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We have very high patient-to-nurse ratios and it seems unsafe for both the patients and the nurses. Are there any guidelines regarding this?

Wednesday August 7, 2013
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Dear Nancy,

I am a long-term care nurse who is trying to find out if there are guidelines regarding staffing ratios in these facilities. We have very high patient-to-nurse ratios and it seems unsafe for both the patients and the nurses. Are there any guidelines or laws regarding this?


Nancy Brent replies:

Dear Eileen,

Safe staffing is a topic that is well beyond the scope of this column, although several responses in the past have covered this topic and you might want to review them for some general information on this subject.

Safe staffing is essential for both the well-being of the patient and of the nurse. It also is important to note that nurse-to-patient ratios are not the only answer to safe nurse staffing. In fact, much more should go into a decision about what nursing staff patterns work best in a particular healthcare delivery setting, including the skill and expertise of the nursing staff, the acuity of the patients being cared for and other unlicensed assistive personnel staff that are available to help with patient care.

There are many resources for you to explore and help you gain perspective into the issue of safe staffing. One important resource is the American Nurses Association's “Principles for Nurse Staffing Plans” (2012) available at www.nursingworld.org/principles. Other resources are an article entitled "Minimum Nurse Staffing Ratios For Nursing Homes"by Zhang, Unrich, Liu and Wan (2006), 24(2) Nursing Economics, 78-85, 93, available at http://www.medscape.com/viewarticle/531036, and on the Central Management's website, www.cms.gov, and the article "Nursing Homes" available at http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/NHs.html. This website has downloads and related links on nursing home staffing.

An Internet search of "Nursing Staff Ratios in Long-Term Care/Nursing Homes" will yield additional resources that may help with additional specific concerns.


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.