Nurse-to-Patient Ratios in Tele–Critical Care

Q: What nurse staffing is optimal in tele–critical care centers?

A: Lory J. Maddox, PhD, RN, replies:

Nursing is integral to high-quality care, and staffing assignments must reflect our ongoing commitment to patient safety, quality, and program outcomes. The literature shows that inappropriate staffing is associated with higher mortality, more nosocomial infections, and higher nurse intention to leave the profession.^1,2  These studies, however, have been conducted in traditional hospital-based settings, not in tele–critical care (TCC) centers.

The lack of evidence for appropriate staffing and workload distribution in TCC makes a simple answer to this complex question a challenge. In the absence of research findings, expert opinion provides one of the lowest levels of evidence and is foundational to clinical practice. In a report published by the Cleveland Clinic, investigators describe 1 intensivist and 2 or 3 registered nurses (RNs) supporting 50 to 100 critical care beds.^3...