How the Number of Surgical Patients Affects Nursing Care

Examining the impact of patient census variability on nurse-to-patient ratios within surgical units and the amount of care provided at the bedside

From 2006 to 2007, researchers at Boston University's Health Policy Institute (now at the Institute for Healthcare Optimization) investigated hourly changes in the number of patients in four hospital units and the impact of those changes on the ratio of patients per nurse and the amount of bedside care nurses provide.

The overall goal was to determine whether hospitals might improve patient care and reduce stress on nurses by smoothing peaks and valleys in the number of surgical patients they must care for.

Key Findings:

  • The total number of patients per hour in each hospital unit varied by a factor of two or more. For example, one unit averaged 25 patients, but the number of patients ranged from 17 to 35 during the two to three weeks of the study.
  • Patients admitted after scheduled, elective surgery were a significant driver of variability in the total number of patients in all four units. Such patients accounted for an average of 37–62 percent of all patients across the units.
  • The number of patients per nurse in the units varied substantially from hour to hour.
  • Rising numbers of patients per nurse had a negative effect on the number of minutes nurses spent in each patient's room each hour in two of the three units where project staff studied this effect.