Safety Concern: Unsafe Nursing Ratios

Solutions such as newly required nurse-led staffing committees aim to end unsafe nursing ratios that compromise patient safety.

At a recent conference, a group of nurse leaders came up with this catch phrase, “You cannot fix it with a pizza day.”

“It’s one of my favorite expressions now because it’s just so apt for the way nurses are feeling,” said Cindy Bacon, PhD, RN, CNE, NE-BC, Associate Professor and Program Director of MSN Programs at the University of North Carolina Greensboro School of Nursing.

The consensus was that free lunches aren’t going to cut it anymore. Nurses want a manageable workload with adequate staffing, among other things. “Nurses are taking on more patients and more responsibilities. And they’re to the point where — after two years of COVID — staffing just continues to deteriorate. They just aren’t doing it anymore,” said Bacon.

Mandated ratios in just one state

Nearly one-third of nurses said they’re considering leaving their direct patient care role, a recent McKinsey study found. The biggest factor driving this decision? Insufficient staffing levels and concerns over unsafe nursing ratios. In fact, the 2022 Nurse Salary Research Report by found that the pandemic led to a precipitous increase in the number of nurses considering leaving the profession.

Currently, no federal mandates regulate the number of patients a registered nurse cares for. If passed, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act would require hospitals to set mandated minimum nurse-to-patient staffing ratios.

“Presently, exact ratios are disputed,” said Allison A. Norful, PhD, RN, ANP-BC, FAAN, Assistant Professor at Columbia University School of Nursing in New York. Ratios are driven by state-based legislation and in most states are determined by the severity of the patient’s condition.

California remains the only state with mandated nurse-to-patient staffing ratios, which have been in effect for years. Hospitals were allowed to adjust their ratios because the pandemic put such strain on the nursing workforce. “So while institutions aren’t getting slapped on the hand right now, they certainly are having a difficult time adhering to the ratios,” said Anita Girard, DNP, RN, President of American Nurses Association – California.

Hospitals counter that mandated ratios would fiscally strain organizations. Yet one study found that cost savings (due to fewer admissions and shorter length of stay) were more than double the cost of additional nurse staffing. Another study found that on medical/surgical units, the odds of 30-day mortality increased by 16% for each additional patient added to a nurse’s workload.

A growing number of states are passing safe staffing laws, with requirements such as nurse-led staffing committees. “Even in those states, nurses are still being overworked,” said Jason Ritchie, Associate Director of State Advocacy in ANA’s Government Affairs department. You may not even get time to eat or use the restroom during your shift. Then at the end of a shift, you might be required to stay for mandatory overtime. “That’s what we’ve been hearing from …read more

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