Should a hospital nurse-patient ratio be imposed in all departments? On February 1, the Senate will consider a bill going in this direction. In France, the number of simultaneous patients for which a nurse or nursing assistant is responsible has been determined by law for about twenty years. But this provision only concerns specific activities: critical care, resuscitation, intensive care unit, obstetrics, hemodialysis and cardiac surgery. In so-called “non-standard” services, the calculation most often takes into account the recommendations of the National Health Performance Agency (Anap), according to which a nurse can simultaneously take care of… 12 to 14 hospitalized patients! A figure well above European averages.
The purpose of the bill, according to its defenders, consists in reducing this ratio in order to guarantee a better quality of care for patients, better safety for carers, as well as a gain in attractiveness for establishments. They also recall that similar laws have already been successfully applied in other countries. The State of California (United States) is the pioneer in this area with the establishment of a law in 2004. Since then, several Australian States, Switzerland, South Korea and Portugal have followed. Opponents believe that the establishment of a ratio in favor of increasing the number of caregivers per patient would be too complex and would take too much time, that it would benefit the private sector to which the standard will not be applied and that it would weigh too heavily on budgets. But what does science say?
Lower mortality and… more savings
It turns out that on this subject, the scientific literature is particularly abundant. Year after year – and for more than twenty years – the results have been confirmed and a consensus seems to be emerging: imposing a ratio of nurses per patient would reduce patient mortality, reduce waiting time in emergencies, the number of work accidents and the turnover of teams while increasing the time spent at the bedside of patients and the quality of care. Finally, such a measure would even save money.
Already in 2002, researchers who had carried out a large survey in 210 American hospitals bringing together more than 10,000 nurses and 230,000 “surgical patients”, showed, in a study published in the journal Jama, that each time a nurse has to take care of an additional patient, the risk of death increases by 7% and the risks of burnout and job dissatisfaction increase by 23 and 25%. The same year, another team indicated, in The New England of Medicine, that the more time nurses spend with their patients, the shorter the length of stay, the rates of urinary tract infections, pneumonia, gastrointestinal bleeding and cardiac arrest. In another study published in International Journal of Nursing Studies, in 2007, researchers this time compared the nurse-patient ratio in 30 English hospitals with nearly 4,000 nurses and 118,000 patients. They revealed that the hospitals with the highest ratio have a mortality rate of + 26% and a risk of burn-out multiplied by two.
And in 2014, researchers conducting a survey of 300 European hospitals including more than 26,000 nurses and 422,000 patients confirmed, in their study published in The Lancet, that for each additional patient per nurse, the “30-day death rate” increases by 7%. Seven years later, they published a new study, this time in BMJ Open, including 87 hospitals in the State of Illinois (USA), 210,000 patients and 1,391 nurses establishing that each additional patient per nurse increases the risk of death (+ 16%) and the length of stay (+ 5% ) and indicated that a ratio of four patients to one nurse – compared to a ratio of more than six to one – prevents almost 1,600 deaths and saves 117 million dollars (107 million euros) per year . Always in 2021, work published in The Lancet comparing 28 hospitals with ratio policies to 27 establishments without them, showed that the latter have, on average, nearly 150 deaths and 255 more readmissions per year, as well as longer lengths of stay.
If these results have not been duplicated in France, their confirmation over time and in many other countries, gives them a certain weight. The World Health Organization (WHO) has also launched an appeal to the United Nations so that its Member States make significant investment efforts in terms of hiring nurses in order in particular to guarantee safe ratios. A call shared by the international council of nurses.