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More Nurses Means Better Care

What's the nurse-to-patient ratio at your hospital?

Featured Author:

Marijke Durning, RN

Marijke Vroomen-Durning has been an RN since 1983 and although she has been writing since the mid-90s, she continued to work clinically until last year. Her passion is patient education and helping the general public understand the medical world by translating medicalese into real-life language. Marijke’s popular blog, Marijke: Nurse Turned Writer has been the catalyst for her career as she now claims the number one spot in Google searches if you type in “Nurse writer.”

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While my first reaction is that this is a Duh Study, the more I think about it, the more important a study like this may really be. Nurses know how to give good nursing care. They also know they are extremely limited in giving quality care by the number of patients they have on any given shift and how much care a patient needs. There’s a huge difference between a patient who is recovering from major trauma surgery and a post-partum mother.

The lack of time to give good care causes a spiral effect: the nurse may be too busy to notice a change in a patient when it first begins, the family knows something is wrong, but doesn’t know what – they only know the nurse isn’t there. The patient continues to deteriorate. The nurse finally notices and kicks into action. Now, the outcome can be good or bad, but you can bet that the patient likely underwent more procedures, took more medications, or experienced more discomfort than if the initial deterioration was noted earlier. And of course, chances are, the management would get an earful from family members about the lack of quality care, even if they have already verbally abused the nurse on the floor. How can this be prevented? The answer is obvious – to nurses.

What is particularly interesting is that until 2004, no state in the United States had any laws regarding the number of patients a nurse could have under his or her care. California changed this by publishing its nurse/patient ratios that year. Of course, there were detractors who said that either the ratios would not be met or they wouldn’t make much of a difference.

In 2006, two years after California’s ratio implementation, Linda Aiken, RN, Ph.D., director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, and her team of researchers, investigated patient outcomes in California, compared with two states that didn’t have mandated ratios, New Jersey and Pennsylvania (Implications of the California Nurse Staffing Mandate for Other States). The nurses in these states had an average of one more patient per nurse than they did in California.

The general finding was that patients had better outcomes in California, patients and families had fewer complaints, and nurses felt better about their work and nursing retention was higher. The authors wrote, “We find for every outcome that higher percentages of nurses in a hospital reporting patient-to-nurse ratios in line with the benchmark set by the California mandates are significantly associated with lower reports of unfavorable outcomes.”

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