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Look Beyond Nurse-Patient Ratios

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

Education as a Marker
Vitello also says that when it comes to the right nurse-to-patient ratios, "there was no fixed number [of nurses] that was the magic bullet." But there is one thing that does seem to be something of a magic bullet for patient safety: Education.

Study after study shows that the more educated nurses are, the better the outcomes. And education is something that the IOM wants too, illustrated by its recommended goal that the proportion of nurses with baccalaureate degrees be increased to 80% by 2020.

"That's where we need to start pouring what little monies we have," Vitello says.

But like it or not, the question of whether maximum nurse-patient staffing ratios should be mandated by law may go before Massachusetts voters in November. With that in mind, Vitello says it's up to nurses and nurse leaders to show the voting public that "more" doesn't necessarily mean "better."

"I think it's going to be incumbent on nursing… to educate our public that this is a recipe for waste," she says.


Alexandra Wilson Pecci is a managing editor for HealthLeaders Media.

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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