The For Patient Staffing Ratios

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

Duffin (2012) stated, “The California Nursing Association argues that this [mandated nurse-to-patient ratios] reduces mortality levels and allows nurses to spend more time with patients” (p.7). Duffin also quoted the co-president of the California Nursing Association, who said “A study from the University of Pennsylvania which concluded that New Jersey hospitals would have 14 percent fewer deaths if they matched California’s surgical unit ratios” (p.7). Increased nurse-to-patient ratios have been shown to decrease the infection risks in facilities. The Centers for Disease Control and Prevention (2004) stated, “They have identified a link between improved nurse to patient ratios and lower hospital outbreaks of bloodstream infections”(p 1). Mandated staffing ratios have shown to have many positives but they are not without flaws.

Primarily, it is crucial for health care organizations to focus on ensuring safe and quality patient care, as well as improved job satisfaction by enforcing an optimal and adequate nurse-to-patient ratio and creating innovative and long-term strategies through a collaborative effort. In order to ensure the safety of patients and nurses, state-mandated safe-staffing ratios are necessary. Adequate nurse staffing is key to patient care and nurse retention, while inadequate staffing puts patients at risk and drives nurses from their profession. As baby boomers age and the demand for health care services grows, staffing problems will only intensify. Consequently, safe-staffing ratios have become such an ever-pressing concern. In 2004, California became the first state to implement minimum nurse-to-patient staffing ratios, designed to improve patient care and nurse retention. Subsequent studies show that California’s program measurably improved patient care and nurse retention.

Dr. Linda Aiken is the leading researcher in nursing staffing rates within the United States (Kerfoot & Douglas, 2013). She suggests that each state follows California’s example of conducting research to determine a minimum staffing ratio and making it a law (Kerfoot & Douglas, 2013). The California legislation enhanced nurse staffing in hospitals across the state and improved the patient care results of millions of patients (Kerfoot & Douglas, 2013). After the bill went into effect, job satisfaction increased, and the nursing shortage ended (Kerfoot & Douglas, 2013).

The California Department of Health Services (CDHS) developed the staffing ratios. Although some recommendations existed for critical care patients there was little in the way of recommendations for other patients (Tevington, P., 2011). The ratios were determined from input from three California nursing unions, the California Healthcare association, a University of California survey, and the CDHS (California Department of Public Health, 2003). All of the summited ratios were based assumptions of severity and required nursing care. The unions all used nursing panels to determine the recommendations. Almost all the recommendation used the mandated ICU 1:2 ratio as the common denominator for determining the other patient care ratios.

Durning, (2010) tells how nurses are limited in giving quality care due to the number of patients they have on their shift. It also explains the huge difference in the task of caring for a post-partum mother and a patient recovering from a major trauma surgery. When nurses are too busy because they have too many patients to care for, they are more likely to overlook an important change in their patient. This will cause the patient to deteriorate unnecessarily and could potentially result in death (Durning 2010). “Nurses are the main surveillance system in hospitals” (Queensland Nurse, 2010, p.14). If they have too many patients to look after, something is more likely to be missed. There was a study done last year by Nursing Times, that showed the more nurses a hospital had per bed, resulted in fewer patient deaths, and actually lowered the patient’s length of stay (Queensland Nurse, 2010). The state of Victoria in Australia, like California actually has government mandated nurse-to-patient ratios. Since its implementation of the ratios 10 years ago, Victoria’s health system has been made considerably better. There is a safer environment for the patients, the workplace morale is better, and there are less complaints from the public about the quality of care they receive while hospitalized (Holmes, 2010).

Mandatory staffing ratios have been suggested as a way to meet nursing staffs’ concerns of high nurse to patient ratios. Mandatory staffing ratios are used as a way to reduce workload and patient mortality and are aimed at addressing the perceived imbalance between patient needs and nursing resources. (American Nursing Association, 2014). However, issues have been raised on applicability of staffing ratios since it could lead to increased costs without the guarantee of improvement in the quality of health care and could also lead to unintended consequences including unit closures, limited infrastructural development and limited access by patients (American Nursing Association, 2014).

