The Legislative Process, Analyze Nurse-To-Patient Ratio

The economic impact on healthcare has taken its toll on the number of registered nurses providing bedside care to patients, compromising patient safety and dramatically increasing the potential for negative outcomes. Several factors have immensely contributed to the nursing shortages over the years, including healthcare organizations downsizing, increased workloads, inadequate staffing plans and job dissatisfaction. Mandated nurse-to-patient staffing ratios have been implemented in several states to date with many more trying to pass some type of legislation. Have these ratios affected the quality of care or is it more realistic to create staffing committees that are based on each unit’s unique situation and varying requirements?

California passed Assembly Bill 394, making them the first state to pass a law that required hospitals to limit the amount of patients included in a nurse’s workload. The California Assembly Bill 394 (AB394) was put into effect on January 1, 2004. In 2012 a study was conducted to determine if mandated nurse-to-patient ratios actually had a positive impact on patient outcomes. This study examined medical/surgical units in California hospitals. The data used to compare outcomes before and after passing AB394 was from the year 2000-2002 for the “before” data. The “after” data was from the years 2005-2006 (Cook, Gaynor, Stephens, & Taylor, 2012).

Nurse-to-patient ratios is not a new topic of debate for all of us who deliver care to patients every day. Only lately it has been a big issue that have caught the attention of many. Demands by the medical community for changes concerning staffing, asking for the government interventions in minimum staffing laws. Registered nurses have long acknowledged and continue to emphasize that staffing issues are an ongoing concern, one that influences the safety of both the patient and the nurse. (ANA, 2015) .nowadays hospitals are running for profit and the emphasis is not put on job burnout, stress, and endangerment of patients. Nursing shortages is a very pertinent problem, it will be optimum to have laws in place to help with the issue, however meanwhile leadership and management methods to the matter can help to mend the nursing situation and avoid many of the damaging effects of unfitting nurse-to-patient ratios.

Current nurse-to-patient ratios is a topic that has constant focus on today’s patient outcomes and safety. There have be many studies and there continues to be studies done on how a higher nurse to patient ratio effects not only patient and nurse safety and patient outcomes once they leave the hospital, but also patient mortality rates as well. When a nurse has been assigned more of a patient load than they can safely handle, whether it be because of a large patient volume or patient acuity, patients suffer and the quality of care declines. With the higher ratio,

Mandatory staffing ratios may improve the working conditions of nurses, provide safety to patients and achieve desirable outcomes for everyone involved in health improvements. One might assume quality health with lower nurse to patient ratios could reduce complications, shorten patients’ stays at the hospitals and lower nurse turnover rates. Lower turnover rates may be much more cost effective then adding additional staff for each shift. Safe training ratios identify the fact that shortage in nurses endangers the lives of patients while at the same time driving nurses from their professions (Silvestre, Bowers & Gaard, 2015). With increasing populations and

The ratios were also intended to have benefits on the nursing profession itself by reducing turnover rates, retaining staff, raising morale, and reducing burnout (Clark, 2010).

Nurse staffing have an effect on a variety of areas within nursing. Quality of care is usually affected. Hospitals with low staffing tend to have higher incidence of poor patient outcomes. Martin, (2015) wrote an article on how insufficient nursing staff increases workload and job dissatisfaction, which in effect decreases total patient care over all. When nurse staffing is inadequate, the ability to practice ethically becomes questionable. Time worked, overtime, and total hours per week have significant effect on errors. When nurses works long hours, the more likely errors will be made. He also argued that inadequate staffing not only affects their patients but also their loved ones, future and current nursing staff, and the hospitals in which they are employed. An unrealistic workload may result in chronic fatigue, poor sleep patterns, and absenteeism thus affecting the patients they take care of.

Safe nursing ratios provide better outcomes for patients and provide better working conditions for nursing staff. Unsafe nursing to patient ratios have detrimental and negative outcomes in the nursing care that patients can receive in the hospital. For example, medications that are administered to patients late can alter their drug administration schedule. The late administration of cardiac drugs can be detrimental to patients’ well-being because this can cause a failure in maintaining the drugs therapeutic serum levels and consequently increasing the likelihood of arrhythmias. High patient to nurse ratios can also cause nurse burnout. Nurse burnout is precipitated by the increased physical and emotional exhaustion from being assigned too many patients depending on the type of floor that one is working. This causes nursing staff to leaves the nursing field due to the undue stress and look for positions that aren’t as stressful. This will only contribute to the nursing shortage. Patient hospital stays can also be effected due to the number of days that a patient stays in the hospital. This leads to an extended number of days in the hospital which can cause a loss of money that insurances would not agree to pay. The safety of the patients need to be a nurse’s priority and this can be a great cause of concern with an unsafe number of patients being cared for by the nurse. As nurse timing becomes a priority, it becomes important to be able to take care of each patient that is

