Diverse perspectives on unit-level nurse staffing ratios in medical-surgical units: A Delphi policy analysis.

ABSTRACT

BACKGROUND: Appropriate staffing is essential to acute care delivery. Staffing ratio policy generates controversy. PURPOSE: This study examines perspectives on unit-level nurse-to-patient ratio policy in adult medical-surgical units. METHOD: Delphi methodology uses an invited diverse panel to analyze a policy's effects. Panelists completed iterative surveys about the impact they expect from unit-level ratio policy. FINDINGS: Panelists demonstrated moderate agreement that the proposed policy could increase staffing levels, decrease patient length of stay, and reduce nurse attrition. Other potential outcomes included reducing staffing in units above the minimum and increasing short-term costs. Panelists agreed that the policy could increase patient safety and nurse satisfaction and did not agree about the effect on long-term cost and innovation. Panelists also anticipated a mostly positive effect on patients and nurses. DISCUSSION: Policies that set unit-level nurse-to-patient ratios offer a potential strategy to improve medical-surgical staffing. Policy design should consider the range of expected outcomes.