Comment

Winning the case for nurse-patient ratios

UK nurse managers can learn from their Californian counterparts.
UKUS

US-style nurse-to-patient ratios could work in the UK.

I admit it: in the argument about mandated nurse-to-patient ratios I was concerned that the ratio would become an end in itself. Having heard attempts to justify decisions on quality and safety with we havent breached the 1 to 8 ratio, I was worried.

Experience has shown me that, in some acute environments, one registered nurse for every eight patients does not provide enough critical decision-making skill to meet the needs of patients.

Last autumn, keen to see the effect of mandated ratios for myself, I visited a hospital in San Francisco CA, where such ratios are in place.

No one could fail to be inspired by the demeanour of the nurses, how frequently they smiled, and their confidence and attention to detail. I was struck though, not by how many staff were around,

...

US-style nurse-to-patient ratios could work in the UK.

UKUS

I admit it: in the argument about mandated nurse-to-patient ratios I was concerned that the ratio would become an end in itself. Having heard attempts to justify decisions on quality and safety with ‘we haven’t’ breached the 1 to 8 ratio’, I was worried. 

Experience has shown me that, in some acute environments, one registered nurse for every eight patients does not provide enough critical decision-making skill to meet the needs of patients.

Last autumn, keen to see the effect of mandated ratios for myself, I visited a hospital in San Francisco CA, where such ratios are in place. 

No one could fail to be inspired by the demeanour of the nurses, how frequently they smiled, and their confidence and attention to detail. I was struck though, not by how many staff were around, but by their sense of calm. This was in contrast to the frenetic atmosphere of many UK hospitals. 

Could American patients be less sick or more stable than their British counterparts? Or were we meeting only the best of the hospital’s staff?

American colleagues said that the calm atmosphere is due to a mandated ratio of no less than one registered nurse to four patients. The ratio was agreed in state law despite concerns about whether enough nurses could be recruited and funded. 

Patient safety

The case for the ratio was won by focusing on the safety of patients. Mandated ratios had reduced staff sickness levels to between 1% and 2%. They have also encouraged people who had left the nursing profession to return to it, those who planned to retire to keep working and nurses from other states to fill vacancies.

As the UK profession gathers evidence that higher ratios of registered nurses to patients result in safer care and better outcomes, nurse managers must consider the whole clinical picture. They should take into account the economic case of lower turnover and sickness, and ask themselves whether in the long term a higher skill mix could be safer and cheaper.


About the author

Elaine_Strachan-Hall

Elaine Strachan-Hall is clinical director of Healthcare at Home and registered nurse on South Warwickshire Clinical Commissioning Group’s governing body. She is also a member of the Nursing Management editorial advisory board

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