Mandated nurse-patient ratios: Where do you stand?

By | 2022-05-05T12:30:33-04:00 September 18th, 2014|0 Comments

The issue of adequate nurse staffing remains a challenging one for the profession. We know that adequate nurse staffing means better and safer care for patients. We also know that nurses with appropriate levels of staffing are more likely to stay in the profession.

But how, exactly, we arrive at that outcome of appropriate nurse staffing remains a hotly contested topic among the profession, as nurse leaders work to create legislation that will protect both nurses and their patients.

In 2004, California became the first state to adopt mandated nurse-patient staffing ratio legislation. An unprecedented practice, many  wondered what the outcome would be.

Now research is beginning to emerge to tell us the story of how things appear to be playing out in California after those legislative changes. In this study, California hospitals that complied with mandated regulations had improved outcomes as compared to hospitals in New Jersey and Pennsylvania. Nurses, on average, took care of one less patient and med/surg nurses took care of two fewer patients. Mortality rates were lower and nurses reported consistently better quality of care.

The debate continues … in favor

Proponents of mandated nurse staffing say that the practice will ensure safer care for patients and will reduce the burden that most nurses now face, caring for an unreasonable number of patients. National Nurses United is organizing a safe patient campaign. Its members support two bills currently being introduced to the legislation:

  1. The National Nursing Shortage Reform and Patient Advocacy Act | S. 739 (Boxer): This bill establishes requirements for acute-care facilities to provide registered nurse staff based on the acuity of patients provided that minimum nurse-to-patient ratios for each unit are met at all times. Registered nurses shall also have the obligation to act in the exclusive interest of their patients, and the right to be patient advocates.
  2. Safe Nurse Staffing for Patient Safety and Quality Care Act – HR 1907 (Schakowsky): Nurses are increasingly put into impossible situations by hospital managers who demand they care for more patients than is safe. There is a proven method to save patient lives and save hospital money — mandated minimum nurse-to-patient staffing ratios. In Congress, Rep. Jan Schakowsky (D-Ill.) re-introduced her Safe Nurse Staffing for Patient Safety and Quality Care Act to improve patient quality of care by establishing a requirement for nurse-to-patient ratios that put patient safety first.

The debate continues … opposed

Those who do not support the notion of mandated nurse-patient staff ratios argue that nurse-patient staffing needs are far too complex and variable, given varying degrees of patient population and acuity. They express concern that mandated nurse staffing fails to address those individual and dynamic needs that can change from moment to moment.

Says the American Organization of Nurse Executives:

“… it is the position of AONE that mandatory nurse staffing ratios will only serve to increase stress on a health care system that is overburdened by an escalating national and international shortage of registered professional nurses and has the potential to create a greater risk to public safety. Research has shown that professional nurse staffing is a critical component of quality patient care, decreased patient mortality and morbidity. Mandatory nurse staffing ratios based solely on an arbitrary equation of nurses to patients are viewed as ineffective, inefficient and potentially harmful to patients.”

One article cites that as hospitals increase nursing staff without seeing changes in patient reimbursement, they will be likely to cut other non-nursing staff to offset the financial burden, leaving nurses responsible for tasks done by unlicensed personnel. Those who worry that mandatory nurse-patient ratios are an overly simplistic fix think that other approaches to more systemic healthcare problems should be part of the conversation.

One proposed solution is to “link cost and billing with reimbursement by separating nursing care from daily room and board charges and billing for nursing care based on the actual hours of care delivered to patients.”

What do you think?

Should mandated nurse-patient staff ratios be adopted from state to state? Why or why not?


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