It is the position of AMSN that:

• Patient care assignments should be made based on the medical-surgical nurse's ability to meet needs of individual patients rather than predetermined or fixed patient-to-nurse ratios.

• Medical-surgical nurses should be involved in ongoing research and open discussions concerning staffing principles as a practice issue.

Overview

Hospital nurse staffing levels impact patient safety and quality of care. Research indicates that nurse driven quality indicators, including value, survival after an in-hospital cardiac arrest, nurse satisfaction and patient satisfaction, improved with lower nurse-patient ratios. (Aiken, et al., 2010; McHugh et al., 2016; Silber et al., 2016)

Providing a safe environment for both the patient and nurse is a paramount concern. The patient should receive resources according to need, and the medical-surgical nurse must be able to provide the resources based on his or her licensure, education, and role. Demand for staffing guidelines comes not only from the nursing profession, but also from consumers and policy makers seeking parameters for safe, quality patient care.

Currently, no legislation has been passed on a national level regarding nursing staffing standards but the topic continues to be introduced through proposed legislation at the national and state level. Nurses have the responsibility to be engaged in the political process to ensure patients’ rights and needs are the focus of any legislation being proposed.

Rationale

AMSN supports provision of the highest quality patient care through appropriate use of staffing standards as deemed reasonable by the ever-changing standards of care; as established by health care practice.  

References

• Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., Spetz, J. and Smith, H. L. (2010), Implications of the California nurse staffing mandate for other states. Health Services Research, 45 (4), 904–921. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908200/

• Auerbach, D., Spetz, J. Mandated nurse-patient staffing ratios in Massachusetts: research presentation, analysis of cost impact. Massachusetts Health Policy Commission, Oct. 15, 2018. Retrieved from https://www.mass.gov/files/documents/2018/10/16/NSR%20Cost%20Impact%20A…

• Duffield, C., Roche, M., Diers, D., Catling-Paull, C., Blay, N., (2010). Staffing, skill mix and the model of care, Journal of Clinical Nursing, 19 (15/16), 2242-2251. doi: 10.1111/j.1365-2702.2010.03225.x

• Furukawa, M., Raghu, T., Shao, B. (2011). Electronic medical records, nurse staffing, and nurse-sensitive patient outcomes: evidence from the national database of nursing quality indicators. Medical Care Research & Review, 68 (3): 311-31. doi:10.1177/1077558710384877

• Havaei, F., et al. (2019). Effect of Nursing Care Delivery Models on Registered Nurse Outcomes. SAGE Open Nursing, Aug. 13, 2019. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2377960819869088

• McHugh, M.D., Rochman, M.F., Sloane, D.M., Berg, R.A., Mancini, M.E., Nadkarni, V.M., Merchant, R.M., Aiken, L.H. & American Heart Association’s Get with the Guidelines Investigators. (2016). Better nursing staffing and nurse work environments associated with increased survival of in-hospital cardiac arrest patients. Medical Care, 54(1), 74-80. doi.10.1097/MLR.0000000000000456

• O'Keeffe, M. (2016). Acuity-adjusted staffing: A proven strategy to optimize patient

• care. American Nurse Today, 11(3), 28-34. Retrieved from https://www.myamericannurse.com/wp-content/uploads/2016/04/ant3-Special…

• Oppel, E., and Young, G. (2017). Nurse Staffing Patterns and Patient Experience of Care: An Empirical Analysis of U.S. Hospitals. Health Services Research, August 14, 2017. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12756

• Schiakowsky, J. (2019). Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019, HR 2581. U.S. House of Representatives. Retrieved from https://www.congress.gov/bill/116th-congress/house-bill/2581

• Shang, J., Stone, P., & Larson, E. (2015). Major article: Studies on nurse staffing and health care–associated infection: Methodologic challenges and potential solutions. AJIC: American Journal Of Infection Control, 43581-588. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0196655315002175

• Silber, J.H., Rosenbaum, P.R., McHugh, M.D., Ludwig, J.M., Smith, H.L., Niknam, B.A., Even-Shoshan, O., Fleisher, L/A., Kelz, R.R. 7 Aiken, L.H. (2016). Comparison of the value of nursing work environments in hospitals across different levels of patient risk. JAMA Surgery, 151(6), 527-536. Retrieved from https://jamanetwork.com/journals/jamasurgery/fullarticle/2482670

Updated April 2020