A Case Study in Turkey-Importance of Right Nurse Staffing Plans & Ratios in Turkish Private Hospitals (Acibadem Healthcare Group)


  • Saliha Koc Acibadem Healthcare Group
  • Aslihan Bardak Acibadem Healthcare Group


Nurse staffing plan, nurse-to-patient ratio, nurse workload, AHG case study.


Shortage of nurses in Turkey has gained momentum in recent years and severely  threatens nursing profession. However, medical errors caused by lack of nurse staffing, patient outcomes, increased infection rate, nurse burnout, nursing injuries negatively affect the nurse, patient and hospital management at the same rate. Today, arrangements on nurse staffing plan are still made according to the prediction of the director nurse. Over the past 10 years, floors reshaped according to nursing needs of patients and the number of nurses included in staffing plan display a more realistic picture.  Other than the number of nurses assigned to floors, the factor of nurse workload planning is also an issue avoided to be expressed in Turkey. The number of patients per nurse is twice the figure recommended and no arrangement has been made on this matter, leading to inefficient use of the nursing workforce. Our staffing plan based on patient care needs (Acuity) which we introduced into Acibadem Healthcare Group in 2005 offers a realistic approach  to hospital managers by considering the number of required and available nursing staff members and seasonal changes. Study method is based on literature support, and our staffing plans we put into use since 2009 when they are described.



• Hayes E. (1991). Matching demands and resources in an intensive care environment. Intensive Care Nursing. 7,4, 206-213.

• Carayon P, Gürses A.P.(2005). A human factors engineering conceptual framework of nursing workload and patient safety in intensive care units. Intensive and Critical Care Nursing, 21, 284-301.

• Beaudoin L.e., Edgar L. (2003). Hassles: Their importance to nurses’ quality of work life. Nursing Economics, 21(3), 106-113.

• Hurst K (2003). Selecting and Applying Methods for Estimating the Size and Mix of Nursing Teams. Nuffield Institute for Health., pp:3-17.

• Rosseter R.(2011). Nursing Shortage. American Association of Colleges of Nursing. Retrieved from http://www.aacn.nche.edu/media-relations/NrsgShortageFS.pdf

• Survey of Leading Healthcare Executives Identifies Top Factors Impacting Nurse Turnover (2005). Retrieved from http:// www.allbusiness.com/health-care/health-care-professionals-nurses-nursing/5155333-1.html

• Hunt T. S. (2009). Nursing turnover: Costs, Causes, and Solutions, Success factors. Retrieved from http://www.uexcel.com/resources/articles/NursingTurnover.pdf

• Minnick A.F, Mion C.L. (2010). Nurse Labor Date: The Collection and Interpretation of Nurse to Patient Ratios.US National Library of Medicine National Institutes of Health. 39(9), pp. 377-381.

• Hendrich A, Chow M, Skierczynski AB, Lu Z. (2008). A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?. The Permanente Journal/ Summer,Volume 12, No.3.

• Rogers P, Overfelt F, Mc Nally C. (2003). Nursing Ratios-Is There a Better Way?. Delta Healthcare Consulting Group, Inc. Retrieved from www.iienet.org/uploadedfiles/SHS/Resource.../28_overfelt.pdf

• The International Council of Nurses, (2001). Nursing Matters Fact Sheet. ICN. Retrieved from http://www.ordemenfermeiros.pt/relacoesinternacionais/gri_documentacao/ICN_FolhasInformativas_vsINGePT/FI_versao_ING/Patient_Safety/p_FS-Medication_Errors.pdf .

• Spetz J, Donaldson N, Aydin C, Brown SD. (2008). How Many Nurses Per Patient? Measurements of Nurse Staffing In Health Services Research. Health Services Research. 43(5p1), pp.1674-1692.

• Unruh LY, Fottler MD, Talbott LL.(2003). Improving Nurse Staffing Measures: Discharge Day Measurement in “Adjusted Patient Days of Care. Inquiry. 40(3):295–304.

