Nurse to Resident Ratio Guide

September 2, 2022 Kimberly Anderson-Mutch

The nursing staff at a long-term care facility has a lot to do. Nurses provide medical care to residents when needed, distributing medications and caring for any wounds. They also offer support to residents' family members, keeping them updated and sometimes even forming special bonds. To provide optimal care to residents, a nurse shouldn't have too many people under their supervision. 

While most nurses are trained in multitasking, there are certain limits facilities might set to ensure all residents receive an equal standard of care. These ratios determine how many nurses should be on staff at different times of the day based on the total number of residents. 

To help ensure a high quality of care, many states have staffing ratios for long-term care and assisted living facilities. Having enough staff working during each shift means that residents get the best care possible. Take a closer look at the standard nurse-resident ratio and learn more about what you can do to improve the nurse-to-resident ratio at your facility. 

A Nurse talking to a resident

Are There Nurse Ratio Laws?

Most, but not all, states in the U.S. have minimum staffing requirements for long-term care facilities. The exact laws vary from state to state. In addition to state laws, there are also federal regulations concerning nurse to resident ratios.

The federal regulations require a facility to have sufficient nursing staff to provide care that ensures resident safety and maintains residents' well-being. From a numbers perspective, that means that a facility needs to have enough registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) working on a 24-hour basis. There needs to be an RN working for at least eight consecutive hours each day. An RN also needs to act as the director of nursing full-time. 

A facility is responsible for ensuring that nursing staff has the skillsets and competencies required to care for residents.

State nurse to resident ratios are a bit more in-depth and detailed than the federal regulations. For instance, a facility needs to have one nursing staff member for every 20 residents in Pennsylvania. At least two nurses need to be working at any time, and the state requires 2.7 hours of direct resident care daily.

Examples of nurse to resident ratio laws from other states include:

•          Kansas: One member of the nursing staff for every 30 residents.

•          Maine: One nursing staff member to every five residents during the day, one nurse to every 10 residents during the evening, and one nurse to every 15 residents overnight.

•          Florida: One CNA for every 20 residents, one LPN for every 40 residents.

What Is an Ideal Nurse to Resident Ratio in a Long-Term Care Facility?

Some argue that the nurse to resident ratios mandated by some states is insufficient and that in states without any specific ratios, the problem is even worse. When a nurse has too many residents to care for, the quality of care declines. When there aren't enough nurses working during a shift, residents are more likely to experience falls, develop infections or bedsores, and experience malnutrition. 

A nurse with too many residents to care for and not enough support from other team members is more likely to struggle to provide residents with the medications they need and the attention they deserve.

The standard nurse to resident ratio can vary based on the needs of the individuals who reside in a facility. At facilities with very ill residents, such as cases of severe dementia or medical problems, an ideal ratio might be one nurse to one resident. At facilities where residents' needs aren't as severe, an ideal ratio could be one to five.

Why Should Your Facility Care About Nurse to Resident Ratios?

Resident safety is the primary reason why a facility should concern itself with adequate staffing. When nurses are stretched too thin and have to provide care to more residents than is feasible, the quality of the care and the amount of attention they can give each person drops. A resident might not get their medication at the appropriate time or miss a dose if the nursing staff has to focus on other residents or issues. 

Safety concerns can stem from other issues, as well. If only one nurse is working on a particular floor, and that nurse is needed on one side of the floor, a resident on the other side might try to get up from their bed or chair, increasing their risk of falling. Even if there is an alarm that sounds, a nurse might not reach the resident in time to prevent the fall.

A facility's reputation depends in large part on the nurse to resident ratio and overall resident safety. If there are rumors that the nursing staff is overworked, people are likely to consider having their loved one go elsewhere. Not following federal and state regulations can mean that your facility doesn't get reimbursed by Medicare or state programs. 

Additionally, having a more balanced nurse to resident ratio improves the work environment for your nursing staff. Nurses are likely to feel less stressed and overwhelmed by the workload when they have fewer residents to care for. That can lead to lower rates of turnover and improved employee morale. Furthermore, they can focus on providing the best care to their residents rather than having to do the bare minimum just to get to everyone on their rotation.

How To Improve Your Facility's Ratios

You can improve your facility's nurse to resident ratios, either to bring them in line with state and federal regulations or to surpass those regulations in a few ways. Using a nurse scheduling tool allows you to create a work schedule that meets your facility's needs. If a nurse has to call out last minute, you can use the tool to find a replacement quickly so that a shift doesn't end up understaffed. 

Talking to your nursing staff can also help you improve ratios. If understaffing or retention is a common issue, find out what you can do to keep your team members from leaving or missing shifts. Often, workload issues are cyclical. Inadequate staffing increases turnover, and high turnover rates make it more difficult to have adequate staffing levels. If you fix one problem, you are likely to improve the other. 

Try a Demo of SmartLinx Today

SmartLinx software can help to streamline scheduling, allowing your long-term care facility to meet or exceed staffing ratios. The platform also has features built-in that help you comply with regulations, such as Payroll-Based Journal reports. To learn more, schedule a demo today to see how it works for yourself.

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