So, What About Nurse Staffing Ratios?

Adequate nurse staffing ratios are associated with better patient outcomes, says this CNO.

The nursing shortage impacts other nurses by causing burnout and exhaustion, and inadequate staffing directly affects patient safety and experience.

CNOs must be aware of those risks and consider all possible staffing models and solutions so that they can make the best decision for their hospitals and health systems.

According to the American Nurses Association, proper nurse staffing improves patient outcomes and satisfaction among nurses and patients. One proposed solution for ensuring proper staffing is staffing ratios.

Staffing ratios refer to the number of patients assigned to each nurse during their shift or a specific timeframe, and according to Vicky Tilton, vice president of patient care services and chief nursing officer at Valley Children’s Healthcare, there are many benefits.

"Adequate nurse staffing ratios are associated with better patient outcomes," Tilton said, "including lower mortality rates, reduced rates of hospital-acquired infections, [and] decreased medication errors."

What are the benefits?

According to Tilton, higher nurse staffing ratios can reduce the likelihood of adverse events, falls, and patient deterioration. In this case, nurses have more time to monitor patients and spot warning signs, and they can intervene quickly when complications arise.

"Optimal staffing ratios enable nurses to conduct thorough assessments, administer medications safely, and implement proper infection control measures," Tilton said, "thereby minimizing the risk of errors and harm to patients."

Proper staffing ratios can also help mitigate burnout and job dissatisfaction, Tilton explained, by lowering workload intensity, stress, and fatigue.

"When nurses are not overwhelmed by excessive patient assignments, they can maintain a healthier work-life balance, experience less emotional exhaustion, and feel more engaged and fulfilled in their roles," Tilton said.

Additionally, staffing ratios can allow nurses to practice at the top of their license, according to Tilton. They provide more time for professional development opportunities as well, such as continuing education, specialty certification, and leadership roles.

"Nurses can collaborate more closely with interdisciplinary team members, participate in care planning, and contribute to quality care initiatives," Tilton said, "when they are not overwhelmed by excessive workload demands."

Financial impact

Just like with any new program or workforce strategy, CNOs need to be able to justify the cost to the rest of the C-Suite.

"While ensuring appropriate nurse staffing ratios may require upfront investment," Tilton said, "it can yield long-term financial benefits for healthcare organizations."

There are several financial benefits to staffing ratios that can lead to saving more time and money for both the nurse and the health system.

"Improved patient outcomes, reduced lengths of stay, lower rates of readmission, and higher patient satisfaction scores associated with optimal staffing ratios can lead to cost savings, enhanced reimbursement rates, and increased revenue generation," Tilton said, "for hospitals and healthcare systems."

Proper staffing ratios also lower nurse turnover rates, according to Tilton, which is an additional financial benefit as well as a solution to the staffing shortage.

"Organizations that prioritize nurse satisfaction and retention by maintaining safe staffing levels can avoid the high costs associated with recruitment, orientation, and turnover of nursing staff," Tilton said.

Overall, Tilton explained, staffing ratios for nurses promote patient safety, quality of care, and better organizational performance.

"By prioritizing adequate staffing levels and workload management," Tilton said, "healthcare organizations can achieve better clinical outcomes, enhance the patient experience, and create a supportive and sustainable work environment for nurses."

Legal implications  

While there is no current federal legislation mandating nurse staffing ratios, several states have legislated standards for staffing ratios or have made attempts to do so.

California has had legally mandated staffing ratios since 1999, which according to National Nurses United, are based on individual patient acuity and are designed to fix unsafe staffing in acute-care settings. The California staffing ratios require numerical RN-to-patient ratios as well as a patient classification system. The law also regulates the use of unlicensed assistive personnel and restricts "floating" nursing staff.

Implementing staffing ratios, however, requires levels of nuance depending on the health system.

"It’s important to note that the impact of legislation mandating staffing ratios can vary," Tilton said, "depending on factors such as geographical location, healthcare setting, patient population, and resource availability."

Health systems might run into several implementation challenges, Tilton explained, including budget constraints, potential staffing shortages, and a resistance to change from staff. These roadblocks can impact the effectiveness and outcomes in a mandated ratio scenario.

"Policymakers, healthcare leaders, and stakeholders must carefully consider the unique context and implications of staffing ratio legislation," Tilton said, "to maximize its benefits and address potential challenges effectively."