Skip to main content Blog

Nurse to Patient Ratios: Leaders Have Their Work Cut Out for Them


When it comes to nurse to patient ratios, it's not just about numbers.

Leaders, assessing how to ensure you have the best nurses in the right numbers rendering the best care to your patients is something you take very seriously. Advocating for the needs of your nurses is something you take just as seriously. Right now is the perfect time to think again about how to do both. Good nurse to patient ratios is a goal the nursing profession has worked on from its earliest days. But for too long, we've struggled with the numbers.

The work involved in establishing the right nurse to patient ratios, measuring their impact on safety and quality, and finding ways to pay for them have been topics of unending discussion and debate -- and not just in nursing.

Experts from other healthcare arenas, as well as the government, have weighed in on the issue and made their voices heard. With California leading the way, more than a dozen states now have laws requiring nurse to patient ratios. Many research studies on nurse to patient ratios have been conducted, with one after another demonstrating improved outcomes in the presence of adequate ratios and negative outcomes in their absence.

Questions and differing opinions

Nursing professionals believe adequate staffing numbers are at the heart of care quality and patient safety. Many, but not all, in the profession believe mandated ratios might be the way to uniformly ensure this. The topic leads to many questions such as:

  • What are the best measurements and instruments to use in coming up with nurse to patient ratios?
  • Must everyone measure acuity the same way with the same instruments?
  • Are there variables that might call for different measurements from organization to organization?
  • Must everyone have uniform ratios in similar patient populations, or can they differ from state to state?
  • How many organizations have the staff needed to meet uniform ratios or have the budgets to pay for them?

The consensus in leadership is that patients deserve to be cared for by nurses with manageable assignments, and nurses deserve assignments they can safely handle. There are standards in place based on the premise that like ratios equal like care quality. Many of us tend to focus on the numbers, but are they proof of better outcomes or just predictors? There are many variances among patients with similar diagnoses. And all patients and all care units are not alike. So should they use the same staffing ratios? And what about differences in staff skill levels, education and experience? These are the questions that continue to prompt study and research.

Advocacy: What you can and must do

Nurses have always been good at collaborating with and for one another, and we must continue to advocate for both patients and staff. Nurse to patient ratios and schedules are linked to patient safety, but they're also linked to the staff safety. Illness, absenteeism, stress, fatigue and burnout are just some of the negative outcomes of inadequate staffing nurses deal with. Staffing is under continued scrutiny, and ratios are only a part of that analysis. It's a multi-faceted issue, and many nurse leaders and hospital administrators are champions of ratios. Some, however, still are not. Putting emphasis on your nurses and their safety, well-being, job satisfaction and their lasting ability and staying power is crucial. Organizations must ensure everyone in management understands and appreciates the important role staffing plays when it comes to your nurses feeling safe and satisfied.

No good organization wants its nurses walking out because it was all too much for them to handle.

The nursing role always has been caring for patients, getting them well and keeping them safe. Falls, medication errors and like incidents are the things we know lead to complications, morbidities and deaths. Staffing plays a big role in them. Nurse leaders, talk with staff about your commitment to them, staffing, job satisfaction, workloads and overall work lives. Know what you want to say to them and try to have answers to their questions about nurse to patient ratios. Review your staffing patterns and work schedules with a critical eye, and share your thoughts with staff regarding issues such as overtime, unnecessary shift length, acuity keeping pace with staffing ratios, issues with staff mix, and financial or administrative challenges your organization is facing. Let them know what management is doing about these issues. Tell them you appreciate the many contributions they make every day, even when nurse to patient ratios are not what they'd like them to be. Share some articles or research findings on what's happening with legislation within your state and encourage them to get involved. Help them understand that knowledge of the issues allows them to have a voice in future legislation. Remember that staffing matters to them, and as their advocate, show them it matters even more to you.

Take these courses to learn more about what leadership entails:

Learning to Lead: From Staff Nurse to Charge Nurse (5 contact hrs) All nurses are leaders. They not only support patients in doing what they are unable to do for themselves, but they also manage their care and lead them toward a vision and personal goal of better health. Most nurses find themselves in a position to lead a group of colleagues in a team or on a patient care unit. This course focuses on the skills needed to manage both the patient and the staff caring for an entire group of patients. Implementation of leadership and management strategies -- such as conflict resolution, interprofessional communication, coaching, delegation, and assessment -- is outlined and demonstrated in case examples. Developing Your Leadership Potential (6.8 contact hrs) As the largest healthcare profession in the U.S. and the profession positioned on the front line of patient care, nurses are crucial for leading change and advancing health. The Robert Wood Johnson Foundation and the Institute of Medicine made recommendations to transform the nursing profession in their report "The Future of Nursing: Leading Change, Advancing Health." A key message from the report is the recommendation that nurses be full partners together with physicians and other healthcare professionals in redesigning the country's healthcare system. This activity will provide practical strategies to help you develop your personal plan for developing your leadership potential regardless of your chosen career path. Evidence-Based Effective Nursing Leadership: Check Your Practice (1 contact hr) Rarely do nurse leaders consider that their leadership practice should also be evidence-based. The use of evidence-based practice helps leaders to make more effective leadership decisions based on research and knowledge rather than traditions, hunches, and the advice of colleagues, or outdated leadership information. In this module, we will examine five evidence-based strategies you should consider to improve your leadership effectiveness.