Hospital: a place that employs one doctor to work a bazillion-hour week, one nurse to care for 4 very sick people, and three maintenance men to put up 1 small shelf.
There has been quite a bit of discussion (particularly in the US) lately surrounding nurse patient ratios. The question is often put to examine what would be a safe nurse to patient ratio.
Well, seems to me what we should be striving for is not a ratio that provides safe patient care, but rather a ratio that fosters quality nursing care.
In our own emergency department we usually run about one nurse to 4 or 5 patients in the acute care setting1.
I think (without trawling the literature), this is probably a minimum safe level of staffing. But it is far from a level that promotes quality care delivery in an emergency department setting.
Just ask most nurses following a typically busy shift and they will complain of feelings of frustration and dissatisfaction. They feel that they couldn’t deliver the care they wanted to.
This is not surprising really, as patients in most emergency departments are an unstoppable queue of complex, undifferentiated, acutely unwell people who require continuous and careful assessment, frequent interventions, and constant vigilance2.
Most nights we spin the plates and juggle the balls and get through the show.
But its a pretty crap show.
Which is a crying shame. We have some fantastic nurses working in our department the best of the best. And nobody wakes up in the morning thinking “gee, I think I’ll skip my observations today, and I’ll pass on any pressure area care.”
But as the workload increases and nurses try to cover an exponentially increasing list of tasks, orders, interventions, interactions, interruptions, prioritisation’s and documentations…..quality is often the first casualty of the shift.
So what do I think is a quality nurse-patient ratio? Well, and feel free to scoff at this point, I think it would be one nurse to 2 patients in the acute care setting, one to two nurses for a critically unwell/unstable patient and four to one for a trauma or similar emergency.
Now we could get down to delivering some seriously good standards of nursing care.
â€¦â€¦â€¦.I know, I know3.