The typical nurse-to-patient ratio varies depending on the type of healthcare setting and the specific unit within that setting. In a long-term care facility, such as a nursing home, the nurse-to-patient ratio may be overwhelming. With one nurse responsible for caring for a larger number of patients.
Nursing Home Minimum Staffing Requirements
In many states, there are no enforceable ratio laws for nursing homes. This means that healthcare facilities have the flexibility to set their staffing levels.
House Of Representative Nursing Home Summary Analysis 2019
- A minimum weekly average of 3.6 hours of direct care per resident per day by either a CNA (certified nursing assistant) or a licensed nurse
- A minimum of 2.5 hours of direct care per resident, per day provided by a CNA
- A facility CANNOT staff at a ratio of less than 1 CNA per 20 residents
- A minimum of 1.0 hour of direct care per resident per day provided by licensed nursing staff
- A facility CANNOT staff at a ratio of less than 1 licensed nurse per 40 residents
In the state of Florida, one of the largest hub for retirement homes, has a nurse to patient ratio of 1:40 and a CNA to patient ratio 1:20. This comes with a caveat that “facilities to determine their direct care staffing needs based on certain assessment & resident care plan.”
Policy makers deem these ratios reasonable for quality patient care. However, the nursing staff say otherwise. With acuity increasing more and more, nurses and CNAs are stretched thin with these overwhelming assignments. It is no doubt that these conditions contribute to burnout and poor staff retention.
Read our story why nurses remain the most trusted profession for 22 years
The nursing home industry has opposed this proposal, arguing that it would add more than $11 billion a year to their operating costs. But nurses and other essential healthcare workers are speaking out about the negative impact of understaffing on their working conditions. Understaffing is also affecting the quality of care for patients.
Nursing Home Staffing Ratios Is A Problem
The Biden Administration has announced plans to improve staffing levels in nursing homes. In fact, this proposition is based on Medicare and Medicaid’s 2001 recommendations.
It would require all nursing homes to provide a minimum of 4.1 hours of care per resident each day resulting to a 1:7 nurse to patient ratio.
Criminalizing Nursing Home Nurse Caring For 39 Patients
The American Nurses Association (ANA) supports the concept of Just Culture. It is a concept that promotes a process where mistakes or errors do not result in automatic punishment, but rather a process to uncover the source of the error.
Whereas last year’s case of Christann Gainey is a prime example of how Just Culture has been disregarded in favor of securing a guilty verdict.
Christann Gainey, an LPN, pleaded guilty to falsifying records to show that she had performed neurological and vital sign checks on a patient at a senior living facility in Philadelphia. The patient, Herbert R. McMaster SR., an 84-year-old resident, suffered a fall, hit his head, and died hours later due to a brain bleed.
Unfortunately, this was the fifth fall that the patient had in four days. Gainey was a staffing agency nurse on duty the night of McMaster’s death and was caring for 39 residents. The facility’s policy required her to perform neurological and vital sign checks on a strict schedule. However, video footage showed that Gainey was not near McMaster at the documented time of the neurological checks.
Sentenced to six months of house arrest followed by four years of probation. During this time, the verdict barred Gainey from reinstating her license or working in a care facility.
Holding The Healthcare System Accountable
From the criminal liabilities of nurses who cannot meet expectations in an already-understaffed system, to the systemic issues that need to be addressed – it is clear that accountability must be shared among all healthcare stakeholders for tragedies like Herbert R. McMaster SR’s death.
In fact, a report from the Pennsylvania Health Department revealed many system failures. These include
- Failure to develop a fall prevention plan,
- Failure to complete required neurological checks
- Failure to perform CPR
Reports indicate that the Director of Nursing and facility administrators neglected their duty by not providing sufficient supervision or putting into effect precautionary measures against accidents and falls.
The ANA believes that the death of McMaster does not lie solely with Gainey and that systems need to change. The association argues that until systems are changed and nurses are not the only ones held accountable, the reporting of incidents will continue to decrease. This is because nurses worry about their future and fate within the profession.
Nursing professionals around the country have been raising their voices warning of the dangers of understaffing in healthcare facilities. The plea for a minimum number of staff members at healthcare centers, particularly nursing homes, is not only applicable to nurses working in hospitals.
The recent strike by nurses in New York City may show future labor actions within the healthcare industry. The nurses, represented by the New York State Nurses Association, announced a deal. The deal is to establish set nurse-to-patient ratios for all inpatient and emergency units at both hospitals.
What Nurse Staffing Ratios Look Like In California
Indeed California is unique as it is the only state that established base nurse-to-patient ratios that must be upheld by the unit. For instance, the ratio of nurses to patients in critical care units must always be 1:2 or less. Moreover, the state’s laws mandate that the ratio of nurses to patients in emergency departments must always be 1:4 or less while treating patients.
In California, the nurse-to-patient ratio for different types of care varies.
- Intensive and Critical Care – 1:2 ratio
- Neo-natal Intensive Care unit – 1:2 ratio
- Operating Room – 1:1 ratio
- Post-anesthesia Recovery – 1:2 ratio
- Labor and Delivery – 1:2 ratio
- In Antepartum and Postpartum couplets, the ratio is 1:4, and in Postpartum women only, it is 1:6
- Pediatrics – 1:4 ratio
- Emergency Room – 1:4 ratio
- ICU Patients in the ER have a ratio of 1:2 and for Trauma Patients in the ER, it is 1:1
- In 2008, systematically changed the ratio for Step Down and Telemetry from 1:4 and 1:5 initially to 1:3 and 1:4 respectively
- In Medical/Surgical, the ratio changed from 1:6 initially to 1:5 in 2008
- For Other Specialty Care, the ratio has been changed from 1:5 initially to 1:4 in 2008
- Psychiatric – 1:6 ratio
Final Thoughts
The challenge of inadequate staffing in nursing homes is multifaceted and requires a comprehensive solution. Although there are no quick fixes, meaningful progress can be made by investing in training initiatives, offering better salaries, and enforcing strict standards for staffing. In doing so, quality of care and patient safety will be improved while also allowing nurses to remain focused on providing the best care possible.