Journal of Intensive and Critical Care Nursing

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +1 (629)348-3199

Short Communication - Journal of Intensive and Critical Care Nursing (2023) Volume 6, Issue 6

The impact of nurse-to-patient ratios on quality of care in intensive care units

Hyunjung Bae*

Department of Anesthesiology & Pain Medicine, Chonnam National University Hospital, Gwangju, Korea

*Corresponding Author:
Hyunjung Bae
Department of Anesthesiology & Pain Medicine, Chonnam National University Hospital, Gwangju, Korea

Received: 29-Nov-2023, Manuscript No. AAICCN-24-127302; Editor assigned: 01-Dec-2023, PreQC No. AAICCN-24-127302 (PQ); Reviewed:15-Dec-2023, QC No. AAICCN-24-127302; Revised:18-Dec-2023, Manuscript No. AAICCN-24-127302 (R); Published: 26-Dec-2023, DOI:10.35841/aaiccn-6.6.177

Citation: Bae H. The impact of nurse-to-patient ratios on quality of care in intensive care units. J Intensive Crit Care Nurs. 2023; 6(6):177

Visit for more related articles at Journal of Intensive and Critical Care Nursing


Intensive Care Units (ICUs) are high-stakes environments where critically ill patients receive complex medical interventions and close monitoring. The quality of care provided in ICUs is influenced by various factors, including the nurse-to-patient ratio, which plays a pivotal role in patient outcomes, safety, and satisfaction. In this article, we explore the impact of nurse-to-patient ratios on the quality of care in ICUs, examining the evidence, challenges, and implications for healthcare practice[1].

Understanding nurse-to-patient ratios

Nurse-to-patient ratio refers to the number of patients assigned to each nurse during a specific shift or time period. In ICUs, where patients require intensive monitoring and interventions, the nurse-to-patient ratio is a critical determinant of the level of care provided. A lower nurse-to-patient ratio allows nurses to devote more time and attention to each patient, facilitating closer monitoring, timely interventions, and better coordination of care [2,3].

The importance of adequate staffing

Adequate nurse staffing is essential for ensuring patient safety, preventing adverse events, and optimizing outcomes in ICUs. Research has consistently demonstrated a correlation between lower nurse-to-patient ratios and improved patient outcomes, including reduced mortality rates, lower rates of healthcare-associated infections, and shorter lengths of stay in the ICU [4].

Impact on patient safety

One of the primary concerns associated with inadequate nurse-to-patient ratios in ICUs is compromised patient safety. Nurses are responsible for performing numerous tasks, including medication administration, monitoring vital signs, responding to emergencies, and providing emotional support to patients and their families. When nurses are assigned too many patients, they may experience increased workloads, leading to fatigue, stress, and the potential for errors. Studies have shown that higher nurse-to-patient ratios are associated with an increased risk of adverse events, such as medication errors, patient falls, and pressure ulcers [5].

Quality of care and clinical outcomes

The quality of care provided in ICUs is closely linked to nurse staffing levels. Research indicates that higher nurse-to-patient ratios are associated with improved clinical outcomes, including lower mortality rates and reduced rates of complications. Nurses play a critical role in recognizing subtle changes in patients' conditions, initiating appropriate interventions, and advocating for their needs. Inadequate staffing levels can compromise nurses' ability to deliver timely and comprehensive care, leading to delays in treatment, suboptimal outcomes, and increased healthcare costs [6,7].

Nurse satisfaction and burnout

In addition to its impact on patient care, nurse staffing also influences nurses' job satisfaction, morale, and well-being. High nurse-to-patient ratios are associated with increased levels of job stress, burnout, and turnover among ICU nurses. Nurses who are consistently understaffed may experience feelings of frustration, disillusionment, and moral distress, negatively impacting their ability to provide compassionate and effective care. Addressing nurse staffing concerns is essential for promoting a positive work environment, retaining experienced staff, and ensuring continuity of care for patients [8].