1.) What are three steps you can take to influence policy in your community? As a nursing student on the cusp of entering my chosen profession, I am excited at the prospect of finally working within a major hospital to assist patients, but this excitement is tempered by the divisive health care debate currently consuming the country. Rather than simply respond to policy changes affecting my community, I hope to play an active role in developing these policies both in my capacity as a nurse and as a voter. To this end, I diligently monitor the American Nurses Association (ANA) website at www.nursingworld.org to educate myself about candidates in local elections and their stances on issues pertinent to nursing. Another great resource is the ANA's State Government Affairs program, which "monitors over 1,000 nursing and healthcare related bills introduced in state legislatures across the country" (2012), because this tool helps to make me an informed voter. Another great opportunity to influence policy in my own community is to attend city council and hospital board meetings and actively contribute my opinions and ideas. 2.) Do you believe the use of paraprofessionals (non licensed personnel) to assist nurses in medication administration and other duties will affect patient outcomes? Please explain. While every hospital, nursing home and physical therapy center needs a qualified staff of paraprofessionals, a group which includes Licensed Practical Nurses (LPN), Nursing

All of these outcomes are dependent on the availability of a nurse to assist and monitor their patients continuously throughout the day, which can be difficult when caring for a large patient load. The Minnesota Nursing Accent (2015) also conducted research on the topic of understaffing within hospitals and concluded that a smaller nurse to patient ratio lead to fewer medication errors, fewer medications given late, and shorter hospital stays for patients. Nurses are in control of all medications given, so having a medication error or administering a late medication adversely affects the patient and the issue being treated by the medication. Likewise, Yoder-Wise (2015) reports that having more registered nurses per shift results in a reduction in hospital stay length and less hospital related mortalities. After reviewing current literature on the topic, it is evident that a relationship between understaffed nurses taking on large patient loads and declining patient satisfaction and safety exists.

Patient safety and quality care is top priority for every nurse in any healthcare setting. However, nurses are put in stressful situation on a daily bases and staffing issues should not be one of these. Staffing shortages, patient acuity, higher patient to nurse ratio, and deadlines contribute to increase risk of medical misses or errors, lower quality of care, decrease in patient safety, nursing fatigue, job dissatisfaction, and employee turnover. According to Cho, Kim, Yeon, You, and Lee (2015), units with higher number of nursing staff missed less nursing care than those working on units with less staffing (p. 273). I even addressed how understaffing issues and acuity of patients can impact the quality of nursing care when administering

Nursing ratios vary by state, facility and specialty. Nurse to patient ratios are often guided by the acuity of the patient population; however, the status of an admitted patient is fluid and may change quickly at any time requiring nursing intervention and close monitoring. In NJ, Nurses in hospital settings have patient loads of up to ten (10) patients. Staffing within hospitals is a very challenging aspect of healthcare as numbers fluctuate frequently, however, with the use of agency staffing, PRN staffing and overtime this can be achieved efficiently to promote safe and quality healthcare delivery for patients. Currently in NJ “a coalition of labor unions is pushing the state to revise its minimum nurse-staffing rules for the first time

One of the major issues in the profession of nursing today is whether or not an adequate nurse to patient ratio is of importance to the quality of patient care and patient safety; the overall outcome. Over past decades, there have been many disputes about the shortage of nurses to patients and how nurses would get overworked and do overtime. This would then reflect on the effect that this shortage has on quality of care and safety of patients, whether in a hospital setting or not. There have been many studies done that support the importance of nurse to patient ratio; however, there have been studies that do not support the nurse to patient ratio because of future financial budget issue as well as enough proof to show that implementation of the mandated nurse-to-patient ratio is effective towards positive patient outcome and work satisfaction from nurses. The following peered review research studies include approaches that have been taken to support the positive and negative outcome of nurse to patient ratio.

The ability of a health professional to provide excellent and safe nursing care is dependent on the staff to patient ratio. There is a strong relationship between the two and fixed ratios are the answers to the nursing patient care crisis. Hospitals are filled with seriously ill patients and by mandating nurse to patient staffing ratios, stress is reduced and quality of care is enhanced. Mandating ratios is a way to apply professional control over workloads that can otherwise impede the health and recovery of patients. Ratios also help to reduce the effect increased work load has on the health of nurses. Under staffing causes health complications, sometimes leading to patient’s deaths (Aiken, 2002), therefore more nurses are needed to meet increase demands. It is difficult for the health professional to provide good quality of patient care when the work load that is presented to them is stressful and difficult to accomplish. Mandated ratios are an essential step in an effort to deal with those challenges. Greater hours spent on direct patient care is associated with good quality of patient care outcomes and an increased rates of shorter length of stays in the hospital (Spats, 2013) . Hospitals with low nursing staff levels tend to have higher rates of poor patient outcomes, many of whom develop pneumonia, experience longer length of stays and increase rates of nosocomial infections or drug resistant bacterias. Nursing staff levels affects patient’s quality of care,

There should be policy changes addressing adequate nurse staffing in all states. Legislation for nurse patient ratios should be mandated federally. These policy changes should mandate having an appropriate patient to nurse ratio to ensure proper care is provided to all patients. Low nursing staffing levels can lead to poor patient outcomes such as mortality, increased nurse burnout, and errors in medication administration.