Fourteen US states have laws regarding nurse staffing hospitals. Unfortunately South Carolina doesn’t. California is the only state with mandatory nurse-patient ratios where it requires units to maintain specific nurse-patient ratios. Based off the state of California there can be some pros and cons about mandating specific nurse to patient ratios. The pros are that it does allow nurses to spend more time, and provide better quality care for their patients.

One can wonder if there is any correlation between patient-nurse ratio and it’s effect on patient safety. In the research conducted by Jack Needleman and his associates (2002), they examined the relationship between amount of care provided by the nurse and compared it to patient outcome. The result showed that the increase amount of time a nurse is able to spend with the patient better the quality of care is. The data for this research was collected from seven hundred and ninety-nine hospitals across eleven states. This covered both medical and surgical patients that were discharged and the data was evaluated the relationship between the time provide to the patients by the nurses and patients’ outcome. As research showed,

Mandatory nurse-patient ratios have been a controversial topic facing nurses for decades. Nurses, patients, physicians, nursing organizations, researchers, hospitals, federal government, and state governments have opposing views in regard to mandatory nurse-patient ratios. Those that support the idea of mandatory nurse-patient ratios believe that there would be an improvement in quality of patient care, decreased nursing shortages, increased job satisfaction, decreased client hospitalization, and increased nurse recruitment (Pamela Tevington, 2012). Groups that oppose mandatory nurse-patient ratios believe that mandatory staffing laws ignore factors such as the level of care a patient requires from a nurse, treatments, length of hospitalization, improvements and differences in technology, the expense of an increased nursing staff, and nurse experience and education (Tevington, 2012).

The final bill mandates minimum, specific and numerical nurse-patient ratios in hospitals. For example, a mandated nurse patient ratio of 1:5 was set for medical surgical units and smaller ratios were assigned to specialty units (Tevington 2011). Today, California is the only state with mandated nurse-patient ratios. 14 other states have set laws and regulations addressing nurse staffing in hospitals but they all address the issue differently and have set different requirements (ANA,

This is a sobering statistic: “the odds of a patient dying in hospitals with an average workload of 8 patients per nurse are 1.26 times greater than in hospitals where the mean workloads of 4 patients per nurse” (Aiken, Clarke, Sloane, Lake & Cheney, 2008). A rubber band can only stretch so far before it breaks. It would follow that attempts to improve patient care must address adequate patient-to-nurse ratios and workload.

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Nursing is the powerhouse in the delivery of safe, quality patient-centered care in the healthcare industry. To ensure continued safety of the patient and nursing staff, the issue of inadequate staffing must be addressed. Consequently, patient’s mortality rate has been linked to the level of nursing staff utilized in ensuring an utmost outcome (Aiken, 2011). This paper will outline the issue associated with inadequate nurse to patient staffing ratios in the hospital setting; essential factors such as economic, social, ethical and political and legal affecting the issue will be established; current legislature and stakeholders will be ascertained and policy option, evaluation of bill and the results of analysis will be reviewed.

When was the last time you were in the hospital or a loved one was in the hospital, and ever wondered where the nurse is, and they haven 't returned for hours. You finally push the assistance button several times, and they open the door and hurriedly say, “I will be right back”, then you don 't see them for a while again. When they come back to check up on you, you explain to them what you need, and then they send in a less qualified staff member to assist you. At this point, you become very annoyed and frustrated not to mention scared to be admitted in the hospital to begin with. Little do you know, your nurse has ten other patients and other non-nursing tasks that they are responsible taking care of. They have been working a double shift and are extremely exhausted, and a large stack of charts that they will have to do before their shift is over. As a patient, you now become frustrated and are not happy about this; as a nurse, they are just as frustrated as you are, not only because the amount of work they have but more importantly they can 't deliver the appropriate care they long to give. For most hospitals they do not hire enough registered nurses for reasons that are good and bad. This is an issue that needs to be addressed not only locally but nationally and on a constant basis. When there are too many patients for one registered nurse to attend to, nurses become exhausted, mistakes are made, and patients are unsatisfied. A minimum nurse to patient ratio needs to be