The nurse-to-patient ratio is the maximum number of patients a single nurse can directly care for. This ratio has been a controversial topic for decades, but it gained a heightened level of relevance during the COVID-19 pandemic. Hospitals were filled to capacity, and a handful of nurses could be exposed to dozens of patients with a highly communicable disease over a single shift. This not only made it more difficult for nurses to provide adequate care, but it also put nurses' lives at unnecessary risk. Had there been higher staffing levels, exposure to COVID-19 among nurses would have been limited, ensuring a safer hospital setting overall.
The struggle over nurse-to-patient ratios has been taken up by nurse unions, which are advocating for fewer patients per nurse in hospitals across Pennsylvania. One of the issues that is both a cause and an effect of low nurse-to-patient ratios is burnout. Nurses, especially in public health facilities, are turning over much faster, and it's harder for health departments to retain experienced nurses or recruit new ones. It has led to chronic short-staffing, which has only made nurse-to-patient ratios worse.
Workplace injuries and occupational illnesses are another cause and effect of dangerously low nurse-to-patient ratios.
Nurses Face Some of the Highest Injury Rates of Any U.S. Job
According to The National Institute for Occupational Safety and Health (NIOSH), medical workers face rates of injury and occupational illness that are "among the highest of any industry sector,"1 That includes higher injury rates than even the construction industry.
Some of the physical risks that nurses face include:
- Back and joint injuries (especially from lifting and moving patients)
- Violence from patients
- Slips, trips, and falls
- Fatigue and stress from working long hours
Medical workers are often exposed to blood and bodily fluids as well. Needlestick injuries alone occur hundreds of thousands of times annually in the U.S.2
As an occupational hazard, nurses face the risk of contracting infectious disease and illness, such as:
- HIV
- Hepatitis B, Hepatitis C
- Influenza (seasonal flus, pandemics, and others)
- Tuberculosis
- MRSA
- Severe Acute Respiratory Syndrome (SARS)
- Middle East Respiratory Syndrome (MERS)
With high injury and illness rates forcing nurses to take time off of work to recover, or convincing them to quit, this exacerbates the nursing shortage. The more nurses are overextended, the higher risks they face in an already hazardous workplace, a vicious cycle that keeps the nurse-to-patient ratio low. Our firm would argue that nurse-to-patient ratios are not only a matter of patient safety, but of nursing safety as well.
Better Nurse-to-Patient Ratios Help Nurses Stay Healthy
In comparing hospitals with higher nurse-to-patient ratios to lower staffed hospitals, the higher ratio was linked to:
- 50% fewer needlestick injuries
- Lowered risk of infection spreading to medical staff
- Lower rates of spinal cord and shoulder injuries
- 50% reduced risk of violence breaking out and injuring nurses
In California, the only state with legislated nurse-to-patient ratios so far, the higher nurse-to-patient ratios created by this legislation has been credited for the 31.6% drop in injuries and illnesses RNs suffered3.
Higher Nurse-to-Patient Ratios Help Patients
In one study conducted for two years in 75 hospitals across Pennsylvania, New Jersey, Florida, and California, the results showed that lower nurse-to-patient ratios led to a 5% decrease in survival rates in medical-surgical units for each extra patient a nurse had to take on3.
In another study, every patient added to the nurse-patient ratio has been linked to a:
- 12% increase in dying at the hospital
- 7% increase in mortality rate 60 days after hospital treatment
- 7% increase in odds of being readmitted 60 days later
In other studies referenced by the National Nurses United, researchers found that:
- An increase from four to six patients per nurse led to a 14% higher mortality rate
- A jump from four to eight patients per nurse led to a 31% higher mortality rate
- Nationwide, the likelihood of dying from a heart attack in-hospital jumps almost 20% during night shifts, when the nurse-to-patient ratio is lower
In response to grim statistics like these, bipartisan efforts to keep nurses and patients safe have resulted in the Patient Safety Act, which would enshrine nurse-to-patient ratios into law.
The Patient Safety Act in Pennsylvania
If this proposed legislation does become law, the ratios would be determined by the department and organized by level of patient need. For instance, the ICU, burn unit, and critical care unit would have a maximum ratio of one nurse per two patients. Meanwhile, rehabilitation units would be limited to one nurse per five patients.
Higher Nurse-to-Patient Ratios Can Help Medical Systems Overall
While in the short term, hospitals may try to cut expenses by keeping nursing staff levels low, it costs tens of thousands of dollars to recruit and train replacement nurses. Higher nurse-to-patient ratios could spare hospitals the financial costs of high nurse turnover. With lower rates of injury and illness, this would also save healthcare systems the costs of workers' compensation for injured employees and liability over harm suffered in-hospital by patients. With better care, patients can also be discharged from hospitals sooner, which ultimately saves hospitals on the costs of their care, since delayed discharges are a drain on resources and staff4.
More nurses caring for fewer patients each helps the hospitals, patients, and nurses themselves.
Regardless of Ratio Laws, Nurses Have a Right to a Safe Workplace
For now, it is still up to Pennsylvania hospitals themselves to regulate the number of patients that each nurse cares for, as well as the supplies, training, and other resources that nurses are equipped with. Like in any other employer-employee relationship, hospitals owe medical workers a workplace that is free of preventable hazards. If a nurse or other healthcare worker is injured or contracts an illness in their line of work, they are owed compensation through their employer to help with recovery and missed time at work.
Our firm advocates for injured medical workers who have suffered due to COVID and other hospital injuries or illness. If you want to know your options. call us today at (888) 498-3023.
For Further Reading
- Safety and Health Information for Healthcare Workers - NIOSH and the CDC
- Nurses' Working Conditions: Implications for Infectious Disease - Emerging Infectious Diseases®
- The Science of Ratios - National Nurses United
- "Interventions to Decrease Hospital Length of Stay" - Agency for Healthcare Research and Quality