NICE calls for nurse-to-patient ratio draft guidelines

One nurse caring for more than eight adult patients may lead to inadequate care, according to the National Institute for Health and Care Excellence's (NICE) draft guidance issued out of the U.K.

Hospital boards and senior management should take the nurse-to-patient ratio guideline actions in tandem with a National Quality Board 2013 report. Although the draft guidance doesn't recommend minimum nurse-to-patient ratios, it highlights the importance of noting "red flag events," which require immediate response, such as patients who don't receive basic care like assistance to the bathroom or experience delays in medication adminitration, according to Onmedica.

Hospitals should ensure capacity, support flexibility, monitor adequacy of nursing staff, focus on patient care, and promote staff training and education. To do this, the proposed guidelines suggest that organizations determine daily nursing staff levels using a staffing toolkit consistent with NICE recommendations.

Organizations should then consider patient conditions that need continuous monitoring as well as the estimated patient turnover in a 24-hour period and the physical size of the unit. The nursing staff also factor into the requirements, including individual responsibilities, and planned and unplanned absences.

To determine the right patient-to-nurse ratio, organizations must estimate the total number of nurses needed throughout a 24-hour period, then monitor and evaluate the unit to see whether the available nursing staff meets the actual need. 

"Too often, staffing levels are allowed to yo-yo because of finances, and this puts staff under strain and patients at risk," said Peter Carter, chief executive and general secretary of the Royal College of Nursing, Onmedica reported. "A minimum should not become a default staffing level, and there is more work to do in ensuring staffing levels are safe for every setting."

In the U.S.nurses call for lower nurse-to-patient ratios, squaring off against hospitals in a legislative battle. A Health Professionals and Allied Employees union in New Jersey said short-staffed nursing can lead to inadequate patient care, with 44 percent of nurses reporting they haven't been able to provide proper patient care at least once because of under staffing, FierceHealthcare previously reported.   

To learn more:
- here are the draft guidelines
- read the Onmedica article
- check out the National Quality Board report (.pdf)