Nurse Staffing: Nurse to Patient Ratio

Nurses and midwives are central to Primary Health Care and are often the first and sometimes the only health professional that people see and the quality of their initial assessment, care, and treatment is vital. They are also part of their local community – sharing its culture, strengths, and vulnerabilities – and can shape and deliver effective interventions to meet the needs of patients, families, and communities.

 Maintaining appropriate nurse staffing levels does not just promote better care, in most cases, it’s the law. But pinning down a specific number is hard to do, given the legal vagaries from state to state.

In the United Kingdom (UK) and Australia, the nurse to patient ratio is typically 1:1 in the ICU, while in the United States, the nurse to patient ratio is commonly 1:2 or 1:3 (Clarke et al., 2000; Goldhill, 2002). The lower nurse to patient ratio in the USA is partly compensated for by non-nurse support staff. There is some evidence to show that lower nurse to patient ratios and organizational factors may be associated with a higher incidence of complications. Additionally, physical restraint has been described in the literature as a potential substitute for nursing supervision and care when staffing patterns are inadequate (Amaravadi et al., 2000; Durbin, 2006; Moss and La Puma, 1991).

Nigeria is currently the most populated country in Africa with over 195 million people, yet the nurse-population ratio is low at 2:1000.

Nursing and Midwifery Council (UK) revealed that in the six months of 2021 to September 2021, 1,334 nurses joined the register from Nigeria, and 336 joined from Ghana. Both countries are on the WHO’s Health Workforce Support and Safeguard List. Chief executive of the International Council of Nurses, Howard Catton, said the figures “merit further investigation”.

This year over 10,000 nurses relocated despite WHO placing Nigeria on the red list. It should be noted that the health workforce of Nigeria is an index for determining the quality of care that is available to the population and affects its global health ranking.

The nurse to patient ratio is calculated using various approaches as no single approach would find its place in all settings. Over many years, staffing was determined by the census, i.e. the volume of patients indicated the volume of nurses needed to care for them. This was indeed rigid enough to meet the health needs of the patients during unforeseen emergencies etc.

Victoria state in Australia was the first region in the world to introduce mandated minimum nurse/midwife-to- patient ratios during 2000 in its public sector enterprise agreement of nurse to patient ratio, 1:4 on morning shifts, 1:5 on afternoon shifts and 1:8 on night duty shifts, plus an in-charge nurse on all shifts, who have flexibility to allocate even fewer number of patients to a nurse based on patients’ level of dependency.

California RN to Patient Staffing Ratios

Type of Care	RN to Patients
Intensive/Critical Care	1:2
Neo-natal Intensive Care	1:2
Operating Room	1:1
Post-anesthesia Recovery	1:2
Labor and Delivery	1:2
Antepartum	1:4
Postpartum couplets	1:4
Postpartum women only	1:6
Pediatrics	1:4
Emergency Room	1:4
ICU Patients in the ER	1:2
Trauma Patients in the ER	1:1
Step Down, Initial	1:4
Step Down, 2008	1:3
Telemetry, Initial	1:5
Telemetry, 2008	1:4
Medical/Surgical, Initial	1:6
Medical/Surgical, 2008	1:5
Other Specialty Care, Initial	1:5
Other Specialty Care, 2008	1:4
Psychiatric	1:6

Source: California Nurses Association

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Key facts on Nurse Staffing

• Approximately 27 million men and women make up the global nursing and midwifery workforce. This accounts for nearly 50% of the global health workforce.
• There is a global shortage of health workers, in particular nurses and midwives, who represent more than 50% of the current shortage in health workers.
• The largest needs-based shortages of nurses and midwives are in South East Asia and Africa.
• For all countries to reach Sustainable Development Goal 3 on health and well-being, WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030.
• Nurses play a critical role in health promotion, disease prevention and delivering primary and community care. They provide care in emergency settings and will be key to the achievement of universal health coverage.
• Achieving health for all will depend on there being sufficient numbers of well-trained and educated, regulated and well supported nurses and midwives, who receive pay and recognition commensurate with the services and quality of care that they provide.
• Investing in nurses and midwives is good value for money. The report of the UN High Level Commission on Health Employment and Economic Growth concluded that investments in education and job creation in the health and social sectors result in a triple return of improved health outcomes, global health security, and inclusive economic growth.
• Globally, 70% of the health and social workforce are women compared to 41% in all employment sectors. Nursing and midwifery occupations represent a significant share of the female workforce.

Nurse to hospital bed ratio, 2019 – Country rankings:

 The average for 2019 based on 26 countries was 1.41 nurse to bed ratio. The highest value was in the United Kingdom: 3.09 nurse to bed ratio and the lowest value was in South Korea: 0.42 nurse to bed ratio. The indicator is available from 1980 to 2020. Below is a chart for all countries where data are available.

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Download data

Countries	Nurse to hospital bed ratio, 2019	Global rank	Available data
UK	3.09	1	2009 – 2020
Iceland	3.07	2	2007 – 2020
Norway	2.64	3	2002 – 2019
Canada	2.52	4	1980 – 2019
New Zealand	2.42	5	2010 – 2020
Mexico	2.29	6	2012 – 2019
Switzerland	1.96	7	2003 – 2019
Ireland	1.86	8	1990 – 2019
Netherlands	1.44	9	1999 – 2019
Italy	1.42	10	2003 – 2019
Portugal	1.26	11	1999 – 2019
Spain	1.22	12	2000 – 2019
Slovenia	1.15	13	2000 – 2019
Israel	1.04	14	1995 – 2020
Austria	1	15	2000 – 2019
Estonia	1	16	2006 – 2019
France	0.98	17	1997 – 2019
Turkey	0.91	18	2002 – 2019
Czechia	0.89	19	2004 – 2019
Germany	0.88	20	2000 – 2019
Greece	0.87	21	1999 – 2019
Lithuania	0.82	22	2000 – 2019
Latvia	0.55	23	2012 – 2019
Hungary	0.51	24	2006 – 2019
Chile	0.49	25	2010 – 2020
South Korea	0.42	26	2004 – 2019

Definition: The ratio of the number of professional and associate professional nurses to the number of hospital beds.

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