Letter to the Editor by Chime Dolkar to the topic “Patient Safety: Who Guards the Patient?”

Patient Safety: Who Guards the Patient?

Response by Chime Dolkar to the OJIN topic, “Patient Safety: Who Guards the Patient?” (September 30, 2003)

Dear Editor:

I am writing in support of establishing mandatory minimum nurse staffing levels to improve patient safety. Griffiths, Ball, Murrells, Jones and Rafferty (2015) reported that ward-based RN staffing is significantly associated with reduced mortality for medical patients. Mortality was higher where RNs cared for more patients.

The provision of adequate quality of care conceptually requires sufficient numbers of nursing staff who can spend more time with each patient (Sakr et al., 2015). Time constraints related to a reduced nurse:patient ratio may increase the likelihood of mistakes by creating a stressful environment with distractions and interruptions that adversely affect quality of care (Sasichay-Akkadechanunt, Scalzi, & Jawad, 2003). Kalisch, Landstrom, and Williams (2009) found that when too few nurses are available to meet the needs of patients, nurses may omit steps, take shortcuts, or deviate from approved standards in order to get the work done.

One of the major issues at the forefront of healthcare delivery is the cost containment. Hence, unless we mandate staffing ratio, it is nearly impossible for the nurses to meet the business demands of providing efficient care that is effective, high quality, and safe. California mandated a staffing ratio of four or fewer pediatric patients per nurse and found that treatment in a hospital meeting this standard significantly reduces the risk of readmission, up to 63% (Tubbs-Cooley et al, 2013). However, the rest of the country still has not mandated the staffing ratio. As nurses are the guardians of patients, it is our responsibility to raise awareness of this issue by contacting the state and national legislative representatives in support of staffing ratio mandates.

Thank you,

Chime Dolkar, RN
RN-BSN Student
SUNY Downstate Medical Center
Brooklyn, New York


Griffiths, P., Ball, J., Murrells, T., Jones, S., & Rafferty, A. M. (2016). Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: A cross-sectional study. BMJ Open 2016; 6:e008751.

Kalisch, B., Landstrom, G., & Williams, R. (2009). Missed nursing care: Errors of omission. Nursing Outlook, 57(1), 3-9.

Sakr, Y, Moreira, C. L., Rhodes, A., Ferguson, N. D., Kleinpell, R., Pickkers, P.,..Vincent J. (2015). The impact of hospital and ICU organizational factors on outcome in critically ill patients: Results from the extended prevalence of infection in intensive care study. Critical Care Medicine, 43(3), 519–526. doi:10.1097/CCM. 0000000000000754

Sasichay-Akkadechanunt T., Scalzi, C. C., Jawad, A. F. (2003). The relationship between nurse staffing and patient outcomes. Journal of Nursing Administration, 33:478-485

Tubbs-Cooley, H.L., Cimiotti, J.P., Silber, J.H., Sloane, D. M., & Aiken, L. H. (2013). An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf 2013;22: 735–742. doi: 10.1136/bmjqs-2012-001610