Nurse-Patient Ratios and Infections in Intensive Care

There is no doubt that inadequate staffing levels can be listed among the barriers to success in a variety of industries. Importantly, when it comes to healthcare, the costs of the problem are especially high since work overload in nurses can be detrimental to their ability to concentrate and, therefore, affects the effectiveness of treatment received by patients. Paying focused attention to the issue of nurse staffing, the paper provides a PICOT question for the planned project and links it to the learnings about the problem reported by other researchers in the field.

The PICOT Question

  • P: Patients at intensive care units;
  • I: The introduction of mandatory nurse-patient ratios;
  • C: Units without mandatory ratios;
  • O: The reduced incidence of hospital-acquired infections (HAI);
  • T: A 6-month period.

Clinical Problem, Evidence-Based Solution, and Nursing Intervention

The problem of low nurse-to-patient ratios and its consequences for the health outcomes of healthcare consumers belongs to the number of popular research topics in the field. The conclusions are claiming that the introduction of strict rules concerning staffing levels in different units guarantees better patient outcomes are often regarded as evidence. The planned study will focus on the problem that lies at the confluence of staffing levels and the common consequence of medical mistakes – hospital-acquired infections.

The links between nurse-patient ratios and the rates of HAI belong to many researchers’ areas of scientific interest. In their systematic review, Shang, Stone, and Larson (2015) demonstrate that the cases of HAI have a detrimental impact on patients’ general health and treatment outcomes, which justifies the need for special strategies for their prevention. Many peer-reviewed studies published from 1994 to 2013 indicate the presence of an inverse correlation between nurse staffing levels and HAI incidence (Shang et al., 2015). However, despite these results, further practical experiments are needed to address the problem of the heterogeneity of study designs and explore the situation in specific units or hospitals.

The potential solutions to the problem of inadequate staffing levels refer to the introduction of new human resource policies, retention strategies, or mandated nurse-patient ratios. The introduction of mandatory staffing levels depending on the healthcare unit and the risks of sudden complications is an evidence-based intervention that is widely discussed (Chen & Grabowski, 2015).

For instance, the research conducted by Chen and Grabowski (2015) indicates the positive impact of nurse staffing standards on care quality in nursing homes. Based on it, the intervention that will be tested in the proposed research project involves the introduction of obligatory nurse-to-patient ratios in intensive care units. The implementation of the intervention may require the redistribution of human resources and other practices, but its use will help to further analyze the links between staffing levels and the incidence of HAI.

Patient Care, Healthcare Agency, and Nursing Practice

The intervention has the potential to introduce positive changes to patient care and nursing practice. The introduction of mandatory patient-nurse ratios results in an increased amount of time that nurses can spend caring for one patient. More time devoted to patient examinations and necessary manipulations can positively impact patient care and reduce the incidence of medical mistakes that lead to infections. At the same time, the intervention can change nursing practice by eliminating the consequences of overwork and enabling nurses to provide more focused care. As for healthcare agencies, the proposed intervention can be used to improve patient outcomes in large hospitals with ICUs located in the United States.


To sum it up, nurse staffing levels and their impact on the health outcomes of critical patients present a significant clinical problem that captures the interest of many researchers. The planned study will focus on defining the potential links between fixed nurse-patient ratios in ICUs and the prevalence of infections. The results of the project are expected to add to the existing knowledge concerning the practicability of mandated nurse staffing levels.


Chen, M. M., & Grabowski, D. C. (2015). Intended and unintended consequences of minimum staffing standards for nursing homes. Health Economics, 24(7), 822-839.

Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and healthcare-associated infection: Methodologic challenges and potential solutions. American Journal of Infection Control, 43(6), 581-588.

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