Featured Members
Glenda M. Burrow
member-pic VIP Member of the Month Hospice Nurse,
40 Years
Elisabeth Milbourne, RN
member-pic Disaster Relief Nurse

Achieving Safe Nurse Staffing Ratios

Keywords: career advice , stress , healthy life , work-life balance , mind , self-help
The Registered Nurse Staffing Act was introduced to the United States Congress in 2013 and it marked a significant tide shift when it comes to nurses voicing their opinions on what needs to be done with possible mandatory nurse staffing ratios. Some of the findings that are posted in this bill are surprising.

For example, Section 2 Article 1 states that research allows that patient safety in hospitals is directly proportionate to the number of registered nurses working in the hospital. Higher staffing levels by experienced registered nurses are related to lower rates of negative patient outcomes. Section 2 Article 2 states that a 2011 study on nurse staffing and inpatient hospital mortality shows that sub-optimal nurse staffing is linked with a greater likelihood of patient death in the hospital. Lastly Section 2 Article 9 describes that when hospitals employ insufficient numbers of nurses to take on multitudes of patient cases, there is a greater probability of developing health hazards and life-threatening situations. 

In the cases of Pennsylvania and New Jersey, an April 2010 study revealed that hundreds of surgical patients could be saved if hospitals in these two states had the minimum nurse staffing ratios that the state of California has required since 2004. Two-thirds of New Jersey hospitals have medical-surgical nurse-to-patient ratios of 1 to 5.5 or less. 

California's mandatory nurse-to-patient ratio since 2004 has been 4:1. 

A study was conducted on 799 hospitals in 11 states and it was discovered that there was a high prevalence of infections, pneumonia, urinary tract infections, failure to rescue and shock or cardiac arrest. (Needleman, Buerhaus, Mattke, Stewart, Zelevinsky – 2002) A study conducted by Marquette professors in 2011 stated that the balanced non-overtime nurse staffing ratios resulted in lower patient readmission into the hospital. This study notes that payers saved $607.51 per patient. 

Going by practicality alone, hospitals should determine nurse staffing based on how sick patients are. Nurses are in the business of taking care of people, and preserving the safety of patients is their top priority. However, there is only so much a single nurse can do when he or she has to deal with an entire unit of patients who are in dire need of help.

Nurses have recently become more vocal in expressing just how they feel regarding the issue of whether or not to establish mandatory nurse staffing ratios. The general consensus of nurses throughout the United States shows that there is a need for improved ratios. 

“Many times especially over this past year and a half we have had multiple nurses with 3:1 ratios for sick kids and 2:1 for critically ill kids. On top of that we have no CRN and no charge nurse because they have patients as well. Who do we call for help when our patient starts crashing? Each other, because that's all we have!” one nurse commented. 

A nurse who has worked in various hospital departments for over 21 years had this to say. “Back in the day when we had sufficient staff and aids, things ran pretty smoothly for the most part, but now it's absolute chaos! Gone are the days when you could be a real nurse and actually have time to do the little extras for your patients, which mean so much to a patient who is sick and probably scared and needs time with his nurse to talk, vent or needs some extra care.”

A nurse with 3 years experience chimed in. “I worked for 2 years at a facility, often times on a unit with up to 60 residents and 3 CNA's. Needless to say, I was overwhelmed and nervous 90% of the time. People tend to forget not only are patients in the hospital sicker and requiring more care but the same goes for long-term care patients. Not only do we need to be on top of what our patients need but we have to keep tabs on what the CNA's are doing or not doing for the patients as well as other responsibilities including stocking supplies, charting, procedures that need to be completed. I worked this way for 2 years before I couldn't take it anymore.” 

Another nurse pointed out the obvious imbalances of patient numbers. “Working in LTC (long-term care) night shifts for most of my nursing career I have never understood why the administration believes that one nurse is sufficient to handle anywhere from 24-30 patients on a unit. Between all of the paperwork, charting, and patient care that need to be done, it is way too much for a nurse to handle.”

There are indeed a few reasons why laws should be enacted and enforced when it comes to mandatory nurse staffing ratios. All of these following reasons pertain to practicality and common sense and in no way should these reasons be viewed as hindering the general foundation of a hospital. 

The first reason for establishing nurse staffing ratio laws would be to protect the patient. When a nurse is initially informed of a patient's condition, he or she will have no clue as to which patient it was on a list of patients the nurse already has. Remembering the core details of 60 or more patients isn't feasible and it isn't safe. Nurses should never be caught in situations where they have to hesitate before they make a decision on which patient to take care of first. Some nurses today unfortunately know only as much as what is written down in reports, and without the proper knowledge of telling all the patients apart, it becomes more likely for the nurse to make an error.

The second reason for establishing nurse staffing ratios would be to protect the nurse. Nurse have gone above and beyond the call of duty when it comes to patient care, and over the years the amounts of work that nurses have put into a single shift have grown significantly. Recent times have indicated that not only are nurses being overworked in the hospital, but they are also being forced to multitask on a regular basis. There is a reasonable way to be multitasking and there is an unreasonable way to be multitasking, and judging by the opinions of the nurses themselves, the latter seems to be the case. 

Administrators tend to forget to take into account the psychological impact high ratios are causing. Fair and balanced ratios narrow the consequences for a nurse. When patients suffer from a lack of care, the reputations of nurses get hurt and it takes a psychological toll on them. There is also a great possibility of a nurse obtaining a condition like PTSD, Post Traumatic Stress Disorder.

The third reason for establishing nurse staffing ratios is to keep the hospitals honest, and more specifically the administrative departments. It has been rumored among nurses that hospitals will do anything to get away with as few nurses and as many patients as possible, and that the use of common sense isn't considered but rather the bottom line. It is unfortunate that in some hospital administrations the bottom line is the only thing that is worried about. As long as certain practices, no matter how underhanded or corrupt they are, make the hospitals money, then that's all that matters. Hospitals establish a matrix for nurses to follow, and depending on the census and the acuity of a patient, only a determined number of nurses are kept. 

The fourth reason for establishing nurse staffing ratios would be to establish better economic responsibility. 13 hospital locations in the state of Ohio recently established police units specifically tied in with their programs, meaning that for any suspicious criminal activities that occur on hospital campuses, these new hospital police forces are allowed to intervene. Robert Coburn has been hired as the Chief of Police for the Adena Hospital in Chillicothe, Ohio, who has an extensive governmental background. While this might look good on the surface, this doesn't do anything to solve the ongoing need of taking care of patients. This could be a classic example of leadership mismanaging its priorities. If money can be raised to establish hospital-specific police forces, then why can't money be raised to support mandatory nurse staffing ratios? There is a saying “Follow the money,” but where exactly is the money leading to?