Research Supports Improving Nurse-to-Patient Ratios

Patricia Pittman, PhD, Director of Health Workforce Research Center at George Washington University, discusses the research behind improving nurse-to-patient staffing ratioson KUOW radio station.

Transcript here.


A healthcare researcher weighs in on the nurse-to-patient ratio debate

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Feb 09, 2022 at 6:39 pm

By: Kim Malcolm

Washington state lawmakers are considering a new law that would set nurse-to-patient ratios at hospitals. A group of healthcare unions called Washington Safe + Healthy is pushing hard for the proposal. They say even before Covid, nurses had way too many patients, which was leading to burnout and poor outcomes for patients.

What’s the evidence that’s true? To find out, KUOW’s Kim Malcolm spoke with Patricia Pittman, a health policy researcher at George Washington University, and director of its Health Workforce Research Center. She was hired by the union group to analyze previous studies on healthcare staffing.

This interview has been edited for clarity.

Patricia Pittman: There have really been decades of research and hundreds of studies that have shown that low nurse-to-patient staffing ratios have a negative effect on patient outcomes. In particular, we know that patients die more frequently if there’s low nurse staffing. We also know that there are more hospital-acquired infections and other kinds of harms that can occur when patients are in the hospital if they’re not sufficiently staffed with nurses.

Kim Malcolm: Can you give us a concrete example of how not having enough nurses working on a particular shift could lead to a patient dying?

The primary mechanism here is what’s called “missed care,” where nurses are covering say six different patients, as opposed to four, and two patients are having a crisis at the same time. They may not be able to attend to that patient in a timely fashion, so care is missed. That may begin an infection, that may be actually sepsis when a patient is dying, and the nurse doesn’t get there in time to be able to rescue the patient. There are a variety of situations that can occur, but the main problem is that nurses can’t be everywhere at once, and that leads to missed care.

I understand you’ve also looked into how staffing ratios affect the nurses who are on the job. What did you find there?

There are a number of studies, at least six, that show that low nurse-to-patient ratios lead to low job satisfaction. A few studies started using the burnout measure as well. We know that higher burnout leads to turnover and the kind of crisis that we’re seeing in hospitals today where large numbers of nurses are leaving the bedside. We’ve also seen some research showing an increase in injuries to nurses themselves, in particular needlestick injuries, related to nurse staffing.

Does the research indicate anything on what staffing ratios mean for the economics of hospitals?

Actually, it does. There are at least three studies that suggest that increased nurse staffing may actually not only pay for itself but have significant benefits to payers and to patients in terms of reducing costs over time. It’s also a big question now as hospitals have had to rely increasingly on travel nurses, which are four or five times more expensive for the hospital than increasing the number of nurses that they directly hire.

The old equation of when it might make sense to use travel nurses versus increasing the number of budgeted positions, I think, is beginning to change. So hopefully, there are some hospitals beginning to see that this is potentially not entirely negative, or at all negative for them.

The Washington State Hospital Association is against this legislation. The association says we’re having a nursing shortage right now, and a law like this is not going to help solve that problem. What do you say to that?

Well, it might actually solve that problem. One of the reasons that nurses are leaving is precisely because they feel that they’re working in unsafe conditions, and that has everything to do with nurse staffing. The problem is, in the last 20 years, despite this massive evidence base, hospitals have really not been investing in nurses to the extent that is needed to improve health outcomes, and nurses under the current circumstances are fed up. I think if hospitals want to attract nurses back to the bedside, things are going to have to change.

Kim Malcolm

Afternoon News Host

Kim hosts KUOW’s All Things Considered. She joined KUOW as a newscaster and hosted KUOW’s Morning Edition for a time.

She previously worked at KERA in Dallas as a reporter, All Things Considered host, and occasional host of Think, KERA’s award-winning live interview and listener call-in program.

Kim got her start at the Canadian Broadcasting Corp.

The root cause of the nursing “shortage” is hospital greed

An essay in the Opinion Today section of the New York Times stated that the real cause of the nursing shortage is hospital greed.

It’s a bleed (nursing shortage) that began many years ago. The root cause? Hospital greed. It is the result of decades of mismanagement in a money—driven hospital system that prioritizes profit over patient safety. Far from a shortage, there’s never been more licensed nurses in America—they’re not being hired.

King, Lucy. “The Root Cause of the Nursing Crisis isn’t Covid.” The New York Times, 19 Jan. 2021.

My last post discussed the various obstacles that led to nurse burnout, which eventually caused nurses to leave the profession. I overlooked hospital greed. Paying more attention to the bottom line, many hospitals limit adequate nurse staffing.

California passed AB 394 in 1999 that established minimum registered nurse-to-patient ratios for hospitals. The final regulations were implemented on January 1, 2004. The law has improved patient care, lowered mortality, and improved nurse retention.

While no other state has passed a nurse-patient-ratio law, two Congresspersons, Jan Schakowsky (D-IL) and Sherrod Brown (D-OH), are introducing a new bill on the national level: Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.

This bill will improve the health of patients by improving nursing care—establishing minimum registered nurse-to-patient ratios in hospitals, providing whistleblower protections to nurses who advocate on behalf of their patients, and investing in training and career development to retain hardworking nurses in the workforce. The pandemic has only magnified the need to support nurses in their work.

What excites me is that rather than states working on individual bills, this bill will direct behavioral change in all USA hospitals. I’ll be keeping an eye on its progression and giving support to its passage whenever I can. I hope you do, too.

Watch this powerful video that shows how insufficient hospital staffing undermines safe nursing practice.

We Know the Real Cause of the Crisis in Our Hospitals. It’s Greed.

click here to view 6 minute video

Nurses would like to set the record straight on the hospital staffing crisis. Video By Lucy King and Jonah M. Kesse

Nurses are nuts or do they just need “secretaries?”


Nurses Are Nuts by Anthony Langley, RN





Anthony Langley contacted me to ask if he could send me a copy of his book to review and possibly discuss on my Blog. I am always happy to support a fellow nurse who takes the plunge and writes a book about nursing, so I said sure.




About the Author

Anthony Langley has been a registered nurse for twenty-nine years. He also has a bachelor’s degree in criminal justice. His interest in nursing started after getting a job as a security officer in the emergency room of a hospital. A male nurse who worked in the emergency room showed him the things that nurses did, which got him interested in nursing.

Anthony Langley

He got his bachelor’s degree in nursing in 1990. At his first job, he started on a medical-surgical unit. He has worked in many areas of the hospital, which include surgical stepdown unit, surgical intensive care, same-day surgery, and the post-anesthesia care unit (PACU) recovery room.



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