Table 4.

International Nurse Staffing Norms

Staffing Norms Agency	Summary of Nurse-Patient Ratio Recommendations
BACCN, RCN, CC3N & In-flight forum, (2009), UK[28]	All agencies worked together to develop contemporary standards for critical care nurses in the UK. In Wales, Scotland and Northern Ireland may have different health policies specific to these areas, however, the principles are transferable to all critical care units.
Adult Intensive Care- 1:1 (Ventilated)
RCN (2003), UK[29]	Children General ward and departments- <2 years- 1:3, other ages- 1:4 (day), 1:5 (Night).
DH guidance (2003), British Association of Perinatal Medicine (2001), UK[29]	Minimum RN: Infant ratio- Special care - 1:4, High dependency- 1:2, Intensive care- 1:1.
Paediatric Intensive Care Society, UK[30]	Level 1-0.5:1, Level 2-1.5:1, Level 3-1.5:1, Level 4-2:1.
The European Federation of Critical Care Nursing Associations, (2007), UK[31]	Level 3 (intensive care) patients- 1:1 to deliver direct care Level 2 (high dependency) patients - 1:2 to deliver direct care.
NNU RNs Sponsor National Ratio Legislation, USA[32]	ICU/NICU- 1:2, OT - 1:1 (Plus at least one additional scrub assistant), Post anaesthesia- 1:2; Labur and delivery- 1:2; Antepartum/Postpartum couplets/Combined labur & Delivery & postpartum- 1:3; Intermediate Care Nursery- 1:4, Well baby nursery- 1:6, Paediatrics- 1:3; Emergency Room-1:3; Trauma patient in ER-1:1; ICU patient in ER- 1:2; Medical/Surgical wards- 1:4; Coronary Care/Acute Respiratory Care/Burn- 1:2; Psychiatric/Other speciality care units-1:4; Rehabilitation- 1:5; Skilled Nursing facility- 1:5.
California, (2008), USA[32]	Intensive/Critical Care- 1:2; Pediatrics- 1:4; Neonatal Intensive Care- 1:2; Emergency- 1:4; Operating Room- 1:1; PAR- 1:2; Trauma Patients in ER- 1:1; Ante partum- 1:4; Labour & delivery- 1:2; Postpartum- mother & baby- 1:4; Postpartum- women only- 1:6; Medical Surgical wards- 1:5; Other speciality care- 1:4; Psychiatric- 1:6.
Victorian Staffing Ratio, (2001), Australia[9]	General medical/surgical wards- 1:4-6 plus in-charge nurse (M & E), 1:8-10 (N); Ante/postnatal-1:4 plus in-charge nurse (M & E) and 1:6 (N); NICU- 1:2 plus one in-charge nurse on all shifts; Acute wards- 1:6 plus one in-charge nurse (M); 1:7 plus one in-charge nurse (E); 1:10 (N); Aged Care Wards- 1:7 plus one in-charge nurse (M); 1:8 plus one in-charge nurse (E); 1:15 (N); CCU- 1:2 plus one in-charge nurse (in all shifts); Palliative Care- 1:4 plus in-charge nurse (M); 1:5 plus in-charge nurse (E); 1:8 (N); PACU Recovery Room- 1:1 (unconsciousness patients).
Canada MIS Database, CIHI, (2014-2015)[33]	General Medical-1:4; Surgical-1:3; Combined Med-Surg-1:3; Paediatrics -1:2; Adult ICU- 1:1; Palliative nursing unit- 1:3; Obstetric nursing unit-1:2; Mental health and addiction services nursing unit- 1:4.

BACCN: British Association of Critical Care Nurses, CC3N: Critical Care Networks Nurse Leads, RCN: Royal College of Nursing, DH: Department of Health, UK: United Kingdom, USA: United States of America, RN: Registered Nurse, PAR: Post Anaesthesia Recovery, ER Emergency Room, NICU- Neonatal Intensive Care Unit, M: Morning, E: Evening, N: Night, CCU: Coronary Care Unit, PACU: Post Anaesthesia Care Unit, CIHI: Canadian Institute for Health Information, MIS: Management Information System, NNU: National Nurses United, RNs: Registered Nurses, ER: Emergency Room.