Determining adequate nurse staffing is a very complex process that changes on a shift-by-shift basis. A PSNet Classic 2011 study showed that increased patient turnover was also associated with increased mortality risk, even when overall nurse staffing was considered adequate. Overall nursing workload is likely linked to patient outcomes as well. The nurse-to-patient ratio is only one aspect of the relationship between the nursing workload and patient safety. According to the American Nurses Association, only 14 states have passed nurse staffing legislation as of March 2021 and most states do not specify registered-nurse (RN)-to-patient ratios, which vary by state and are also setting-dependent. The strength of these data has led several states, beginning with California in 2004, to establish legislatively mandated minimum staffing ratios. Several seminal studies linked in this sentence have demonstrated the association between nurse staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity, and even mortality as the number of patients per nurse increases. ![]() There are many key factors that influence nurse staffing such as patient acuity, admissions numbers, transfers, discharges, staff skill mix and expertise, physical layout of the nursing unit, and availability of technology and other resources. It is logical, therefore, that assigning increasing numbers of patients eventually compromises a nurse’s ability to provide safe care. Nurses' vigilance at the bedside is essential to their ability to ensure patient safety. From a patient safety perspective, a nurse’s role includes monitoring patients for clinical deterioration, detecting errors and near misses, understanding care processes and weaknesses inherent in some systems, identifying and communicating changes in patient condition, and performing countless other tasks to ensure patients receive high-quality care. ![]() Nurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team and are crucial to timely coordination and communication of the patient’s condition to the team. While physicians make diagnostic and treatment decisions, they may only spend 30 to 45 minutes a day with even a critically ill hospitalized patient, which limits their ability to see changes in a patient’s condition over time. Nurses play a critically important role in ensuring patient safety while providing care directly to patients. PSNet primers are regularly reviewed and updated to ensure that they reflect current research and practice in the patient safety field. Originally published in December 2011 by researchers at the University of California, San Francisco.
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