1. RUNNINGHEAD: Strict Patient-Nurse Ratio Policy 1
Strict Nurse-Patient Staffing Ratio Policy
Date of Submission:
The policy that was to be implemented was a strict nurse-patient staffing ratio. This issue
was a priority because the nurses were experiencing horrific stories when their patient ratio got
out of hand. A nurse who was working on a 36-bed med-surgical unit in an inner city hospital in
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New York had a direct horrific experience in regard to the matter. The nurse was working on an
eight-hour night shift. Owing to call-outs, the regular nurse-to-patient ratio of 1: 7 was not
observed. Instead the nurse was to attend to eighteen patients. There was a policy in the hospital
that prevented nurses from the specialty areas to be floated to the other units. From that stand,
there was no in-house help and the nurse had to frantically attend to the eighteen patients until a
third nurse came in two hours later.
Any nurse with a group of acute care, sick patients was bound to get overwhelmed. The
nurse was completely overwhelmed with the task to an extent of forgetting the patients to be
attended. A nurse working with such large number of patients could not be able to administer
adequately to them. The patient stood to suffer from harm since the nurse would practically fail
to monitor them well in the way they were responding to the treatment. On the side of the nurse,
he would be overworked and overwhelmed which reduced his normal performance terribly even
after getting a relief and assignment of the normal ratios. In the community hospitals, the nurse-
to-patient ratio was 1:8 in the med-surgical unit. On the progressive care unit, the ratio was 1:5.
When there was a call-out and a nurse was floated from another unit, assignments had to be
switched so that the floated nurse had no IV drip or IV push cardiac medication. In addition,
each nurse had to oversee one or two of the float nurse’s monitored patient. Hence, the nurses
became overloaded with work. Technically, the nurse-to-patient ratio then is 1:7 which puts the
patients in danger of being harmed.
There was an incidence when with the technically 1:7 ratio, three patients of a nurse
coded, one after the other. The nurse had no time to look in on the other patients or to monitor
their charts. It was impossible for the nurse to do so since the three of his patients ended up in the
ICU. The nurse was frazzled and headed home three hours later after the expiry of his normal
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twelve hours shift. He was scheduled to work that night too which left him exhausted and
questioning the satisfaction of his job.
When patients were acutely sick, the amount of patients a nurse had needed to be
controlled to protect the patient from harm. Ratios were not only a good idea but they were
necessary for the safety of the nurse and the patient. There was a growing concern that
inadequate staffing was harming the patients. The harm was mostly in the areas where there was
critical illness or the need of extra care. In the cases where nurses were assigned more than the
usual number of patients or in the event that there was a high patient turn-out in a shift; the
patients experienced high mortality rates. A legislation mandating minimum staffing ratios was
required to ensure long-term sustainability. Research showed improvement in patient outcomes
with improved nurse-to-patient staffing ratio. When nurse-to-patient ratios were as depicted by
the California law in the three states (California, New Jersey, Pennsylvania) the nurses' were
significantly satisfied with their job. The nurses and the patients reported better care and
improvement in the quality of the health services provided. (Aiken, et al., 2010). It was vital that
a mandatory nurse-to-patient staffing ratio policy be implemented to alleviate nurse workloads,
increase job satisfaction, and ultimately, produce better patient outcomes (Tevington, 2011).
Also, many studies had established that larger nurse-to-patients ratio contributed to poor patient
outcomes. The outcomes were medical errors, complications and more patient deaths. (McHugh,
Kelly, Sloane & Aiken, 2011). A survey was carried out in 2003 (NEPPC, 2005) and two thirds
of the MNA members were positive that insufficient nursing care brought serious medical
complications and could be fatal. The survey found that, more than 85% of the nurses felt that
they were being overworked in terms of the patients they were forced to take care of. Many
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studies by other organizations like the Health Research and Quality, Joint Commission on the
Accreditation of Health indicated try tract infection, pneumonia, ulcers, sepsis, cardiac arrest,
gastrointestinal bleeding and a longer hospital stay. In some cases, death could occur.
The Significance of the Implementation of the Policy
1. Implementation of mandatory nurse-to-patient staffing ratio: 1. 5 protected the patient.
Caring for twelve patients was accompanied by difficulty in remembering all the
specifics of all the patients. It was almost impossible and not safe.
2. There was need to protect the nurse whose licenses were directly in the line when they
were required to take care of large numbers of patients, that was not practically possible
with a normal human being.
3. The policy would also serve to keep facilities honest and prevent them from assigning
nurses too many patients as they felt was possible.
Thoughts on Issue
The issue of the patient-nurse ratio had been having controversies as to which ratio was
exactly the most optimum level. The level was in regard to ensure patient safety and the quality
of health services they received. The nurses on the other hand were not to be overworked or
underworked. The assigned number of patients a nurse was to administer to was a critical point
of examining. The time allocated for each shift was also very important as long hours of work
would cause fatigue and affect quality of the performance negatively. The state and the local
Government were entirely left with the choice as to the right nurse-to-patient ratio. However, it
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was very important for qualitative research is done and a recommendation be done based on this
rather than implementing a policy blindly.
Current Status of Issue
The situation that had left the state entirely to making the choices as to what ratio was
adequate was challenged in the year 2013. Many bills that included the legislation to implement
nurse- patients staffing regulations were introduced. (Melissa, 2014) However, the congress had
not taken any action on the bills apart from referring them to committees. In California, they had
a policy that restricted their ratios to 1:5 in their hospitals. They also prohibited against
mandatory overtimes. Many states were following suit with some states requiring the hospitals to
have a staffing regulation committee that would oversee the staffing depending on the nature of
the hospital. An act that was called the Florida Hospital Patient Protection act was filed in the
senate and the state house. The bill set terms of the nurse to patient ratios to be varying from one
registered nurse attending five patients. The bill set terms that the registered nurse would even
attend to one patient for patients receiving conscious sedation, active labor, in trauma or in
operating room. However, the bill lay in the hands of the committee and no further action had
1. The nurse-to-patient ratio was found to be the key in ensuring patients` safety, protecting
the nurses and ensuring the overall quality of the health service.
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2. The adequate ratio was in question but it was felt that, a ratio of 1:5, and varying to one
depending on the critical level of the patient was advocated for
3. California was the only state that had implemented such a law, but it had been in practice
for a very short time to warrant its benefits
4. The health providers should were hand in hand with the state and the local Government
to establish the best way to go about it
5. For long term sustainability, a legislation that mandated the maximum staffing ratios was
important. The legislation would be important because it would take more time to amend
it than hospital policies which could be amended anytime.
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Melissa L (2014) Nurse Unions Continue to Push for Nurse-Patient Ratio Legislation.
Retrieved on 12 Nov, 2014 from: http://www.littler.com
NEPPC, (2005) Nurse-to Patient Ratios, Research and Reality. Retrieved on Nov 12,
2014 from: http://www.bostonfed.org/economic/neppc/conreports
LH Aiken. (2010) The Aiken Study:DPEAFLCIO. Retrieved on Nov 11, 2014 from:
Tevington P. (2011). Mandatory Nurse-Patient Ratios. Retrieved on Nov 11, 2014 From:
MD. McHugh. (2011) Contradicting Fear, California`s Nurse-to-Patient Mandate.
Retrieved on Nov 11, 2014 from: http://www.ncbi.nlm.nih.gov/