Nurse To Patient Ratio Analysis

People are living longer and healthier lives now more than ever before. Much of this can be attributed to the advances in modern medicine over the past few decades. However, in healthcare, there is now a growing population of patients that are becoming sicker and more complex to care for. With the new generation of sick patients present in the hospitals, today’s nurses are stressed and fatigued more than ever before. Much of the stress and fatigue can be attributed to the nurse to patient ratio and the associated workload.

Traditionally, the nurse to patient ratio is determined by the supervising nurse’s (charge nurse) best judgment or an established acuity protocol (Kidd, Grove, Kaiser, Swoboda, & Taylor, 2014). A multitude of factors

are considered when assigning a care giver to a particular patient workload. Some of those factors include the amount of bedside care, teaching the patient, psychosocial interventions required and amount of medications administered. These factors are present in many charge nurses minds when they begin to make assignments. However, these factors may not be the thought of all charge nurses. When these variables are not accounted for, the bedside nurse can experience an overwhelming assignment. This not only endangers the patient, it also stresses and fatigues the bedside nurse. What if there was a scale to assist in the charge nurses decision of patient assignments? An acuity scale can offer an objective measurement when additional staff is needed (Kidd et al., 2014). This paper will aim to increase the awareness of nurse to patient ratios and how the proper patient assignments in relation to acuity can improve patient outcomes.
Literature Review
In healthcare today, there are very few state imposed mandates that provide permanent nurse to patient ratios. In 2004, California became the first state ever to mandate these ratios (Penoyer, 2010). After many years of research, findings would show that the mandate did not improve patient outcomes in medical-surgical floors or stepdown units (Penoyer, 2010). Recently, Massachusetts joined the ranks of California and mandated patient ratios of 1:1 and 1:2 in intensive care units (ICU) (Ready, 2015). The typical nurse to patient ratios of 1:1 and 1:2 are traditionally reserved for the ICU, operating room (OR), labor and delivery (L&D) and the post anesthesia care unit (PACU) ("Safe Nurse," 2015).
A systematic review and meta-analysis performed by Kane et al (2007) showed strong associations between increased registered nurse (RN) staffing ratio to patients lowered the odds of patient mortality and adverse events. The study utilized two different methods of evaluating previously performed research. The first method was measured by the number of patients cared for by 1 RN per shift. The second method utilized was measured by 1 RN full time employee per patient day. Assumptions for this study included a nurse working an average of 37.5-hours per work week in an ICU. An increase of 1 RN per patient day was associated with decreasing the odds of death in ICU by 9%. This statistic was also expressed as saving 5 lives per 1000 hospitalized patients in ICUs. Statistically speaking and relating to ratios, the study pointed out that reducing a patient assignment of 3.3 patients down to 2 patients per RN in an ICU would decrease the chance of death by 6%. By keeping this ratio at 2 patients per RN, the study also showed a 30% decrease in the odds of hospital-acquired pneumonia, 60% decrease in the odds of respiratory failure, 51% decrease in unplanned extubations and 28% decrease in cardiac arrest (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007).