Laws regulating staffing ratios are increasing in number across the United States. And as we saw in Oregon last year, they’re starting to focus on hospitals as well as nursing facilities. While meeting these new standards can be a challenge, there are also some big advantages in doing so. From improving safety and care to shoring up revenue, here are seven ways that employers can benefit from updating their nurse-to-patient ratio standards.
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What Are Nurse-to-Patient Ratios?
What are nurse-to-patient ratios, and why have they become so prominent in healthcare management? Just like it sounds, a nurse-to-patient ratio is the number of patients under the direct care of each nurse. And these ratios differ based on setting and facility type. For instance, ICU nurses usually care for fewer patients than those working in a med/surg unit, where acuity is lower.
Why do so many unions and nursing advocates want higher ratios? Nurses and aides spend more time with patients than anyone else. They manage daily activities, coordinate care, interact with family and other caregivers, and more. Given these many responsibilities, it stands to reason that there’s an optimum number of patients per nurse in certain situations. Put another way, a nurse-to-patient ratio is the balance in which nurses can provide the best possible care.
Who Must Follow Nurse-to-Patient Ratio Regulations?
Every nursing home and long-term care (LTC) facility operating in the U.S. must follow federal staffing guidelines. These are expressed either as a ratio of nurse-to-resident, or hours per resident days (HPRD). Most states also impose standards on top of those guidelines, too.
In other facilities, managers set their own ratios based on factors like budget, census trends and the availability of workers. Federal law provides a somewhat vague mandate for hospitals participating in Medicare and Medicaid to follow a general set of guidelines. But as they include language like “adequate numbers,” implementation is often open to interpretation.
Perhaps realizing that this language isn’t specific enough — and without any real consensus on what it means to be understaffed — a handful of states have also set their own laws requiring certain staffing ratios in hospitals. And quite a few others require them to maintain committees to continuously update those ratios, too.
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Benefits of an Optimized Nurse-to-Patient Ratio
Beyond proposed federal mandates, meeting stricter staffing ratios often comes at a cost. But updating nurse-to-patient ratio standards also presents substantial long-term perks, too. From improving care standards to shoring up revenue with less overtime and turnover, discover seven benefits for healthcare providers to invest in updating their nurse-to-patient ratio standards and capabilities.
#1: Improved Quality of Care
Studies have repeatedly shown that nurse workload affects quality of care. For instance, an analysis of 28 such studies published in the journal Medical Care concluded that increased staffing of RNs can lower the chances of “adverse patient events.” And this can include everything from falls and pressure ulcers to respiratory failure and sudden cardiac arrest. Another study states that a higher proportion of RNs providing direct care is “associated with better care for hospitalized patients.”
#2: Lower Rates of Patient Mortality
Hand-in-hand with fewer adverse incidents comes lower mortality — another benefit that’s been documented again and again. For instance, the Medical Care analysis found that adding one full-time RN could result in a 6% lower death rate. And a 2010 clinical analysis of med/surg staffing ratios concluded that New Jersey and Pennsylvania could lower patient deaths by 13.9% and 10.6%, respectively, if they adopted the higher ratios required in California.
#3: Reduced Burnout & Medical Errors
Cutting down on medical errors can also improve patient safety and outcomes. Increasing the number of nurses per patient can help cut down on fatigue and burnout — two common drivers of errors.
“Fatigue results in inattention, a decline in vigilance, poor judgment, and lack of concentration,” reports the Agency for Healthcare Research and Quality (AHRQ). As a result, longer nursing shifts can lead to a triple the amount of errors, they add.
The 2010 study comparing California to New Jersey and Pennsylvania arrived as similar findings. Nurses in the Golden State “were significantly less likely” to miss changes in patient condition than their East Coast counterparts.
#4: Better Job Satisfaction & Retention
By reducing burnout, improved staffing can also boost job satisfaction and retention. And at a time when replacing an RN can cost 200% of their annual salary, this is a significant advantage. As one study points out, the “improved nurse job satisfaction” that comes with higher ratios can “lower RN turnover.”
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#5: Lower Costs
That same study also notes that lowering turnover means spending less “on temporary RNs and overtime.” And the improved outcomes that come with optimum staffing can cut costs in other ways, too. For instance, staffing more nurses can reduce the time patients spend in a facility. That can lower costs in terms of labor, while also delivering greater reimbursem*nt from Medicare and Medicaid.
The Medical Care analysis associated an “increase by 1 RN per patient day” with a 31% shorter length of stay for surgical patients and 24% in the ICU. Another study found that patients in understaffed departments were 5% more likely to stay an extra day in the hospital.
#6: Improved Workplace Safety
Another way of boosting nurse job satisfaction and retention is by measurably improving the safety of the workplace. (The belief that nursing ratios do just this has been a frequent point of debate in the recent nursing strikes.) And, since job safety directly impacts absenteeism and turnover, this can also help cut costs associated with replacements and temps.
For example, one study associated California’s staffing ratios with 31.6% fewer in job injuries and illnesses for RNs working there. And another cited low personnel-to-patient ratios as a risk factor for “work-related assault injuries” among nurses.
#7: Higher Patient Satisfaction
More attention from more nurses results not only in better outcomes but happier patients, too. At a time when patient satisfaction scores directly affect many providers’ revenue, that’s no small matter. Here again, studies have shown a “significant association” between patient satisfaction and the number of RNs on staff.
One study directly connected low staffing levels with the kind of “missed care” that can strongly impact the patient experience. Fewer nurses lead to poorer overall communication with patients, the authors note. That also means fewer opportunities to provide direct comfort or emotional support.
Update Your Nurse-to-Patient Ratio Strategy with CareerStaff
Maybe most important of all, taking a proactive approach to nurse-to-patient staffing ratios gives organizations valuable workforce flexibility. And with the growing number of workforce challenges facing healthcare employers today, that’s not just a benefit but a necessity.
If you’re looking for help achieving an optimal nurse-to-patient ratio in your facilities, CareerStaff can help. Download our free Nurse-to-Patient and Direct Care Ratio Guide today for expert guidance to optimize your nursing workforce, or request nurse staffing now.
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