The Impact of Nurse Staffing on Patient Outcomes
Kelly Adams McCann
Drexel University

The Impact of Nurse Staffing on Patient Outcomes
When my daughter was in the Neonatal Intensive Care Unit (NICU) 11 years ago, I was I was blissfully ignorant of patient-to-nurse ratios and budget constraints. I had confidence in the competence of the nurses and believed that they had the time and the tools necessary to care for my child. Now that I'm a nurse myself and I see my support staff numbers cut and my patient load rise, I wonder what my patients and their families think of me.
In an age when we are all being asked to do more with less, nurse staffing levels are no different. The business of medicine is just that, a business, and
However, in a study done 2 years after the California regulations were passed, no improvement was shown in outcomes for medical-surgical or step-down units (Penoyer, 2010). This could be a result of poor reporting or the removal of resources to recoup the cost of hiring more licensed staff. California is the only state that has mandated patient-to-nurse ratios, although several other states are trying. Hopefully they can learn from the missteps of the past.
At this time, there no scientific evidence supports specific, mandated numbers assigned through mandatory ratios with better patient outcomes. Why? Numbers alone do not take in to account critical variables, such as patient acuity, nurse experience and skill set, available support staff, physician orders and resource limitations (Unruh, 2008). For example, a seasoned nurse with four “walkie-talkies” has a far heavier work load than a new nurse with four total care patients. A Registered Nurse (RN) has a different scope of practice than a Licensed Practical Nurse (LPN).
Research suggests that adequate staffing must be coupled with “balanced workloads” (Unruh, 2008). This is essentially matching the patient assignment to the nurse’s skill set and available resources. Mandated ratios and nurse staffing/scheduling software are doomed to fail unless the needs of the individual—the patient and the nurse—factor in to the decision making