• Welton M.J.(2007). Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. The Online Journal of Issues in Nursing. Vol.12, No:3, Manuscript 1.

• Bayindir U, Durak I. H. (2008).Türkiye’de Tıp-Sağlık Bilimleri Alanında Eğitim ve İnsan Gücü Planlaması-Mevcut Durum ve 2013 Yılı Vizyonu. Tıp-Sağlık Bilimleri Eğitim Konseyi Başkanlığı. Retrieved from http://www.tead.med.ege.edu.tr/Dosyalar/5/tpsalk%20bilimleri%20eitim%20konseyi%20SGP%20rapor.pdf

• Tai T.W.C, Bame S.I, Robinson C.D (1998). Review of nursing turnover research, 1977–1996. Social Science and Medicine 47 (12), 1905–1924.

• Gray A.M, Phillips V.L. (1996). Labour Turnover in the British National Health Service: a local labour market analysis.Health Policy. 36 (3), 273–289.

• Shields M.A, Ward M. (2001). Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. Journal of Health Economics, 20 (5), 677–701.

• Cavanagh S.J, Coffin D.A.(1992). Staff turnover among hospital nurses. Journal of Advanced Nursing 17 (11), 1369–1376.

• Cavanagh S.J, Coffin D.A.(1992). Staff turnover among hospital nurses. Journal of Advanced Nursing 17 (11), 1369–1376.

• California Press Release (2010). The Evidence is In- California RN-to-Patient Ratios Save Lives. Retrieved from http://www.nationalnursesunited.org/press/entry/the-evidence-is-in-california-rn-to-patient-ratios-save-lives/

• Aksu, A. 2012. Hemşirelerin Sorunlarını Çözmek Sağlık Sistemimizin Sorunlarını Çözmek Demektir. Hukuk Köşesi Haberler. Retrieved from http://www.sagliksen.org.tr/index.php?p=381&l=1 .

• Aiken L.H.(2008). Economics of nursing. Policy, Politics & Nursing Practice, 9 (2), 73.

• Dall T.M, Chen Y.J, Seifert R.F, Maddox P.J, Hogan P.F. (2009). The economic value of professional nursing. Medical Care, 47 (1), 97.

• Greenberg P.B. (2006). Nurse-to-patient ratios: what do we know? Policy Politics and Nursing Practice, 7 (1), 14.

• Duffield C, Diers D, O’Brien-Pallas L, Aisbett C, Roche M, King M, Aisbett K. (2011). Nurse staffing, nursing workload, the work environment and patient outcomes. Elsevier Applied Nursing Research, Volume 24, Issue 4, Pp 244-255.

• Johnson J, Griffeth R.W, Griffin M. (2000). Factors discrimination functional and dysfunctional sales force turnover, Journal of Business & Industrial Marketing, Vol. 15, No. 6, pp. 399-415.

• Mcgahan M, Kucharskı G, Coyer F. (2012). Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit: A literature review Australian Critical Care. 25, 64-77.

• Agency for Healthcare Research and Quality (2004). Hospital Nurse Staffing and Quality of Care.U.S Department of Health and Human Services. Retrieved from http://www.ahrq.gov/research/nursestaffing/nursestaff.htm

• Westbrook Johanna I, Duffıeld Chrıstıne Lıng, Creswıck Nerıda J. (2011). How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals. BioMed Central Ltd. BioMed Central Ltd. Retrieved from http://www.biomedcentral.com/1472-6963/11/319




How to Cite

Koc, S., & Bardak, A. (2013). A Case Study in Turkey-Importance of Right Nurse Staffing Plans & Ratios in Turkish Private Hospitals (Acibadem Healthcare Group). Asian Journal of Pharmacy, Nursing and Medical Sciences, 1(3). Retrieved from https://ajouronline.com/index.php/AJPNMS/article/view/433