Celebrating 25 years of uniting nurses


Nurse-Patient Ratios


The issue of nurse-patient ratios is a global challenge and has extensively been debated. There seems to be a direct correlation between the number of nurses and the quality of nursing care that an institution is able to provide. However, the predicament that South Africa’s health system finds itself in on one hand is a dwindling number of nurses which is a trend in most developing countries and on the other extreme the disease burden that is on a steady increase. 

According to Adams & Kennedy (2006), as workloads become more substantial and the number of nurses per patient diminishes, patients and healthcare workers across the globe are put increasingly at risk. The question thus is what are we to do, as South Africa, to ensure that the shortage of nurses does not compromise the quality of service and care nurses provide. Do we legislate the ratio of nurses to patients or do we leave it to the industry to self-regulate in this regard? If we decide to go the legislation route, what will be the proposed nurse to patient ratio? Will this ratio be rigidly applied throughout the country in both the private and public sectors? 

Definition of key terms

The nurse-patient ratio is generally described as the ratio that more directly impacts upon nurses as well as patients as it describes the number of patients each nurse has to care for at any specific point in time. This can be measured for an entire medical facility, but it is more accurate to measure it separately for each ward in a hospital, as different types of wards require different types of care (Joubert, 2008).

DENOSA notes that:
– Whilst in other countries and mostly in the private sector staffing ratios are clearly defined and reasonable, in South Africa the public healthcare sector has enormously disproportionate nurse-patient ratios.

– The absence of clearly defined and prescribed staffing norms compromise the quality of service provision particularly in the public healthcare sector where the demand for service exceeds the supply of nurses at an institutional level.

– Whilst nurse shortages are a cause for hugely disproportionate nurse-patient ratios, there needs to be a reasonable and standardized ratio generated from available nurse population.

DENOSA believes that:

– Clearly-defined and regulated staffing ratios may greatly improve health service provision and may also contribute to positive national health outcomes.

In extreme instances, inconsistent staffing norms place stress and anxiety on nurses leading to burn-out and may worsen preventable conditions on patients.

– The nurse/patient ratio is also an important factor that determines workload, job satisfaction for nurses and inconsistent ratios may lead to nurses leaving the profession due to job dissatisfaction and burnout.

DENOSA position on Nurse-Patient ratios:

  • Regulated staffing norms that are consistent with the demand for healthcare services should be prescribed by relevant stakeholders in the healthcare sector including nurses themselves.
  • Nurse-patient ratios in South Africa should be contextually regulated taking into consideration the disease burden and the number of nurses available in the country.
  • Government should increase investment in training more nurses and incentivize them so


It is clear that adequate staffing levels may not come into effect unless enforced through regulatory framework. Whilst nurse shortages pose a challenge to reasonable staffing norms, it is essential that issues of staffing norms are considered and regulated so as to curb situations in which nurses find themselves overburdened with work which in turn will affect the quality of service they provide. Regulated staffing norms would improve the quality of healthcare service whilst restoring the image of the nursing profession.


Adams, E. & Kennedy, A. 2006. Positive Practice Environments: Key Considerations for the Development of a Framework to support the Integration of International Nurses. International Centre on Nurse Migration. Geneva. Switzerland. Joubert, P. 2009. Nurse shortage in South Africa: Nurse-Patient ratios.

Compiled: March 2012