Our Priorities: Protect Patients

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When it comes to safe patient care, STAFFING MATTERS.
As nurses, we know that numbers matter. Having the right number of qualified nurses and staff at the bedside is critical to safe and effective patient care. But too often, nurses find their units are short-staffed and they are caring for more patients than is considered safe.

That’s why New Jersey’s five nursing unions—working together—fought for and won a law that requires all hospitals in the state to make available to the public the actual number and “ratio” of nurses and other health care staff for every patient on every unit for every shift. This information will help nurses, health care workers and our patients continue our fight for safe staffing.

What does the staffing disclosure law require? Every hospital must post, for each unit and each shift, the ratio of patients to nurses and other health care professionals available for patient care. Nursing homes already are required to post this information under federal law. The ratios are based on the total number of hours worked by nurses and staff.

Who is included? Registered nurses, licensed practical nurses, physical therapists, respiratory care practitioners and such unlicensed assistive personnel as certified nursing assistants (CNAs). A hospital must calculate the ratio for each staff category. Supervisory staff not providing direct patient care cannot be counted.

Reporting period: A hospital must report the information based on three eight-hour shifts or two 12-hour shifts.

Doing the math: To calculate the number of staff and number of patients admitted, the count starts at the beginning of the “shift” up to one hour before the shift ends. The staff-to-patient ratio is the number of patients divided by the number of RNs and their working hours. For example.

Firstly, calculate the actual hours worked:

There were four RNs on a unit, three of whom worked eight hours and one who worked four hours:
3 RNs x 8 = 24 hours + 1 RN x 4 = 4
24 + 4 = 28 hours worked

Secondly, calculate the number of staff on each shift by taking the number of actual hours worked divided by the type of shift (either eight or 12 hours). In our example, it is an eight-hour shift divided by 28 hours worked:

28 hours worked = 3.5 FTE (full-time equivalent)
8 hour shift

Thirdly, count the number of patients admitted to the unit. Start from the beginning of the “shift” up to one hour before the shift ends. This includes those patients who are temporarily in a hallway awaiting a bed. For this example, let’s say there were 21 patients.

Finally, calculate the nurse-to-patient ratio by taking the number of patients and dividing by the number of FTEs. In our example, there were 21 patients and 3.5 FTEs:

21 patients = 6 patients for every RN
3.5 FTEs

Standard for Safety

But requiring hospitals to disclose their staffing levels is not enough. That’s why New Jersey nursing unions are fighting for safe staffing levels for all of our patients, all of the time. So what are safe staffing levels? Two state legislative proposals (S. 1233 and A. 1531) would require hospitals to meet the following minimum staffing levels.

One RN to every six patients on a medical/surgical unit or behavioral health unit.
One RN to every four patients in a telemetry or step-down/intermediate unit.
One RN for every four patients in an emergency room; one RN to one patient in a trauma unit.
One RN for every two patients in a critical care unit.
One RN for every patient in an operating room and one RN for every two patients in a post-operative recovery room.
One RN for every two patients in labor-delivery.
One RN to every four patients in a postpartum-mother-baby unit.
One RN to every six patients in a mothers-only unit.
One RN to every four patients in a pediatric/intermediate nursery.
One RN to every six patients in a well-baby unit.

These requirements are based on numerous studies and standards set by many nursing organizations. When you are comparing your hospital’s staffing, it helps to know the minimum standard for safety.

What You Can Do

RNs Working Together believes nurses are the best patient advocates. We are by our patients’ bedsides and by their side in the fight for safe patient care. In addition, as holders of RN licenses, each of us has a legal obligation to be strong patient advocates.

Check to make sure your hospital is complying with the staffing disclosure law. If not, fill out one of your union’s Unsafe Staffing Reports and make sure your union gets a copy.
Contact the New Jersey Department of Health and Senior Services at 1-800-367-6543 if you think staffing is unsafe for patient care.
If you are not a union member and would like to join us in our fight to ensure minimum staffing levels for quality and safe patient care and/or you want to become an RNs Working Together Patient Advocate, click here.

RNs Working Together is a coalition of 10 AFL-CIO unions representing more than 200,000 registered nurses and is the largest organization of working nurses in America.

New Jersey RNs Working Together is a coalition of five unions representing nurses throughout the state. Our unions include 1199J NUHHCE/AFSCME, HPAE/AFT, NJNU/CWA, JNESO/IUOE and USW.