorly educated staff and then are required to sign their name that all is done. Nursing schools do not teach how to delegate your job away, nor do they teach the reality of caring for 22 patients with one nurse and 2 patient care tech's. Until a federally mandated nurse patient ratio is established nurse burnout will continue, poor nursing care will be provided, nursing shortages will continue and the system will remain the same. Those who can afford the private high cost insurance will receive good quality care and those who need it the most will not have access to it. So yes the education is needed of the administration that poor care results in higher cost and fewer good quality nurses.

Nancy Ballard (4/17/2014 at 2:53 PM)
Good points were made in the article to which I would add the importance of the work environment. When structures and processes (nurse leadership; trust; teamwork, shared decision making, etc.)are good then workload is better managed. Leadership from the CNO to the frontline manager set the tone and expectations that are crucial to providing the work environment where care is provided which has an impact on how well nurses manage in the complex, fluctuating environment in which nurses practice. Static numbers are not the answer.

mary pat teschler (4/17/2014 at 8:29 AM)
Your article states "...study after study.." shows the higher the education of the nurses the better the outcomes. What studies are you talking about? Could you referednce these? I assume that the outcomes you are talking about are concerning staffing ratios, not patient outcomes, is this correct? Thank you