Healthcare Staffing Ratios: Why Are They Important? 

Healthcare staffing ratios are an important factor in protecting patient safety and maintaining a high standard of care in medical facilities. Staffing ratios refer to the number of patients that are assigned to a particular healthcare provider at any given time. When staffing ratios are inadequate, patients may receive lower quality care and experience delays in treatment. A shortage of healthcare providers worldwide and a high rate of burnout among clinical staff has resulted in a dire need for qualified healthcare professionals in the United States and abroad. In this context and in the aftermath of the pandemic, policy changes and organizational shifts are important to ensure adequate healthcare staffing ratios to protect patient safety. 

One of the primary reasons why staffing ratios are crucial in healthcare settings is their direct impact on patient outcomes. Inadequate healthcare staffing ratios can result in patient falls and hospital-acquired infections; both are easily preventable with adequate numbers of staff (3). One study found that the risk of healthcare-associated infections increased when patient-to-registered nurse ratios reached 3:1 (3). Better staffing gives registered nurses room to spend more time with each patient and accurately assess their needs to detect complications faster (2). 

Since the 1990s, research has indicated that adequate nurse staffing leads to lower rates of mortality and adverse events in patient populations (2). Higher staffing ratios, higher numbers of registered nurses relative to nursing assistants, and higher numbers of registered nurses with bachelor’s degrees are all associated with lower patient risk (6). The Covid-19 pandemic exacerbated preexisting shortages in the healthcare workforce by increasing the rate of burnout among clinical staff. Burnout is defined as emotional, mental, and physical exhaustion and can result in a lower sense of personal accomplishment for healthcare workers and decreased quality of care (7). Burned out physicians, nurses, and other clinical staff are more likely to leave the profession, resulting in greater staff turnover and more challenges for healthcare facilities (7). 

Even before the pandemic, a shortage of nursing faculty at nursing schools had restricted the number of registered nurses that were entering the field (1). Inadequate pay at nursing schools deters qualified professors and restricts the number of prospective trainees that are able to enroll in nursing programs (1). Furthermore, the rate of decline in nursing support staff has exacerbated the high workloads put on registered nurses. 

Policy interventions and organizational changes at the hospital level are important to protect healthcare staffing ratios and reinstate a high level of care. In 1999, California became the first state to pass legislation that mandates safe nurse-to-patient ratios. A.B. 394 requires minimum staffing ratios for registered nurses that depend on the type of facility (5). The bill also regulates the use of unlicensed staff for nursing functions and restricts “floating” of nursing staff between clinical areas (5). Nursing unions across the country are fighting to pass similar staffing ratio legislation in other states. Systemic approaches to protecting the mental and physical health of healthcare workers and moderating the workload of healthcare providers, including and especially during public health emergencies, is necessary to ensure the retention of healthcare providers and protect patient safety. 

References 

1. “A Public Health Crisis: Staffing Shortages in Health Care.” Keck School of Medicine of USC, 13 Mar 2023, www.mphdegree.usc.edu/blog/staffing-shortages-in-health-care/ 

2. Costa, Deena Kelly and Olga Yakusheva. “Why Causal Inference Matters to Nurses: The Case of Nurse Staffing and Patient Outcomes.” The Online Journal of Issues in Nursing, 31 May 2016, doi: 10.3912/OJIN.Vol21No02Man02  

3. de la Rosa-Zamboni, Daniela et al. “Patient-nurse ratio as an index related to healthcare-associated infections: a surveillance study.” Bolétin Médico del Hospital Infantile de México, 2023, vol. 80, no. 1, pp. 29-35, doi: 10.24875/BMHIM.22000117  

4. Martin, Brendan. “Examining the Impact of the COVID-19 Pandemic on Burnout and Stress Among U.S. Nurses.” Journal of Nursing Regulation, 14 Apr 2023, vol. 14, no. 1, pp. 4-12, doi: 10.1016/S2155-8256(23)00063-7  

5. “RN Staffing Ratios: A Necessary Solution to the Patient Safety Crisis in U.S. Hospitals.” National Nurses United, n.d., www.nationalnursesunited.org/sites/default/files/nnu/documents/0322_Ratios_Booklet_NNU.pdf 

6. Rochefort, Christian M. “Associations of 4 Nurse Staffing Practices With Hospital Mortality.” Medical Care, Oct 2020, vol. 58, no. 10, pp. 912-918, doi: 10.1097/MLR.0000000000001397 

7. Rotenstein, Lisa S. et al. “The Association of Work Overload with Burnout and Intent to Leave the Job Across the Healthcare Workforce During COVID-19.” Journal of General Internal Medicine, 23 Mar 2023, doi: 10.1007/s11606-023-08153-z