What is the Ideal Nurse-Patient Ratio?

What is the Ideal Nurse-Patient Ratio?

Balancing budget, patient care, and staff retention.

Shane Parker, RN
Co-founder and Chief Nursing Officer

Maintaining the appropriate nurse-patient ratio is more important than ever for nursing leaders across the US. Not having enough nurses to go around can result in poor patient care and nurse burnout.  However, having too many nurses can also wreak havoc on the budget. So, what is the appropriate nurse-patient ratio?

National & State Level Legislation

Both National Nurses United and the American Nurses Association are actively making a push for a legislative model called the Registered Nurse Staffing Act. This act allows hospitals and doctor’s offices to make a staffing plan that is appropriate for their specific unit. This would require hospitals that provide Medicare services to create a committee of 55% direct care nurses to establish and report on staffing plans. This would hold hospitals accountable for their staffing and generally lead to more monetary penalties for violation.

However, there are already a few laws in place regarding nurse staffing. A federal regulation, known as 42CFR 482.23(b), requires that hospitals who provide Medicare services have an appropriate level of RNs and LPNs on staff at all times to care for patients. The law doesn’t specify what those levels should entail, allowing hospitals a bit of flexibility.

Because of this, many states have started to take nurse staffing regulation into their own hands. 14 states have created their own laws regarding a nurse-to-patient ratio. This includes seven states that require staffing committees to devise plans, and five states that require public disclosure on staffing ratios.

California is the only state that has a law requiring hospitals to have a minimum nurse-patient ratio at all times. This law is working in the state, as 88 percent of medical-surgical nurses in California were in charge of five or less patients during their last shift. However, in Pennsylvania and New Jersey, only 33 and 19 percent of nurses could say this. In fact, if Pennsylvania and New Jersey had had California regulations in place, experts estimated that there would have been 10.6 and 13.9 fewer surgical deaths respectively.

Massachusetts has a similar but less all-inclusive law; instead of all patients getting an acceptable nurse-patient ratio, only patients in the ICU require a 1:1 or 1:2 ratio depending on their condition.

Minimum Ratios by Unit-Type

One more legal mandate that nurses across the country are supporting is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. Under this proposed law, hospitals would have mandated minimum nurse-patient ratios depending on the type of unit. Under this law, patients in the ICU, neonatal intensive care unit, post-anesthesia unit, labor and delivery unit, ICU patient in the ER, acute respiratory care unit, and burn unit would have a 1:2 nurse-patient ratio. Patients in the antepartum, postpartum couplets, pediatrics, emergency room, step down, and telemetry units have a little less attention with a 1:3 ratio. The immediate care nursery, medical/surgical, and psychiatric care units all have a 1:4 ratio, while the rehab and skilled nursing facility units have a 1:5 ratio. The unit of a hospital with the least attention is the well-baby nursery, with a 1:6 ratio.

Perhaps the most noteworthy proposed ratio is in the operating room and among trauma patients in the ER, which would both require a 1:1 ratio. This ensures these patients have round-the-clock care to prevent them from suffering complications and side effects. While this might seem extreme, especially from a staff scheduling perspective, it puts the patient first in a system that is increasingly more hectic.

What are some ways to manage the nurse-patient ratio?

One way to manage the nurse-patient ratio is to invest in staff scheduling technology.  The nursing field has shifted away from traditional pen-and-paper scheduling techniques which can be frustrating for staff and managers, but more importantly don’t allow for quick productivity calculations.  Without easy access to data, such as HPPD, it is nearly impossible to proactively manage nurse-patient ratios day-to-day.

ShiftWizard’s staff scheduling software was designed by nurses to help nurse leaders balance budget, patient care, and staff retention.

For more information about how ShiftWizard can help with your scheduling needs, schedule a free consultation today.