Nurse-Staffing Ratio: Patient’s Perspective

The patient’s condition itself is a major piece of the nurse-staffing ratio. For instance, a patient that is fresh out of surgery and arousing from anesthesia is considered to need a nurse-staffing ratio of 1 nurse to 1 patient (1:1) for the first hour of recovery. This usually takes place in the Post Anesthesia Care Unit (PACU) with nurses that are certified in Advanced Cardiac Life Support (ACLS).

When deemed “stable”, the patient can be transferred either to an Intensive Care Unit or to a Medical-Surgical Unit depending on the patient’s diagnosis and/or condition. For example, an uncomplicated appendectomy would go to Med-Surg but an open-heart patient would go to Cardiac ICU.

The OR, PACU, Pediatric ICU, Cardiac ICU, Medical ICU, Surgical ICU, Neonatal ICU, Labor & Delivery, and the ED – are all considered to be Intensive Care Units of a hospital. Patients that are admitted or evaluated in these units are (or are about to become) high-risk patients. The nurses working in these units of a hospital are highly specialized and the best of them are certified in that specific type of care.

The more serious a patient’s illness, injury or condition, the more likely they are to be further injured, differently injured, infected and/or need immediate life support responses. And many nurses have specialized in Case Management for these reasons. Exactly because of these conditions – instability of systems, levels of consciousness, medical regimen and medication administrations (more frequently intravenous medications than not), the actual physical presence of a nurse at the bedside is required for longer, more frequent periods of observation, assessment, documentation and patient care tasks. The patient’s condition dictates their nurse to patient ratio. In an ICU environment, the nurse-staffing ratio is typically 1:1 and sometimes 1:1-2.

As the patient recovers and their medical status is upgraded, the amount of time a nurse needs to spend with them and the frequency of the interactions decrease and interventions. The patient will be moved out of an intensive care environment and into a more traditional Medical-Surgical hospital unit. In these areas of a hospital (Medical floors, Surgical floors, the Pediatric floor, Orthopedic floor, Oncology floor, Postpartum rooms or floor, the Newborn Nursery, or a Telemetry unit), the number of patients assigned to a single nurse increase. Based primarily on the hospital’s nurse-staffing plan and somewhat on the patients’ conditions, the nurses are now assigned at a ratio of 1: 4 – 10+.

As the patient continues to recover, they become more aware of their surroundings and more observant of the people involved in their care. When their call bell is initiated, the length of time between a call and actual arrival of an employee is noted. How, when and what is on their meal plates as it arrives is cataloged as good, nice, fair or disgusting. The timing of their physician’s visits becomes more important to them and RNs play a crucial role here. Their pain medication’s effectiveness and coverage are integral.

The cleanliness of their room and bed and own body is crucial. What they can or should wear can be a 5 – 10-minute discussion and dressing endeavor. What they will do and feel when they get home is anxiety producing. And, modesty and personality return. Caring company, in any form – visitor, chaplain, nurse, aide, physician, family, housekeeper, educator, senior vice president – is most welcome and is often engaged to stay and visit for a while if the patient is feeling good. Being mostly recovered, the actual discharge process from physician order to loading into the car is remembered in infinite detail.

Remembering bits and pieces of their intensive care unit stay and comparing that care to the care they received on the medical-surgical unit through interventions will quite likely leave a no-contest imprint on this patient. The intensive care unit experience will be ingrained in the patient and noted on their patient satisfaction surveys as “Wonderful!!”, “Very attentive”, “Always there to help whenever I needed them.”, “Very professional staff!”, “Explained everything and made me feel safe.” and “I owe them my life!!”

Conversely, the medical-surgical unit will be met with “No one came when I called 5 times!”, “The food was awful.”, “The nurse did not call my doctor to come.”, “The nurses never brought my pain medication when they were supposed to.” “No one changed my bed linen for 2 days!”, “The staff was rude!”, “My own family had to help me up to the bathroom.”, and “It took them 3 hours to discharge me! My family was made to wait to take me home.” We’ve all heard this sort of comments, and to be true, there are good nurses of we may have some questions about whether they’re also good persons

(Patients and their families remain completely unaware that their nurse-staffing ratio in the ICU was 1:1 or 1:1-2 but their nurse-staffing ratio in the medical-surgical unit was 1:8-10. Sadly, hospital administrators fail to recognize this causative relationship also when reviewing patient satisfaction reports and the emotional strengths that are expected of nurses.)