Advocating Safe Nurse-to-Patient Ratios

In a recent state-of-the-profession survey, nearly two-thirds of nursing respondents said they are deeply concerned about current staffing shortages and unsafe nurse-to-patient ratios. The U.S. Bureau of Labor Statistics projects that more than 275,000 additional nurses will need to join the workforce by 2030 to meet the healthcare needs of the nation. “There simply aren’t enough competent nurses to care for our patients,” said one survey respondent. 

The struggle to maintain safe staffing ratios didn’t originate with the pandemic. However, COVID-19 did exacerbate an already difficult situation in many healthcare facilities.  

The pandemic took a terrible toll on our profession,” said Deborah Martin, DNP, MBA, RN, NE-BC, FACHE, Accredited Provider Program Director at Elite Healthcare. “We were face-to-face with the human impact of the ravages of the disease. Many nurses are suffering from PTSD and depression because of their experiences.” 

Legislating for change 

Fortunately, help may be on the way. As the pandemic has thrust healthcare workers into the public eye, conversations around the country have turned to addressing these pressing healthcare needs.  

At a state level, advocacy groups are working hard to promote legislation safeguarding nurse-to-patient ratios. In a recent bipartisan victory for nurses, the Minnesota House and Senate passed the “Keeping Nurses at the Bedside Act,” which will ensure adequate staffing plans in Minnesota hospitals.  

Another bill in Washington State passed in March and April. It was signed into law on April 20, 2023. Included in the bill are minimum staffing standards, as well as: 

  • Staffing committees that include LPNs, CNAs, and other direct patient care staff in addition to RNs 
  • Expanded meal and rest break laws to include all frontline staff 
  • Strengthened accountability for complying with hospital staffing plans set by staffing committees 

Recommended course: Crisis Resource Management for Healthcare Professionals 

National legislation 

Inspired by state legislation, federal lawmakers introduced a similar bill, titled the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023,” in April 2023. This bill would require a staffing plan that “provides adequate, quality delivery of healthcare services and protects patient safety.”  

By the numbers, the bill proposes a staffing plan that would provide for each shift “a full complement of ancillary and support staff.” A direct care RN may not be assigned to more than the following number of patients in these units:  

  • One patient in trauma emergency units 
  • One patient in operating room units
    • A minimum of 1 additional person serves as a scrub assistant in such unit 
  • Two patients in critical care units, including:
    • Neonatal intensive care units, emergency critical care and intensive care units, labor and delivery units, coronary care units, acute respiratory care units, postanesthesia units, and burn units
  • Three patients in emergency room units, pediatrics units, stepdown units, telemetry units, antepartum units, and combined labor, deliver, and postpartum units
  • Four patients in medical-surgical units, intermediate care nursery units, acute care psychiatric units, and other specialty care units
  • Five patients in rehabilitation units and skilled nursing units
  • Six patients in postpartum (3 couplets) units and well-baby nursery units.” 

The bill has been introduced into the U.S. House and Senate and referred to the Subcommittee on Health. Track the bill’s progress here.