Extensive research shows that the fewer patients a nurse cares for, the better the patient outcomes and higher their job satisfaction. Unfortunately, tighter hospital budgets and growing numbers of patients have placed safe-staffing ratios lower on the priority list.
Still, nurses unions across the country are waging a legal battle to reduce the number of patients per RN. One in particular, the California Nurses Association, had success in 2004 after 13 years of fighting. Since the law was enacted, California has seen improved patient care and lower turnover among nurses. National Nurses United, the largest RN union in the country, is also advocating for two federal bills, one in the Senate and another in the House, both modeled after California’s.
So what exactly constitutes “safe staffing”? According to a graphic from National Nurses United, the largest RN union in the country, it’s as follows:
- ONE nurse to ONE operating room trauma patient
- ONE nurse to TWO intensive/critical care, NICU, post-anesthesia, labor and delivery, ICU in ER, coronary care, acute respiratory care or burn unit patients
- ONE nurse to THREE antepartum, combined labor and delivery/postpartum, postpartum couplets, pediatrics, ER, step down or telemetry patients
- ONE nurse to FOUR intermediate care nursery, med/surg, psychiatric or other specialty-care unit patients
- ONE nurse to FIVE rehabilitation or skilled nursing facility patients
- ONE nurse to SIX well-baby nursery patients
Arguments against safe-staffing ratios largely revolve around keeping hospitals cost-effective. But according to the Institute for Health & Socio-Economic Policy, hospital income in California grew substantially after 2004 — from $12.5 billion from 1994 to 2003 to $20.6 billion from 2004 to 2010.
That’s at least in part because unsafe staffing leads to higher rates of costly, hospital-acquired infections and 30-day readmissions. Not to mention, better ratios reduce turnover among nurses, which saves money on hiring and training new employes. Plus, according to the California Health Care Foundation, safe-staffing ratios makes hospitals more desirable candidates for external funding.
To get involved in safe-staffing ratio advocacy, you can join the NNU’s safe-staffing ratio coalition, send a letter to Congress showing your support for the legislation, or contact your federal representative directly. At the community level, you can also meet with your state assemblyman and get involved with a local nurses union.
Taking nurse staffing research to the unit level, NCBI.
National Campaign for Safe RN-to-Patient Staffing Ratios, National Nurses United.
The Second Annual IHSP Hospital 200: Hospitals, Big Pharma, HMOs, and the Health Care War Economy, Institute for Health & Socioeconomic Policy.
Myths and Facts About Safe Staffing, New York State Nurses Association.
Last updated on 10/2/19.