Friday, May 27, 2016

Nurse-to-Patient Ratios and How it Affects You

On June 12, I joined hundreds of other nurses from across the country on the lawn of the U.S. Capitol for a rally and spoke with staffers from my state's representatives offices about the need for nationally regulated patient ratios. I also recently became a member of National Nurses United, the largest union and professional association of registered nurses in U.S. history. 

Why is this significant? If nurses are saying that there are issues with staffing practices at hospitals and longterm care facilities then the general public who receives this medical care, should be worried too. Nurses are concerned because the ongoing focus on profit by corporate healthcare organizations is impeding our ability to provide safe and effective care to you and your loved ones.

In previous posts, I have shared how feeling like I was being expected to care for too many patients affected my ability to provide holistic care and incorporate integrative therapies at the bedside. But being holistic and getting to know their patients is the least of many nurses concerns around the country. They want to know they didn't cause harm to any of their 8+ patients on a medical surgical unit, 5+ patients on the stepdown/progressive care unit, or in some places 4+ patients in the intensive care.

I can relate as I too have worked in a for-profit hospital where nurses were routinely understaffed and continuously expected to do more. More charting, more rounding, more medication administering...more more more...with less nurses and less nursing assistants and unit secretaries to help. Why? Because if they can make us provide care for more patients with less staff then the corporation will make more profit. Pretty simple answer, right? But instead, we are providing less real care and causing more harm to our patients and ourselves.

Numerous studies have demonstrated the increased risks that our loved ones are subjected to when receiving care at a facility with inadequate staffing practices. Increased risk of developing pressure ulcers, hospital-acquired pneumonia, falls, medication errors, respiratory failure, cardiac arrest, readmission, and death are a few examples. *see references listed at bottom of this page*

Nurses are selfless creatures by nature. We work extra hours, stay late, skip lunch breaks, take the rare bathroom break with the ASCOM phone attached to our hip, and join committees. Not because we have nothing else to do, but rather because we don't want to leave our nursing colleagues short-staffed or put our patients at risk of further complications due to short-staffing. But nurses are humans too. I have previously written about the importance of self-care to avoid burnout and caregiver fatigue. Some of the main risk factors for nurse burnout is unsafe staffing practices and increased stress from their job related to these expectations. In one study, 83.7% of nurse participants reported that the number of nurses working on their departments is not sufficient for the amount of work (Obradovic, Obradovic, Cesir-Skoro, 2013). Nurses leave the career they worked so hard for and felt called to because of these issues, leaving us with even fewer nurses at the bedside and perpetuating this cycle. According to Twibell & St. Pierre, roughly 30% of new graduate nurses leave their roles within the first year and 57% within two years, citing heavy workloads, inability to ensure patient safety, and insufficient time with patients as reasons for leaving. The cost of replacing a nurse who leaves is more than $80,000 (2012). 

The view of corporate healthcare in America is too short-sighted to see the simple solution. By providing better staffing ratios we would be providing safer and more comprehensive care to our patients, improving staff job satisfaction and reducing nurse burnout, and ultimately saving billions of dollars by preventing readmissions, reducing errors, and shortening length of hospital stays.

Nurses are organizing and have been for several years on this matter. In 2004, California passed the only government regulated nurse-patient ratios after nurses and patients united to demand safer practices. Why is it now, 12 years later, we cannot have those same regulations in hospitals and longterm care facilities all across America? Greed! Corporate healthcare is not in the business of keeping you healthy. They are in the business of making money like the rest of corporate America, and their practices are self-serving and putting you and your loved ones in danger. 

Would you want your mother or grandfather to be my third patient in the ICU? Or the 8th patient for a nurse on the medical surgical floor? Trust me, you don't. When nurses are expected to provide care beyond safe levels patients suffer: mistakes are made, tiny changes that could save your loved ones life are missed, and they miss out on the potential caring moments that we nurses long to cherish with them. We are rushed, flustered, stressed out, and afraid that we will bring harm to those we work so hard to help. So, what can we do? We need to be active in our government and let our voices be heard. Nurses can join movements and organizations such as National Nurses United or Nurses for National Patient Ratios Facebook Group. Non-nurses who want to be involved and spread the word about safe staffing can find more information on the National Campaign for Safe RN-to-Patient Staffing Ratios

Please feel free to share this information and contact me directly at for more literature and conversation on this very important issue.  And continue to follow me as progress is made on this matter. 

Resource list
Aiken L, Clarke S, Sloane D, Sochalski J, Silber J. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama [serial online]. October 23, 2002;288(16):1987-1993. Available from: MEDLINE Complete, Ipswich, MA. Accessed May 27, 2016.
Cho, Eunhee,PhD., R.N., Chin, Dal Lae,PhD., R.N., Kim, Sinhye,M.S.N., R.N., & Hong, OiSaeng, PhD, RN,F.A.A.N., F.A.A.O.H.N. (2016). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82. doi:
Harless D.W. & Mark B.A. (2006) Addressing measurement error bias in nurse staffing research. Health Services Research 41 (5), 2006-2024.
Harless D.W. & Mark B.A. (2010) Nurse staffing and quality of care with direct measurement of inpatient staffing. Medical Care 48 (7), 659-663.
McHugh MD, Ma C. Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Med Care. 2013;51:52–59. 

Needleman, J., PhD., Buerhaus, Peter,PhD., R.N., Pankratz, V. S., Leibson, C. L., PhD., Stevens, S. R., M.S., & Harris, Marcelline,PhD., R.N. (2011). Nurse staffing and inpatient hospital mortality. The New England Journal of Medicine, 364(11), 1037-45. doi:
Twibell, R., & St. Pierre, J. (2012, June). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today7(16).
Obradovic, Z., Obradovic, A., & Skoro, I. C. (2013). Nurses and burnout syndrome.Journal of Health Sciences, 3(1) Retrieved from


  1. Replies
    1. Thanks Carmen. It is so important that we educate the general public as we are all likely to be receivers of medical care. And continue encouraging other nurses to be active around this issue.

  2. Very informative April! I look forward to updates on this topic

  3. thanks for all the great work you are doing in this area

  4. Wow, what a great article. So much data to speak to the importance of safe workplaces. Interesting that my post this week too spoke to the staffing numbers. More literature like this on blogs helps move this work forward. Great job!

  5. Depending on the exact field of medicine they work in, registered nurses can be found working in hospitals, physician’s offices, emergency rooms, rehabilitation centers and in many other healthcare facilities. They work in shifts or with no permanent time frame. They’re often required to work overtime, during weekends or in emergency hours, which means their work hours are very unpredictable. Registered nurses most of their time spend on foot, walking, bending and standing.

  6. I like your blog a lot. Its informative and full of information. Thank you for sharing.
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