This document discusses the problems caused by overcrowding and inadequate nurse staffing in healthcare institutions, and proposes solutions to address these issues. Specifically, it notes that overcrowding leads to dangerous nurse workloads and compromised patient care. It recommends legislating nurse-patient ratios and implementing dynamic staffing models determined by nursing expertise as ways to match patient needs with appropriate staffing levels. The document advocates engaging nurses in care decisions at all levels and enforcing accountability to ensure staffing supports safe, quality patient care.

1. Safe Staffing
=
Safe Care
The role of Nurse-Patient Ratios
and Dynamic Staffing Models
Based on the research synthesis and report from:
Berry, L. & Curry, P. (2012) Nursing Workload and Patient Care. CFNU:
Ottawa.

2. What’s the problem?
Health care institutions are running over capacity
In a survey of 158 Canadian emergency department directors, 62% reported
overcrowding as a major problem (Bond et al., 2007).
Overcrowded health systems lead to:
1) Dangerous levels of workload & inadequate nurse staffing
 A study of almost 55,000 nurses reported higher levels of burnout are associated with lower
ratings of quality of care (Poghosyan, Clarke & Finlayson, 2010).
 Each additional patient per nurse associated with a 23% increase in burnout and a 15%
increase in job dissatisfaction (Aiken, et al, 2002).
2) Compromised patient care
 A 0.08-hour increase in registered nurse overtime associated with a 33% increase in the
odds of an unplanned patient ER visit after discharge (Bobay, Yakusheva & Weiss, 2011)
 Every surgical patient added to a nurse’s workload increases the odds of a patient dying
under the nurse’s care by 7% (Aiken, et al, 2002).
 Nurses working more than 40 hours per week were 28% more likely to report that patients
occasionally/frequently received the wrong medication or dose (Olds & Clarke, 2010).
 Lower nurse-patient ratios linked to higher rates of mortality, sepsis, pressure ulcers,
medication errors, falls & failure to rescue.

3. How can we fix it?
Staffing solutions for safe patient care
Nurses need direct input into patient care decisions. Staffing solutions must support,
empower and respect nurses by properly applying their expertise to the care environment
1) Nurse Patient Ratios as minimum staffing requirements
— Allows for unit level decision making & staffing based on patient care needs
— Nursing hours per patient day formula (NHPPD)
2) Dynamic Staffing Models
— Synergy Professional Practice Model incorporates unique needs of patients and
specialized skills of nurses into staffing plans
Results observed
• California and two Australian states that have legislated and collectively bargained nurse
patient ratios experienced improvements in nurse sensitive outcomes
— Higher nurse patient ratios = lower mortality rates, CNS complications, ulcers and GI bleeds
— Shorter length of stay and readmissions
• Nurses & patients in British Columbia and Saskatchewan have reported better quality
care when dynamic staffing models were introduced
• Return on Investment
— Cost savings achieved as a result of increased nurse retention, and reductions in nurse
absenteeism, burnout and turnover, reduced length of stay and readmissions

4. Where do we go from here?
Create systems that match patient needs to nurse staffing
• Engage nurse expertise at all levels
— Nurses have the expertise to inform and coordinate care on the front lines & through policy
• Act on the evidence!
— Ensure that staffing models and practices are rooted in evidence based, best practice
guidelines
• Nurse leaders and employers work together to develop dynamic staffing models
— Share decision making, and create staffing processes that respond to the acuity and
complexity of patients
• Address overcapacity in the health care system
— Improve the integration of services between hospitals and their communities
— Improve funding to home care, organizations providing alternate levels of care
— Improve access to primary care services
• Enforce health system accountability for safe quality patient care
— Link institutional funding to improvements in patient outcomes and nursing indicators (ex.
reductions in burnout and turnover)
Visit nursesunions.ca for the full report: Nursing Workload and Patient Care