Nursing Staffing and Quality of Care
An outcome of quality patient care and decrease in mortality rate is one of the reasons I decided to join the health field and become the best nurse I could possibly be. Surveys have shown that the main reasons why people join the health field is to be able to take care of people and for financial reasons. You want to take care of as many people as possible and give each patient one hundred percent of your best efforts and time, but what if, your staffing ratio to patients doesn’t allow that? This has been a topic of discussion for years and even when they “fix” the problem, there will be someone that thinks the ratio is unsatisfactory.
Lets start with a nurse’s job description. A nurse has to play many roles while in the healthcare setting. A nurse has direct other healthcare personnel, record information pertaining to the patients and the staff, make care plans along with other disciplinary, monitor patients symptoms and changes, administer medications, answer any questions related to nursing, order and interpret labs, act in the cases of emergency and be the patients advocate. These few descriptions don’t begin to show all that a nurse does but they play many roles and have to do this with several patients at a time.
I believe that nursing to patient ratios should be based on the units that the nurse is working in. Some units require the nurse to spend more time with the patients as well as the stability of the patients can also vary from stable to critical. Even though it is known that a patient’s status can change at any given moment, within the unit the chances decrease of any changes. “Consistent evidence from observational studies suggest that an increase in registered nurse to patient ratios was associated with reduction in hospital related mortality, failure to rescue and other nurse sensitive outcomes” (Keck,R.2010).
The department of professional employees conducted a study that compared California to New Jersey and Pennsylvania because California has a minimum nursing requirement law which is based on the units a Registered Nurse is within, for intensive Care its 1:2, Operating room 1:1,Post anesthesia care unit 1:2, Labor and delivery 1:2,Emergency room 1:4,Trauma patients within the emergency room 1:1, Telemetry 1:4,Psychiatric 1:6,Medical Surgical 1:5 and other specialties 1:4. These were just a few of the main units within a hospital.
Based on the study it showed a significant difference, New Jersey and Pennsylvania doesn’t have minimum or maximum requirement for nurses to patient ratio so the management is able to regulate it to their own needs and not think about the patients or the nurses that may be mentally or physically drained. The study showed “that seventy-three percent of the nurses in California found their workload to be manageable compared to the sixty-one percent in Pennsylvania and the fifty-nine percent in New Jersey” (Frederick,R.,Tullen,J.T 2011)”. The study also showed results of the burnout rates of the nurses being significantly less than those in California, which can automatically lead to the assumption of more malpractice and injuries occurring.
Another study done by the AHRQ- Agency for Healthcare Research and Quality, which is a government agency, ran by the department of health showed significant results within five different studies. In hospitals with higher registered nursing staffs the patients had a lower rate of unfavorable outcomes, “such as longer hospital stay, pneumonia, urinary tract infection’s and gastrointestinal bleeding, than those with lower staffing. Also patients with major surgeries had lower adverse outcomes  such as urinary tract infections and failure to survive. The other study found that each additional surgical patient per nurse was associated with a seven percent higher likelihood of dying within thirty days of admission and a seven percent higher likelihood of failure to rescue. Another study resulted in a thirty day mortality rates among AIDS patients being lower where there was both a higher nurse-patient ratio and an AIDS specialty physician service. (Albertin, K.Cen, L.Till,P. 2014)”
Within all the healthcare providers wanting to have a mandated nurse to patient ratio there is an opposition, in that some healthcare workers don’t want that bill passed. They believe that its not a one size fits all scenario. They feel as though every hospital and healthcare setting is dynamic and all have different needs. To have a mandated bill pass, “people may lose their jobs in order for them to fit the standards of the law, also units may have to be shut down if they are unable to meet those specifics (Keck,R. 2010)” which would cause a lot of re-routing and turning down certain patients.
Mandating to some healthcare personnel seems inefficient because “every patients needs are individually different and must be evaluated to see what their needs are” (Keck,R.2010), staffing amongst hospitals are different in terms of the level of skills and the actual individuals. So mandating a ratio makes it unreasonably difficult and unfair to certain hospitals. Not all nursing staff will be equivalent in terms of education, skills, background and how long they have been a nurse. There are too many variations to have a one-size fit all law for healthcare.
Since California’s mandated ratio law they have had positive outcomes but also a lot of set backs, they have experienced downsizing due to the fact that they were now “over staffed” in some settings by the new law. Also transfers are more difficult now because every facility has to make sure they are within the law before accepting anyone new, Emergency room bypass was another thing that was greatly impacted because of the law some emergency rooms that are fully capable have to turn people down in order to stay within the proper parameters. One of the greatest impacts that the state had to endure when the mandated law was passed was that twelve hospitals had to go into closure. Showing that the nursing staff cannot be broken down numerically but needs another strategy in making the ratio ideal for nurses as well as patients.
Some hospitals have been doing a quarterly report on the nursing staff to each unit and also factor in the patient outcomes. This has shown to be a good process and keeps the statistic within the hospital up to par. With this strategy it’s keened to the individual hospital and the units within it, making the outcomes favorable. It provides a comprehensible picture of what the ratio is like in the hospital and gives that information to the public allowing them to know the status of their hospital.
Amongst all the studies of having a mandated ratio the results always yielded a positive outcome for patients. From the small study groups to a bigger group it showed significance in the results of how the patient was affected. Many states have been trying to have a bill pass to improve the chances of improving quality of care but many also oppose it. This isn’t going to be something that can be solved overnight but something that needs continuous research. I believe their should be a mandated ratio within each setting because it decreases the chances of nurses being overworked and patients not receiving the quality of care that they need. But I also believe its not a one size fit all scenario. This needs adequate research and a lot of test and trials will have to be done for them to have optimal results.
Citations
– Keck,R. (2010) What’s in the Proposed Law?Nursingworld.org. N.p.,
-Nurse–Patient Staffing Ratios : AJN The American Journal of Nursing. (2008). http://journals.lww.com/ajnonline/Abstract/2013/08000/Nurse_Patient_Staffing_Ratios.17.aspx
-Frederick,R.,Tullen,J.T(2011)”Safe-Staffing Ratios: Benefiting Nurses And Patients” Journal of Nursing Scholarship, . N.p.
-Albertin, K.Cen, L.Till,P. (2014) Hospital Nurse Staffing and Quality of Care | AHRQArchive,https://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.html