Challenges and barriers

Despite the evidence supporting the importance of adequate nurse staffing in ICUs, several challenges and barriers exist in achieving optimal nurse-to-patient ratios. Healthcare organizations face financial constraints, workforce shortages, and competing priorities when allocating resources for staffing. Additionally, fluctuations in patient acuity, unpredictable patient volumes, and sudden surges in demand can strain ICU resources and exacerbate staffing challenges. Balancing the need for cost-effective care with the imperative to maintain safe staffing levels remains a persistent challenge for healthcare leaders and policymakers [9].

Implications for healthcare practice

Ensuring adequate nurse staffing in ICUs requires a multifaceted approach that addresses both organizational and systemic factors. Healthcare leaders must prioritize nurse staffing as a strategic investment in patient safety and quality of care. This includes implementing evidence-based staffing models, leveraging technology to optimize workflow efficiencies, and fostering a culture of safety and teamwork within ICUs. Additionally, advocacy efforts at the local, regional, and national levels are essential for raising awareness of the importance of nurse staffing and advocating for policy changes that support safe staffing standards [10].


Intensive care nurses play a vital role in the management of patients with Acute Respiratory Distress Syndrome (ARDS). Their multifaceted responsibilities encompass assessment, monitoring, ventilator management, oxygen therapy, positioning, medication administration, collaborative care, and patient education. Through their expertise, compassion, and commitment to excellence, intensive care nurses contribute significantly to improving outcomes and enhancing the quality of life for patients with ARDS. As key members of the healthcare team, their invaluable contributions underscore the importance of nursing in critical care settings.


  1. Luo Y, Grinspan LT, Fu Y, et al. Hospital-onset Clostridioides difficile infections during the COVID-19 pandemic. Infect Control Hosp Epidemiol. 2021;42(9):1165-6.
  2.         Indexed at, Google Scholar

  3. Evans ME, Kralovic SM, Simbartl LA, et al . Eight years of decreased methicillin-resistant Staphylococcus aureus health care-associated infections associated with a Veterans Affairs prevention initiative. Am J Infect Control. 2017; 45(1):13-6.
  4.         Google Scholar

  5. Cassone M, Mody L. Colonization with multidrug-resistant organisms in nursing homes: scope, importance, and management. Curr Geriatr Rep. 2015; 4:87-95.
  6.               Indexed at, Google Scholar

  7. Denis O, Jans B, Deplano A, et al. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) among residents of nursing homes in BelgiumJ Antimicrob Chemother. 2009; 64(6):1299-306.
  8. Indexed at, Google Scholar

  9. Jans B, Schoevaerdts D, Huang TD, et al. Epidemiology of multidrug-resistant microorganisms among nursing home residents in Belgium. PloS one. 2013; 8(5):e64908.
  10. Indexed at, Google Scholar

  11. Danaei G, Farzadfar F, Kelishadi R, et al. Iran in transition. Lancet. 2019; 393(10184): 1984-2005.
  12. Indexed at, Google Scholar, Cross Ref

  13. Ghods A. The history of organ donation and transplantation in Iran. Exp Clin Transplant. 2014; 12: 38-41. Suppl.
  14. Indexed at, Google Scholar, Cross Ref

  15. Waterman AD, McSorley A-MM, Peipert JD, et al. Explore Transplant at Home: a randomized control trial of an educational intervention to increase transplant knowledge for Black and White socioeconomically disadvantaged dialysis patients. BMC Nephrol. 2015; 16: 
  16. Indexed at, Google Scholar, Cross Ref

  17. Kumar K, King EA, Muzaale AD, et al. A smartphone app for increasing live organ donation. Am J Transplant. 2016; 16(12): 3548-3553.
  18. Indexed at, Google Scholar, Cross Ref

  19. Allen MB, Reese PP. The ethics of promoting living kidney donation using nonargumentative influence: applications, concerns, and future directions. Am J Transplant. 2016; 16(12): 3378-3384.
  20. Indexed at, Google Scholar, Cross Ref

Get the App