Impact of Nurse-Patient Ratios & Improvement in Patient Care

There has been a considerable conflict in the implementation of Hospital Nurse Patient Ratio bill, which expects presence of more number of Nurses in the hospitals based on the number of patents admitted. Following are the category of wards and number of nurses to be available based on the Nurse Patient ratio:

  • There is requirement one nurse for every two patients in the following categories of wards:
  1. Intensive and Critical care.
  2. Neonatal critical care wards of the hospital.
  3. Post Anesthesia Recovery ward.
  4. All emergency Patients requiring intensive care.
  • Labor Room Ante-partum and Postpartum, Pediatric care, Emergency Rooms require 1 nurse for every four patients.
  • Medical and Surgical wards require 1 Nurse for every 5 patients admitted.
  • The Psychiatry ward requires one nurse for every six patients.

For the time being the Nurse Patient Ratio legislation is applicable in the state of California and it is being considered for implementation in other states also after the states adopt this legislature.

One-to-three patient ratio is required in step down healthcare facilities centers. Similarly One-to-four patient ratio is expected in ante-partum, postpartum, pediatric care, and in the emergency room, telemetry, and other specialty care units.

One nurse for every five patients is required in medical-surgical units and one for every six in psychiatric units.

Since all the other states have to think of making laws and enforcing them to implement hospital nurse-to-patient ratios, it is time to look at the experiences of this law in the state of California, the first state of US, where the law is enforced since 2005.

It is to be discovered have the patients been benefited:

  1. In getting better care.
  2. Are there few adverse eventualities.
  3. Has this measure reduced their stay duration in the hospital?
  4. The vital concern is has it reduced mortality rate?
  5. Are the nurses performing better job?
  6. By this extension, what is the effect on Doctors and other hospital workers?
  7. How much there has been increase in the expenses in affected hospitals’ bottom lines?

Even in spite almost more than a decade of existence of this law the necessary answer is difficult to be observed. In the prevailing circumstances there are two different stories based on the individual varying perception angles felt and expressed as under:

  1. One presented by the nurses viewing their interests only.
  2. The other by the affected hospitals and nursing organizations.

One feels that hospitals and nursing organizations have different stories to tell considering their roles, responsibilities and benefits or drawbacks experienced individually.

The California Nurses Association states that the now implemented ratios shows improvement in nurse’s retention, thus raising the strength of qualified nurses desirous of working, reduction in burnout experiences at the job, with resulting improvement of their morale.

Advocates who have been actively related to influence such a change are of the view that decrease in the patient nurse ratio in departments having higher intensity of nursing care and responsibilities like the emergency room, has resulted in improvement in patient satisfaction and have also reduced chances of medical negligence and erratic functioning. Now there is more responsible environment in the hospital care. There are lesser chances, of medication mistakes and incidences of patients falling because of more number of nurses deployed.

There is on the other hand another group of persons, who unsuccessfully opposed this legislation. The prominent being California Hospital Association on the plea that the patient—nurse ratios are very hard to enforce. The legislation expects continued compliance, which if interpreted compliance in every minute of the shift, every unit and daily without any exception.

If viewed in the light of actual incidences, when a nurse goes for toilet, there should be provision of an alternative nurse to look after the patient. On an average going to toilet means spending 15 minutes off the duty, whereas even a single minute can not be exempted. There are clear cut incidences of non-compliance of the law.

Another problem according to Hospitals Association is related to observing ratios in the emergency room. The stipulated ratio is one nurse to four patients with the exception of a local or state Government declaration of emergency.  Such a rigid ratio becomes one of the reasons that there is  Emergency Room waiting at times shall become lengthy, considering more specifically of a car crash and there  is unexpected rush of Emergency Room patients resulting from the car crash.

Hospitals in fact are doing the best in predicting how many nurses they will require at different times and arrange for staff accordingly. But the rigidity present regarding nature of ratio has no provision for any flexible option in unexpected situations.

The California’s nurse-to-patient ratios, which are completely implemented with effect from April 7, 2005, requires one nurse to look after every two patients admitted in the intensive care, critical care, and neonatal intensive care units including post-anesthesia recovery, labor and delivery, and in situations, patients in the emergency room require intensive care.

One-to-three patient ratio is required in step down units. One-to-four patient ratio is the requirement in ante-partum, postpartum, pediatric care, and in the emergency room, telemetry, and other specialty care units.

One nurse for every five patients is needed in medical-surgical departments and one for every six patients in psychiatric department.

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