How Inadequate Nursing Staff Ratios Impact the Quality of Medical Care

For many years, there has been much debate on whether hospitals should implement nurse to patient ratios. Recently, New York nurses (NYSNA) went on strike in support of drafting, implementing, and enforcing strict nurse-to-patient ratios in their collective bargaining agreement.

Nurses are the frontline of defense in most clinical settings – typically, they are the first point of contact a patient makes during their triage. From our experience advocating on behalf of patients, having less nurses to attend to patients leads to a significant reduction in the deliverance of quality care.

Impact of Inadequate Nursing Staff

The discretionary aspect of nursing ratios can put patients at risk of injury because nursing shortages often bear responsibility for adverse effects on patient health outcomes.

Having less nurses on staff has been shown to contribute to higher rates of mortality, longer hospital status, and higher rates of hospital readmission. On the contrary, adequate nursing to patient ratios lead to lower rates of 30-day inpatient surgical mortality, fewer deaths, lower rates of infection, less instances of delayed treatment, and shorter hospital stays.

Alarmingly, nurses who complain of inadequate staffing often risk being accused of insubordination, even if the inadequate staffing could lead to medical malpractice and risk their license.

Opponents of nurse-to-patient ratios argue that safe staffing ratios are rigid and formulaic, which would cause hospitals to ration the delivery of adequate healthcare and lead to the closure of smaller hospitals. They also argue that the case in support of ratios is unsubstantiated; that there is no reliable, quantifiable evidence which shows that ratios are successful. However, studies have shown that none of these concerns, including the claim that hospitals would shut down, actually came to fruition.

Nursing Legislation and Lack of Federal Oversight

Only a few states have implemented legislation in this area, most notably California where staffing ratios have been in effect since 1989. In 2021, New York passed a bill in alignment with as much, whereby ratios are created through hospital staffing committees (staffed by RNs). Furthermore, the data on staffing will become publicly accessible through the Department of Health in July 2023.

Under federal law, hospitals that participate in Medicare are required to have “adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel” but there is no federal direction to indicate how many nurses should be available per patient.

In March 2023, federal lawmakers indicated that they were planning to re-introduce a bill from 2021 known as the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. If passed, the bill would provide oversight on nursing and patient ratios to increase patient safety and health outcomes. Despite this, as of June 2023, federal law currently contains a discretionary aspect, which allows each state to determine nurse-to-patient ratios.

However, it is important to note that even if the legislation were to be passed, it is often enforced poorly, which allows the issue to persist. To combat this issue, experts including the American Nurses Association embraces an "acuity" based approach, which would empower hospital committees of nurses to measure patient needs at any given moment and staff accordingly, specific to their unit's needs.

Speak to a Medical Malpractice Lawyer

Although enforcing nurse to patient ratios may be controversial and perhaps costly, the value of properly meeting a patient’s needs is indispensable. Staffing ratios ensure that nurses can confidently care for their patients and quickly adapt to any medical issues that may arise during treatment.

As medical malpractice lawyers, we can investigate whether or not your injury was caused as a result of inadequate staffing and negligence.

If you or someone you know believes they were significantly impacted by unsafe nursing staff, contact us to day for a free initial consultation.

Let our family help yours.