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Being at the patient’s bedside is much more than a numbers game. For years and still today hospitals have been utilizing patient to nurse ratios to compute staffing needs. Staffing ratios are locally developed formulas that hospitals use to distribute the patient work load among the nursing force. Typically areas within a hospital where patients are less ill such as medical-surgical areas have the highest ratios where one nurse may be caring for as many as seven patients simultaneously. Specialty areas such as intensive care (ICU) and emergency departments (ED) have ratios that are often much lower, using one nurse to care for two patients in an ICU.

Nationally hospitals have been hit hard with the on going nursing shortage, and patient-nurse ratios have fluctuated reflecting this resource deficit. Compounding the nursing shortage healthcare facilities are also struggling with financial difficulties – increasing bad debt and lower insurance reimbursement rates. The resulting effects for many institutions have been in the form of staffing ratios that have become clearly unsafe. Even with successful legislative action by some states to mandate nurse-patient ratios, hospitals still use numbers of patients to compute nursing workforce demands.

Healthcare facilities need to adopt staffing models that utilize acuity as the foundation for determining workforce requirements. The demographics of today’s hospital patients have dramatically changed. Patients are older; they have more complicated comorbid diseases, and require much greater amounts of resources.

Staffing that reflects patient acuity, not numbers of patients, provides an environment that allows patient safety goals to be realized and it affords the foundational matrix for high quality care to be the norm. Moreover, acuity based staffing increases both patient satisfaction and employee job satisfaction.

Increasing payroll expenses to establish acuity based staffing should not be circumvented in attempts to shave organizational costs. The advancing age of the population and the continued nursing shortage with the volatile health insurance market dictates changes to be made today in healthcare facility staffing. To ensure patient safety, improve the quality of care, and mitigate preventable harm to patients healthcare staffing must be based on acuity.

About the Author

Mike Pringle provides regulary commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. Mike has held positions ranging from department staff and Nurse Manager to Executive positions

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