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Is there a legal nurse/patient ratio to maintain quality and safe patient care?

Thursday September 18, 2008
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Dear Nancy,

Is there a legal nurse/patient ratio to maintain quality and safe patient care? Is there a standard nursing practice or employment standard we can use to schedule staff in a psychiatric facility?


Nancy Brent replies:

Dear Larry,

Nurse/patient ratios have been controversial for many, many years. Recently, California passed legislation to require a specific nurse/patient ratio on some hospital units. The practical reality of carrying out the actual ratios (after several legal challenges) has been difficult at best. There is a great deal of information available about the California experience on the Internet. Simply place “nurse patient ratios in California” in your search engine's search bar, and you can review the information listed there.

Mandating nurse/patient ratios is difficult because so many factors need to be taken into consideration in deciding what is the best ratio at any given time. In fact, the American Nurses Association, for example, has published the Utilization Guide for the ANA Principals for Nurse Staffing (2005). The ANA has identified nine principles that fit into three major categories: Patient Care Unit Related (Principles), Staff Related (Principles), and Institutional/Organizational Related (Principles). An example of a Patient Care Unit Related principle is that appropriate staffing levels for a patient care unit reflect analysis of individual and aggregate patient needs.

The state in which you practice may also have laws or regulations concerning what staffing levels or patterns must exist in psychiatric facilities. You can attempt to research this yourself, or you can consult a nurse attorney or attorney in your state who can help you obtain the information fairly quickly. If you want to try doing so yourself, simply follow the instructions above for the California information on the Internet, and substitute your home state’s name.

Another resource for you is the American Psychiatric Nurses Association’s position statement, “Determining Staffing Needs of Inpatient Psychiatric Units.” The statement is available on the association’s Web site at www.apna.org. Scroll down the left hand side of the home page until you come to “Resource Center.” “Position Statements” is listed as one of the options there. Click on that link, and you will be directed to a listing of all of the association's published statements.


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.