NURSE TO PATIENT

RATIOS

Lauren Kasperlik

INTRODUCTION
What is the issue?
What is the optimal NursePatient ratio?
Advantages/Disadvantages

OBJECTIVES
To identify the reason nurses are fighting for
mandated nurse-to-patient ratios
To examine the effects of Californias nurseto-patient ratios and how it has impacted
nursing
To discuss the current research regarding
nurse-to-patient ratios and the relationship
with patient outcomes

ACTIVITY
https://getkahoot.com/

BACKGROUND
In 2004 California was the first
state mandate nurse-to-patient
ratios
Goal: improve nurse staffing levels and
quality of care to patients
https://www.youtube.com/watch?v=V2VhHl6nco

Reducing the nursing labor

work force
Past studies indicate negative
association between high
nurse-to-patient ratios and
patient outcomes
Highly criticized

THEORY BASE
Betty Neuman
Systems Model

Maslows Hierarchy of
Needs

ASSESSMENT OF THE
HEALTHCARE ENVIRONMENT
Policies/Current Legislation
17 states have mandated nurse-to-patient ratios
legislation
acuity

Resources
Nursing shortage

Safety and Quality

WHATS HAPPENING IN
MICHIGAN?

The Michigan Nurses Association is working for a legislative solution

for safe staffing in Michigan
Michigans Safe Patient Care Act
Staffing plan with written minimum nurse-to-patient ratios

Proposed Ratios:
Critical care 1:1
Operating Room 1:1
Labor and Delivery
During 2nd or 3rd stage of labor 1:1
During 1st stage of labor 1:2
Immediate care newborn nursery 1:3
Noncritical antepartum 1:4
Postpartum mother baby couplet 1:3
Postpartum or well-baby care 1:6

Post anesthesia unit 1:2

Emergency Department
Nontrauma or noncritical care 1:3
Trauma or critical care 1:1
1 RN for triage

Stepdown 1:3
Telemetry 1:3
Medical/Surgical 1:4
Pediatrics 1:4
Behavioral Health 1:4
Rehabilitation 1:5

ROOT CAUSE ANALYSIS

REGISTERED NURSE SAFE

STAFFING ACT
Endorsed by the American Nurses
Association
An approach to determine safe staffing
levels made by the decisions of the nurses
and the manager
https://
www.youtube.com/watch?v=0DPi1reo6Fg

RESEARCH ARTICLE
Staffing Changes Before and After Mandated Nurse-to-Patient Ratios in
Californias Hospitals
Staff Changes
Findings:
Length of stay decreased
Productive hours per patient increased
Specific Ratios changed
Increased number of RNs, but no association with positive patient outcomes

Further research needed

WHAT DOES THE EVIDENCE

SUGGEST?
Time with patients increased
High staffing levels = surveillance
Nurses with high patient ratios more
likely to experience burnout
No proven association with mandated
ratios and patient outcomes
More research must be done

INFERENCES
Evidence not what is expected
Multiple factors effect patient outcomes
Critical factors influence staffing
Census
Acuity
Experience
Available resources

IMPLICATIONS/CONSEQUENC
ES
Patient
More time spent with the RN
Quality care

Nurses
Burnout
Job dissatisfaction

Hospital
Costs
Staffing

NURSE BURNOUT
Symptoms:
Chronic fatigue
Insomnia
Weight gain
Back pain
Depression
High blood pressure

Lower job retention

Contributes to the nursing shortage
Moving away from the bedside

RECOMMENDATIONS
Establish a Nurse-Management Staffing Committee
Create a staffing plan

Communicate with management

Increase the nurse workforce
Get involved
QSEN

ANA STANDARDS
Standard 9: Evidence-Based Practice and Research
The registered nurse integrates evidence and research findings into practice

Standard 10: Quality of Practice

The registered nurse contributes to quality and nursing practice

Standard 11: Communication

The registered nurse communicates effectively in a variety of formats in all
areas of practice

QUESTIONS
1. Do you think nurse-to-patient ratios should be mandated across the United
States in all acute care settings?
2. What do you think could be done to help combat the nursing shortage?
3. Do you think nurse-sensitive indicators (CAUTI, pressure ulcers, falls) would
improve with mandated ratios?
4. Who should determine safe staffing plans?
5. How could we decrease the incidence of nurse burnout?

FINAL QUESTIONS?