I recently read an article by Beverly Waller Dabney and Beatrice J. Kalisch titled "Nurse Staffing Levels and Patient-Reported Missed Nursing Care" in the Journal of Nursing Care Quality. Although the effects of inadequate nurse-to-patient ratios have been studied before, the authors took this research a step further by focusing specifically on patients' perceptions of nursing care received. According to their results, patient-to-nurse ratios are directly related not only to patient safety, but to the patient's perception of good care. The authors concluded that having a higher proportion of RNs leads to timelier nursing care and focusing on improving team work between nursing staff can improve patient perceptions of nursing care. This has important implications, not just in the hospital setting, but also in other healthcare settings across the country. Home healthcare is one of the fastest growing sectors in the healthcare industry, and more research needs to be conducted specifically related to nurse-to-patient ratios and patient perceptions of healthcare in this setting. Studies have been conducted related to nursing staff satisfaction and turnover rates in home healthcare, but no connection has been made between nursing staff levels and patient satisfaction.

Home healthcare agencies do not typically look at patient acuity or time driving between patients when determining productivity, and nurse-to-patient ratios have not been adequately studied. Patients' perceptions of nursing care are extremely important because healthcare reimbursement is based largely on patient satisfaction scores. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey includes questions related to timeliness, communication, and customer service, so it is important to recognize that nurse-to-patient ratios have a direct impact on how patients perceive their care and how they answer these questions. Additionally, clinicians in the home healthcare setting often spend time working independently of other clinicians. In agencies where registered nurses, licensed practical nurses, and nurse assistants are all involved in patient care, miscommunication can lead to poorer patient outcomes. Home healthcare agencies should focus on improving communication among its nursing staff. By doing this and by examining nurse-to-patient ratios in home healthcare, we can keep our patients safe and improve our patients' perceptions of effective and timely nursing care.

More research related to home healthcare staffing and current patient perceptions of home healthcare nursing care is imperative. Patient satisfaction scores may begin to trend down as healthcare consumers become increasingly knowledgeable about their care. Due to technology, patients have more information at their fingertips than ever before, and they are much more inclined to play an active role in their healthcare. The results of the Home Health Care CAHPS Survey can directly impact which home healthcare agency a patient chooses; therefore, it is important for home healthcare agencies to evaluate how patients' perceptions can be improved. Multiple survey questions address customer service. Staff must be able to spend adequate time with each patient while not appearing rushed. Additionally, patients must feel that the individual members of the nursing care team communicate important patient information to one another and all are knowledgeable about the patient's care. There is, however, very little research available on how staffing levels and communication among nurses can affect these scores.

Being aware of patient perceptions of nursing care has important implications throughout the healthcare industry. Nurse-to-patient ratios and communication among nursing staff are two areas that need to be further researched specifically in the home healthcare setting. Improving patient perceptions of the nursing care they receive can lead to improved patient satisfaction scores as well as fewer rehospitalizations, which would directly impact revenue. More importantly, though, it would improve the quality of care our patients receive and thus improve their overall quality of life.

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