Safety in Numbers: Staffing Ratios in Hospitals Matter


Why safe staffing matters:

Studies show patient safety and positive outcomes are directly related to nurse staffing (Registered Nurse Safe Staffing Act of 2013).   Proper staffing increases nurse retention, decreases worker fatigue, and ensures the proper mix of experience, skill level, and specialty knowledge among nursing staff (Registered Nurse Safe Staffing Act of 2013).  By adjusting our method of staffing nursing units we can:

  • Prevent unnecessary death (1.24% reduction), injury, infection, and other adverse events
  • Reduce nurse fatigue and increase retention rates
  • Increase patient and staff satisfaction
  • Cost savings in form of shorter stays, decreased adverse events, lower staff turnover, fewer occupational health claims (Hertel, 2012)
American Nurses Association:  Nurse staffing (2014)

American Nurses Association: Nurse staffing (2014)

In 2013 congress introduced an amendment to title XVIII of the Social Security Act, H.R. 1821 – Registered Nurse Safe Staffing Act, reintroduced in 2014 as S. 2353.  This act requires staffing committees be formed comprised of at least 55% nurses, 1 from each specialty and nurse managers in all CMS funded hospitals.  In this model, nurse education levels, unit acuity/contextual issues, technological resources, and supportive staffing are included in ratio considerations which can be adjusted daily based on needs for each unit.

What can we do?

ANA: Nurse Staffing Plans (2014)

ANA: Nurse Staffing Plans (2014)

Currently 13 states have staffing laws – 7 of which require staffing committees.  Others have proposed (S. 992, HR 2187) or instituted minimum ratios designated per unit, eg 1:1 for all ICUs.  According the Lang et al (2004) this method is not supported, and committee based systems are endorsed by research and nurse/physician professional organizations.  In order to rectify this significant failure on behalf of our healthcare system to appropriately staff our hospitals it is crucial for nurses, hospital caregivers, physicians, and the public who receive care to vote on legislation and insist on safe patient care.


4 Responses to “Safety in Numbers: Staffing Ratios in Hospitals Matter”

  1. ruigutierrez Says:

    This is a great post, thank you for it. The bullet points are great to get a message in a concise manner. The image you shared is also very informative.
    I did not know about the lack staffing laws for nurses and I am convinced that it is beneficial and necessary.
    Thank you for posting this

  2. nrechac1 Says:

    This is an incredibly important topic. I know a nursing student who left the nursing profession because of the lack of appropriate staffing levels of nurses in the hospital she was doing her clinical work in. This made her job very stressful. There was even a story in the news about a nurse who died and whose husband claims that it was due to overwork, stress, and under staffing:

  3. sludmer1 Says:

    Hey guys! Thanks for the comments, it’s nice to hear that there are others out there concerned and in support of fixing this problem. It really is a very serious issue and unfortunately a complicated one. Financial reasons are the most often cited opposition to changing staffing in many hospitals, especially public hospitals who care for uninsured patients. It all comes down to the bottom line.

    I had not heard about that nurse who died, that is terrible! I myself am a nurse and I can say first hand, things need to change. Our union actually just went on strike regarding this issue back in December in an effort to have staffing ratios amended to our contract. We are so far unsuccessful, which is why passing legislative measures would give nurses a lot of help.

  4. lhobbswhollandnrechache1 Says:

    I have been screaming this from the rooftops my entire career. I have been a nurse for 16 years (Nurse Practitioner for the last 4) and nurse patient ratios have always been bad, but they are way worse now with way sicker patients. Previously patients that would have spent a day or two in ICU/CCU where they were 1:1 with a nurse to be sure they were stable and are now being short stayed in recovery post operatively and then sent to a general floor where some time the ratio can be as bad as 6:1 with the nurse not having a CAN/Aid to help them. DANGEROUS!!! Further the cost of keeping someone in the hospital drives hospitals to put patients on the least intensive floor so they can get the biggest profit margin they can (not that they are making money, but it is the place where they can mitigate their losses the most). There was a campaign, “Every patient needs a Nurse!!” I have no idea what happened, but in the face of this new healthcare system where everything seems to be in chaos, every patient, everybody for that matter, really does need a nurse. Thanks for the info. Maybe we can get those other 37 states to work harder for patient safety.

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