How Do Nurse-to-Patient Ratios in the Emergency Department Impact Patient Experience?

There is a lack of consensus about the staffing matrix across nursing and especially in emergency nursing, where variations in arrival patterns, acuity, social determinants of health, and length of stay all impact the workload of emergency nurses. The objective of this paper was to determine if government-mandated staffing ratios had a greater impact on patient experience at hospitals in California than staffing based on hours per patient visit at hospitals in Massachusetts. Seven hospitals from the state of California with government-mandated nurse-to-patient ratios were compared to 7 hospitals from Massachusetts that did not have mandated staffing ratios to determine if there was any significant difference in patient experience. There was no significant difference between the chosen hospitals when comparing door-to-provider time, door-to- disposition time, left-without-being-seen rates, and Press Ganey likelihood-to-recommend scores. Determining a staffing matrix is difficult, and California law sets rigid patient-to-nurse ratios that evidence does not support. The exact science of determining the correct ratio of nurses to patients in the emergency department should be evaluated by experts in the field of emergency nursing and should not be left to the government. A direct correlation between government- mandated ratios and nurse-sensitive outcomes could not be determined