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Posted: January 12th, 2024

The impact of nurse-patient ratios on patient outcomes and nurse burnout

The impact of nurse-patient ratios on patient outcomes and nurse burnout

Nurse-patient ratios are an important indicator of the quality and safety of hospital care. They reflect the number of patients assigned to each nurse on a given shift or unit. Higher nurse-patient ratios mean that nurses have more patients to care for, which can increase their workload, stress, and burnout. Lower nurse-patient ratios mean that nurses have fewer patients to care for, which can enhance their ability to provide individualized and timely care, prevent errors, and improve patient outcomes.

There is substantial evidence that nurse-patient ratios affect both patient outcomes and nurse burnout. A large-scale study by Aiken et al. (2002) found that every additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue (death following complications) among surgical patients. The same study also found that every additional patient per nurse increased the odds of nurse burnout by 23% and job dissatisfaction by 15%. These findings were consistent across hospitals in different states, sizes, and teaching status.

Another study by Aiken et al. (2021) compared the working conditions and outcomes of nurses in New York and Illinois before and during the COVID-19 pandemic. The study revealed that higher nurse-patient ratios during the pandemic were associated with higher rates of nurse burnout, lower confidence in hospital management, and lower priority for patient safety. The study also showed that lower nurse-patient ratios before the pandemic were associated with lower rates of emotional exhaustion, cynicism, and intention to leave among nurses.

These studies suggest that nurse-patient ratios have a significant impact on both patient outcomes and nurse burnout. Therefore, it is essential to implement policies and practices that ensure adequate and appropriate staffing levels in hospitals. Some possible strategies include:

– Adopting mandatory minimum nurse-patient ratios by unit or shift based on evidence and best practices
– Providing flexible staffing models that allow nurses to adjust their assignments according to patient acuity and needs
– Supporting nurses’ autonomy and empowerment to make clinical decisions and advocate for their patients
– Enhancing nurses’ education, training, and skills to cope with complex and diverse patient populations
– Improving nurses’ work environment, culture, and communication with management and other health care professionals
– Offering nurses’ incentives, recognition, and support for their work performance and well-being

By improving nurse-patient ratios, hospitals can improve the quality of care they deliver, reduce the risk of adverse events and complications, increase patient satisfaction and loyalty, and retain a competent and committed nursing workforce.


Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 2002;288(16):1987-1993. doi:10.1001/jama.288.16.1987

Aiken LH, Sloane DM, McHugh MD et al. A Repeated Cross-Sectional Study of Nurses Immediately Before And During The COVID-19 Pandemic: Implications For Action. medRxiv preprint posted online December 23, 2021. doi:

Allsup J. Relationship Between Nurse-Patient Ratios And Nurse Burnout [master’s thesis]. Helena (MT): Carroll College; 2019.


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