Nurse Staffing Plans and Ratios


Issues related to the nurse staffing and patient care in various health care institutions for a long time been left to the market forces to resolve. Moreover, nursing budget cuts by various healthcare institutions and states have resulted into inadequate nurses to patient ratios. However, this issue persist particularly the required nurse patient ratio that would ensure quality care and safety of patients. Therefore, there has been need for mandatory regulations that ensure nurse patient ratio that would result in delivery of quality services (American Nursing Association, 2013). The situation has been made worse with various healthcare institutions taking little consideration on the need to improve on the quality of services they deliver through the observation of various aspects including the number of patients a nurse should care.

In various hospitals, nurses have been working for longer hours to ensure that patients are taken care of at the same time achieving the hospital goals and objectives. The issue of nurse patient ratio not only affects nurses but also the patients, as well as the institutions where nurses work (American Nursing Association, 2013). In particular, nurses have been working in both medical and surgical floors for several hours above the normal designated working hours because of the high number of patient under their care. Drawing from the experience, the most preferred nurse patient ratio should be four patients for each registered nurse. At most, each registered nurse should care for five patients. This will ensure quality care and safety for the patients. On the contrary, more than five patients for each registered nurse jeopardize the quality care and safety of the patients. In fact, the ultimate goal of hospitals, nurses as well as other various stakeholders is the provision of quality care and safety of the patients.

Various legislations, activities, and impacts on nursing practice

In order to address the thorny issue, nurses have lobbied elected leaders at the state and federal levels to come up with various legislations that would offer protection to the nurses as well as the patient safety. The legislations should provide a regulatory framework through which hospitals are held accountable for the provision of adequate nurse staffing to ensure quality care and safety for the patients (American Nursing Association, 2013). In connection to the need for the regulatory framework, various nursing organizations have come up with three proposals.

First is to ensure hospitals are responsible for the implementation of the legislated nursing staffing plans with the help of the professional practicing nurses and their various organizations. This is to ensure adequate nurse to patient’s ratios that are based on patient safety, need and provision of quality services as well as other criteria (Punnakitikashem, 2007). Second, to come up with elaborate nurse staffing plans and specific nurse to patient rations through regulatory framework based on the legislations and finally to combine both the legislated nurse patient ratios and the nurse staffing plans. Theses lobbies have resulted into the enactment of the requirement that all nursing staffing information be made obtainable and conveyed to the public (Punnakitikashem, 2007).

Various legislations have been put in place to ensure implementation and development of nurse staffing plan and the nurse to patient rations by various healthcare institutions. In 2009, legislation on nurse staffing protection was signed into law. The legislations required that a hospital governing body be responsible for the approval, execution and putting into practice of the written nurse staffing policy (Kelly, 2009). This legislation also provided for the wide-ranging approach to the nurse staffing issues including protection to the whistleblowers as well as the mandatory overtime prohibitions. This legislation not only did away with some of the 2002 legislation that required hospitals to adopt, implement and enforce nurse-staffing plans, but also added stiffer requirements. In essence, the legislation is critical in ensuring that there is adequate number of nurse to patient’s ratios as well as mixture of skills that meet the needs of the patients (Kelly, 2009). In addition, the legislation put in place regulations and prohibitions on mandatory unit shifts as well as other aspects that undermine the nurses output and the provision of quality of services.

In the same year, similar legislation was also signed into law requiring hospitals and other healthcare facilities to come up with nurse staffing committee comprising of fifty percent direct care nurses (Marquis & Huston, 2009). This committee will be responsible for the drafting of the staffing policy and it management. The expectation is that this committee will come up with plans that are flexible and comprehensive in addressing the nurse staffing issues relating to nurse patients ratios. Moreover, the nurse staffing policy should accommodate transformations taking place in staff, patients, entity strategy, and expertise (Marquis & Huston, 2009).

In 2008, safe nurse staffing legislation was passed providing hospital-wide nursing care as well as generating evidence-based staffing plan for nursing services. Moreover, the legislation provides guidance on the assignments of nurses within the plan. In addition, the legislation creates a nursing care committee that has the responsibility of reflecting the current standards sanctioning healthcare institutions to put into consideration the multiple nurse and inpatient factors to yield minimum staffing levels with care delivered by competent staff (Hammaker & Tomlinson, 2010). The evaluation of the plan should be pegged on the prevalent care criteria, the delivery cost, the patient outcomes, as well as the resultant recommendations.

All other legislations enacted on various states and at the federal levels emphasizes on the accountability of various healthcare institutions to take into cognizance the minimum number of patients to each registered nurse. In essence, most of the legislations emphasizes on the quality and safety of the patients and the need for all the healthcare institutions to take into consideration the ration of nurse to patients that would ensure delivery of quality services. In most cases, the number of patients to the nurse should be minimal as much as possible. This would allow effective delivery of quality outcomes.


Nursing organizations have promoted and lobbied for the need of hospitals to be held responsible for the execution and advancement of the consistent, effective, and dependable nurse’s conscription strategies. According to these organizations, the nursing staffing plans should be based on the principles that influence directly on nurses and the provision of services to the patients. Nurses should be involved directly in the development of the nursing staffing plans and the decision-making process. This is not to allow nurses to decide on their own to the staffing plan, rather an all-inclusive activity by stakeholders to participate in modifying staffing plans. In addition, it should be geared to the prerequisites of the patients and centered on various aspects of patient care. This is not to jeopardize the responsibility of the hospitals to guarantee sound operations of nurses in most hospitals. In essence, hospitals must not abdicate their duties of ensuring that there is adequate nurse to patient ratios that would provide quality services to the patients.


American Nursing Association (2013). Nationwide state legislative agenda. Web.

Hammaker, D. K. & Tomlinson, S. J. (2010). Health care management and the law: Principles and applications. Independence, KY: Cengage Learning.

Kelly, P. (2009). Essentials of nursing leadership and management. Independence, KY: Cengage Learning.

Marquis, B. L. & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application. Philadelphia, PA: Lippincott Williams & Wilkins.

Punnakitikashem, P. (2007). Integrated nurse staffing and assignment under uncertainty. CSA, Bethesda: ProQuest.

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