Staffing remains a central and enduring concern for nurses, making the creation of research-based safe staffing standards essential for patient and nurse well-being. In the aftermath of the COVID-19 pandemic, the nurse staffing crisis intensified, exposing ineffective and unsafe staffing practices and deepening the urgency for standardized recommendations. The staffing dilemma involves numerous variables and, therefore, does not have a single solution. A passionate and ongoing debate surrounds the role of suggested or mandatory staffing ratios, patient acuity, nursing workload and the lack of autonomy nurses experience in determining what constitutes safe staffing.
Safe staffing has long been a legislative and advocacy priority for the Academy of Medical-Surgical Nurses (AMSN). In 2022, the organization was invited to participate in the National Nurse Staffing Task Force. Among the priorities identified by this collaborative effort was the development of staffing standards led by nursing specialty organizations.
AMSN undertook this initiative to ensure medical-surgical nurses have access to a relevant, specialty-specific framework for safe staffing. Through the work of the Medical-Surgical Nurse Staffing Task Force and feedback from the broader AMSN membership, including insights collected during the 2024 AMSN Convention in Toronto, AMSN is proud to release this updated set of staffing recommendations that support the delivery of safe, high-quality care and empower nurses to advocate for appropriate staffing conditions from the medical-surgical nurse's perspective.
Recommendations
AMSN recommends:
- Establish Evidence-Based Minimum Safe Staffing Standards: To ensure patient safety and nurse wellbeing, a direct patient care registered nurse shall not be assigned more than five patients, as a guideline. Acuity-based adjustments should modify staffing as needed to reflect patient complexity, unit-specific demands, and the nurse’s experience.
- Implement Acuity-Based Staffing Models Using Standardized Tools: Hospitals should integrate validated acuity-based staffing tools (such as EHRS-based acuity tracking) to dynamically adjust staffing based on real-time patient complexity and staff experience. Rigorous testing of standardized tools results in accurate measurement ensuring reliable and trustworthy data.
- Establish Nurse-Led Staffing Councils in Hospitals: Medical-surgical nurses should implement Nurse-Led Staffing Councils to ensure nurses, ancillary support, and their immediate managers participate in shared decision making about staffing.
- Improve Ancillary & Support Staff Integration: Hospitals should invest in ancillary staff to support nurses and reduce non-nursing workload and non-nursing care implemented by professional nurses.
- Strengthen Legislative & Regulatory Advocacy: Advocacy at state and federal levels helps to create lasting, enforceable nurse staffing regulations. Medical-Surgical nurses and AMSN have specialized knowledge of and research about safe staffing levels and the needs and experience levels of medical-surgical nurses.
- Promote and Enable Innovation: Technological advances and evolving research will lead to innovative staffing models and practices which should be considered as future solutions. Medical-surgical nurses should actively engage on all fronts to develop, implement, and evaluate innovations to improve nursing care delivery models which inform medical-surgical nurse staffing.
View the Full Position Statement
Additional Materials
Infographic/Flyer
AMSN has created a one-page flyer that documents the recommendations that can be downloaded and printed out for free.
Download the Infographic
Recommendations for Safe, Effective Medical-Surgical Nurse Staffing Booklet
AMSN is pleased to offer the ability to purchase the full recommendations in an expanded, printed booklet.
- AMSN Member: $0
- Non-Member: $49
Purchase the Booklet