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Is there anything nurses can do when administration won't listen to our concerns about patient-to-nurse ratios?

Friday October 5, 2012
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Dear Nancy,

I started working on a med/surg unit at a rural hospital in one of the poorest areas of the country. Obviously, the state I relocated to doesn’t have a policy regulating the patient-to-nurse ratio. After a little research, I found the only definition the state uses for this unknown figure is a very vague "sufficient staff."

Nurses regularly start their 12-hour shifts with as many as eight to 10 patients under their care — with one unit having as many as 30 patients and only three licensed RNs. I’ve been in nursing for more than 10 years and am in fear every day that I will end up in a lawsuit for negligence because of the number of patients I have under my care. Is there anything nurses can do when the administration thinks we’re just “whining” about the ratio and tells us to deal with it or move on?


Nancy Brent replies:

Dear Michelle,

The staffing in your facility does sound poor at best. Clearly, financial support for more staff may be a problem in your facility, but it is never enough to accept things you might be able to change — especially when it comes to the well-being and safety of the patients for whom you and your colleagues provide care. Adequate and safe nurse staffing, by the way, has been an ongoing problem in healthcare.

It sounds as though your state does not have a mandatory law concerning nurse- to-patient ratios. You did not indicate what you researched to identify that "sufficient staff" is the touchstone of nurse-to-patient ratios in your state, but there are several other statutes that might contain this information. One, of course, is the licensing statute pertaining to that type of facility (e.g., if you work at an acute-care hospital, the licensing statute for that type of facility). The state nurse practice act or rules also may be of some help to you. If you did not research the law that directly applies to nursing practice, you should do so.

Moreover, if the facility is accredited through The Joint Commission and/or Medicare-certified, nurse staffing standards should be reviewed by these organizations also.

On the federal level, two bills were introduced in Congress in 2011-2012 to require safe nurse staffing levels, one of which has been repeatedly introduced since Congress' 2003-2004 session. You can read about these two bills, and a brief history of nurse staffing legislation on the state and federal level, in “The Politics of Staffing” by Pam Chwedyk, located at www.nursing.advanceweb.com/Features/Articles/The-Politics-of-Staffing.aspx.

Professional nursing and other organizations have published extensively in the area of nurse staffing and patient outcomes. One such publication, “Utilization Guide for the ANA Principles for Nurse Staffing,” would be a good one to begin your review. Another available on the Internet is The United States Department of Health and Human Services' “Hospital Nurse Staffing and Quality of Care” (Mark Stanton), available at www.ahrq.gov/research/nursestaffing/nursestaff.htm.

With your help, these resources might assist your facility's administration to make changes in its current staffing model.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.