Mandatory Nurse-to-Patient Ratios: If It’s Good for California, Is It Good For All?

It’s been 10 years since mandatory nurse-to-patient ratios were instituted in California, and the wisdom of this legislation has been confirmed by some studies by Linda Aiken, RN, of the Center for Health Outcomes at the University of Pennsylvania School of Nursing. The overall conclusion of her study is that mandatory ratios reduce patient deaths and enable nurses to spend more time with their patients.

As Aiken points out, with fewer patients to care for, there are fewer complaints from patients and families, and more patients leave the hospital understanding what comes next. In addition, nurse-retention is higher, burnout lower and overall quality of care better.

I can recall days when I was assigned to care for 10 or 12 patients per shift. Granted, patients several decades ago were possibly overall younger and definitely less acutely ill, but still, there were shifts when some patients barely got a hello. I hardly ever left work feeling as though I did all I was supposed to do.

These memories were prompted by two recent editorials in the San Diego Union Tribune regarding mandatory ratios at the federal level. (There is a push in Congress for them, led by California’s senator.) The editorial favoring federal ratios was penned by a nurse; the opposing editorial was written by the director of a health research institute and an anesthesiologist.

(Backgrounder: In 1999, California enacted mandatory nurse-to-patient ratio legislation which provides for 1-to-2 in ICU; 1-to-3 on maternity floors; 1-to-4 on pediatric floors; 1-to-5 on surgical floors; and 1-to-6 on psychiatric floors.)

The nurse argues that the bottom line in debates over mandatory ratios is the concern for patient safety. The ratios are about “…the future of safer patient care, and a solution to keeping nurses at the bedside,” writes Geri Jenkins, RN, past co-president of the California Nurses Association. “It works for patients, for their families, for our communities and for our profession.”

From the other side of the fence is the argument that federally mandated ratios “move responsibility for safe hospital staffing away from communities and local governments in favor of distant bureaucracies that cannot be held accountable for the harm they cause.”

The authors also maintain that mandated ratios would result in closing units to further admissions when there aren’t enough nurses to staff it.

Do you work in a state that has mandated nurse-to-patient ratios?

If so, do you find that it affects working conditions and nurse morale?

Can you compare what it is like to work in hospitals that must comply with mandated ratios versus those that do not?

Do you think a federally mandated ratio is the way to go?

Tell us what you think.