Nurse To Patient Ratios: Government Mandated Or Evidence Based?

Abstract

Nurse to patient ratios are currently controversial in health care. The central issue is what is a safe limit to the number of patients for whom an RN is responsible in the acute care setting? Some states require a committee at each facility to determine ratios whereas in other states, the legislature has established what the ratio must be. A systematic review of the literature was conducted using CINAHL to identify the major factors being used to determine a safe nurse to patient ratio. Criteria for inclusion in this study were (a) published between 2013 and September 2018; (b) peer reviewed; (c) published in English and (d) had at least one nurse as an author. A combination of the following keywords were nurse to patient ratios, safety, patient outcomes and quality of care. Thirteen studies qualified for inclusion in this systematic review. Five major factors identified as determining nurse to patient ratios are the educational levels of the nursing staff, patient acuity, patient outcomes, cost and the staffing method of the institution based upon cost/budget, nurse to patient ratio or patient acuity. The staffing method chosen is a decision between administrators and the nursing leadership. Cost is more heavily weighted by administrators than by the nursing leadership. These five factors are not constants and the dynamic environment of acute care nursing does not lend itself to staffing that does not consider these factors. Government mandated nurse to patient staffing ratios cannot provide the work environment that provides for the nursing needs of today’s patient populations.