Health Issue and Advocacy Assignment: Safe Nurse to Patient Ratio

Wilkes University

NSG 505- Health Policy and Politics

Dr. Michelle Nicoletti

LaTaya Knight

July 9, 2021

Healthcare policies are continuously developing and are significant within the healthcare system. The healthcare structure is frequently changing, and with change comes development or barriers. With a discord between healthcare systems and political parties, it can become challenging to implement improved and new rules. Discussed will be the issue of safe nurse to patient ratio and staffing by summarizing important concern, providing suggestions to enhance treatment of care to patients and reducing nurse burnout through providing a safe staff to patient ratio.

When nurses are compelled to be understaffed and care for a heavier patient assignment, it can cause severe nurse burnout, decrease time of direct patient care, mental support, and comfort to their patients and their family, as well as minimally patient safety (Heath, 2018). Laschinger (2019) explains that apart from the professional danger related to understaffing and heavier assignment various findings have shown an association between insufficient nurse staffing, reduced nursing working conditions, and inadequate patient outcomes. It was also found that increased patient assignments can be associated to higher medical errors and infections, and patient injuries, and death of a patient.

By conveying concerns to politicians regarding unsafe nurses/patient ratios needs to occur to request change. As nurses and nurse practitioners, we must advocate for our patients and their wellbeing, and it is time for administrators to implement a new policy that supports us, nurses. Nurses that are under daily stress have an increase in burnout which then leads to increased nurse turnover. Hospitals have started to condense nursing roles and put additional workloads on the nursing staff (Cho, Chin, Kim, & Hong, 2016).

The patient acuity on the unit should determine the staffing of nurses on a unit. For example, nurses working in intensive care units should have a lessor patient assignment than nurses working on an inpatient psych unit. Just as a nurse working on the maternity unit’s patient load ought to be less than a nurse on a general female's surgical unit. Having inadequate staffing affects the safety of the patient as well as placing harm on the nursing staff. One example of nursing staff safety being jeopardized is needlestick injury occurring, which has a two-to-three times higher chance of occurring when nurses/ patient ratio staff is not adequate (Cho, Lee, Choi, Park, Yoo, Aiken., 2013).

When nurses are emotionally exhausted, dissatisfied with their work environment, they are more likely to call out of work, change departments or quit altogether. Exhausting experienced nurses can cost hospitals more money; due to having to train new nurses, hiring graduate nurses with less experience, recruiting cost increases, offering sign-on bonuses, or paying overtime to remaining staff. Hospitals can save money and improve patient safety by adequately hiring nursing staff to reflect the acuity of the nursing unit (Cho, Lee, Choi, Park, Yoo, Aiken., 2013).

The main priority today within the systems of healthcare is effective patient care and hospital reimbursement. Suppose healthcare administrators collaborate with the political parties to develop and enforce new laws to provide a safe staffing policy to guarantee suitable nursing staff ratios. In that case, this can create financial increase, staff satisfaction, and quality patient care. This will also assist in providing nurses the time required to complete daily tasks, take lunch breaks, and give the patient the support they need to sustain a positive outcome (Heath, 2018).

Acquiring different staffing ratio guidelines; will deliver safer patient outcomes, increase hospital reimbursement, and institute financial gain.  New policies that change the nurse/patient ratio can also help close communication and collaboration between hospital administrators, management, and the nursing staff.  

It is the responsibility of administrations and management to request, develop, and implement new work standards for a safe nurse-to-patient ratio. Management must be continuously aware of the need for safe nurse-to-patient ratios and how dangerous and ineffective it is for the hospital when these goals are not met. Management also needs to frequently analyze the nursing needs based on specific departments and patient acuity to provide proper staffing. Research completed related to the nurse-to-patient ratio shows that “nurses who are required to care for eight patients were two times more likely to experience a high emotional exhaustion score than nurses who are caring for four patients” (Heath, 2018).

To elevate effective quality patient care, an elevation of staffing is essential to deliver good patient care. The National Nurse United (NNC) (2015) explains “the patient safety crisis in the U.S. has an estimated 700 people die from preventable errors in their medical treatment or complication from those errors”. It is projected that these deaths occur largely due to avoidable errors which could be eluded if there were safer hospital environments (NNU, 2015).

When looking for practical solutions to the staffing ratio issue, you must look at the positive and negative outcomes of applying the change.

A healthcare policy presented as a bill to the federal government speaking to the nurse-to-patient ratio was the H.R. 2392 bill. The bill requests a staffing plan to address the nurse-to-patient ratios that would be a common law implemented by the government. If the bill is passed, nurses would be legally able to refuse by law to take an unsafe number of patients based on nursing judgment and patient acuity.

California is currently one of the only states in the United States with a mandatory law to maintain a safe nurse-to-patient ratio. These mandatory staff ratios have been instructed in California since 2004. Florida was the next state to propose and request a staffing policy; however, the bill did not pass. Surely nurses nationwide will agree that delivering skilled quality care is the primary goal. Providing a safe nurse to patient ratio will create environments that promote safe, effective, quality care (Simpson, 2017). When nurses are burdened with increase patient ratios, they are at risk of omitting a potential health risk factor or treatment process. One study completed at the Pennsylvania School of Nursing found that increased nurse to patient ratios causes reoccurring hospital admission that effects hospital finances. By increasing the nurse-to-patient staffing ratio, there is a 25% lower chance of hospitals being penalized under the affordable care act for excessive readmissions (Simpson, 2017).

In conclusion, lowering the nurse-to-patient ratio will allow nurses the opportunity to deliver more effective, quality, safe patient care, establish and develop a trusting relationship with their patients, provide adequate patient education, and decrease hospital-acquired illness along with decrease mortality rates. A mandatory policy will also increase an organization's financial revenue through reimbursement and stakeholder investments.


Cho, E., Chin, D. L., Kim, S., & Hong, O. (2016). The relationships of nurse staffing level and work environment with patient adverse events. Journal of Nursing Scholarship, 48(1), 74-82 doi:10.1111/jnu.12183

Heath, S., (2018). How nurse staffing ratios impact patient safety, access to care.

Laschinger, H., et al. (2019). Safe staffing: critical for patients and nurses, Fact Sheet.:

National Nurses United. (2015). RN staffing ratios: a necessary solution to the patient safety crisis in U.S. hospitals.

Simpson, K. R. (2017). Safe nurse staffing is more than numbers and ratios. The American Journal Of Maternal Child Nursing, 42(5), 304. doi:10.1097/NMC.0000000000000366