Maximizing Patient Care with Nurse Staffing Ratios

Nurses help doctors diagnose health problems that inflict patients, provide treatment to alleviate severe injuries or illnesses, and maintain a high quality of health that enables patients to live long and productive lives. However, determining how many nurses to hire can be a complicated and difficult challenge for hospital administrators. Administrators often must consider many factors, including the size of the community population, the average number of hospital patients, and the diverse types of treatments required. Although administrators generally must consider several factors, some states have established minimum nurse staffing ratios that require hospitals to hire an appropriate number of nurses in accordance with the number of patients in the hospital. Mandatory nursing staff ratio requirements should be implemented because many studies indicate that the ratio requirements improve the performance levels of the nurses and maximize patient care quality.

The concept of nurse staffing ratios has been contemplated and debated by many nursing professionals and government legislators in the recent decades. Mandatory nurse staffing ratios requires health care facilities to employ a correct number of nurses to proportionately accommodate the number of patients that the hospital treats (Buerhaus, 2010). The staffing ratios generally increase the number of nurses that a hospital employs, the exact ratios that must be achieved depends on the hospital unit, and the goal is to ensure that each hospital unit possess a sufficient and optimal number of nurses to effectively provide high quality treatment for each patient in the unit. California established nurse staffing ratio requirements in 2004, and the law mandates that all hospitals in California must achieve appropriate nurse to patient ratios. Although exact ratios are different for each type of unit in the hospital, the law requires that hospitals achieve a 1 to 1 nurse to patient ratio in operational units and a 1 to 6 ratio in psychiatric units (Furillo, 2012). The California law provided the medical community with an opportunity to evaluate the law, analyze the effects the new policy yields regarding hospital performance, and determine whether or not mandatory staffing ratios significantly improve the quality of care that is provided to the patients.

Supporters of mandatory nursing staff ratios contend that the legislation provides the important function of alleviating the workload of nurses. Many hospitals and health care facilities have experienced difficult situations in which the hospitals lack the sufficient amount of nurses required to adequately treat the relatively high volume of patients that need care. During these detrimental situations, the nurses often must endure intense high-anxiety situations in which they are under extreme pressure to rapidly provide care for an excessive number of patients in a very short amount of time. The intense stress of the excessive workload diminishes the quality of care that patients receive because the nurses become exhausted and depleted of energy, vulnerable to make mistakes, and unable to realistically provide sufficient care for the abundant volume of patients. However, mandating nursing staff ratios can alleviate the overload problems by requiring hospitals to increase the size of the nursing staff. Adding more nurses to the staff and ensuring that the staff adheres to an appropriate ratio would prevent nurses from experiencing the overwhelming stress and debilitating fatigue that accompanies needing to provide care for an excessive number of patients. Thus, mandatory staffing ratios are beneficial because the ratios would alleviate the intense workload of nurses, improve the performance levels of the nurses, and would ensure that there are a sufficient amount of nurses available to effectively provide high quality care for each particular patient.

Opponents of nurse staffing ratio requirements often contend that the requirements are expensive for hospitals to implement, the expensive costs hinder the ability of hospitals to spend money on advanced technological or medical resources, and that the minimal benefits provided by the requirements do not justify such excessive hospital costs (Welton, 2007). However, many experts disagree with the premise that the effects of mandatory staffing ratios are only minimal. Several comprehensive research studies comparing the results of the California staffing ratio legislation with other states and hospitals that do not implement ratio requirements demonstrate that California hospitals experienced significant improvements regarding the quality of patient care. The studies indicate that the ratio requirements yield substantially effective results, as the California hospitals demonstrated a higher level of nursing staff productivity, facilitated less burnout and higher job satisfaction among individual nurses, and enhanced the quality of care provided for patients. For instance, New Jersey and Pennsylvania lack minimum nurse staffing ratios. Compared to the hospitals in these states, California hospitals with nurse staffing ratios experienced a reduced likelihood of in-patient death within 30 days of being admitted, a reduced likelihood of death caused by a failure to adequately respond to symptoms, a 13.9 percent reduction of surgical deaths, a 24 percent decrease in the amount of time patients must spend in intensive care units, and a 31 percent decrease in the amount of time that patients must spend in surgical units (Dorning, 2014). Thus, research studies indicate that the vast improvements of nurse productivity and patient care generated by nurse staffing ratio requirements were significant and substantial enough to justify the costs associated with the requirements.

Governmental financial grants can help offset the costs that communities and hospital administrators must spend to fulfill the staff ratio requirements. For example, the California government helped communities and hospitals implement the new nurse staffing patterns by providing beneficial financial grants to health care facilities and to college nursing training programs (Furillo, 2012). As result, state governments can provide grants that enable nursing programs to equip a high volume of registered nurses with the superior knowledge and skills required to provide excellent treatment. Additionally, the grants can enable hospitals administrators to hire more nurses while still having enough money to pay for other essential medical and technological expenses. Thus, the problem regarding the expensive costs of mandatory nurse staffing requirements can be solved and alleviated with the help of governmental agencies providing financial grants to hospitals and medical universities.

The positive effects that the California nurse staffing ratio requirements yielded for nurses, hospitals, and patients has encouraged 17 other states and hospitals to also implement the ratio requirements. Although the costs of implementing the ratio requirement laws can be expensive for hospital administrators, studies indicate that governmental grants can help compensate for the costs and that the substantial benefits provided by achieving appropriate nursing ratios validates the legitimacy of the requirements. States should establish mandatory nurse staffing ratio requirements because the minimum standards would ensure that each hospital unit possesses a sufficient amount of nurses to proportionately accommodate the number of patients, would enhance the happiness and productivity of the nurses, and would maximize the quality of care that patients receive.

References

Buerhaus, P. (2010, June 8). What is the Harm in Imposing Mandatory Hospital Nurse Staffing Regulations?. Texas Hospital Association. Retrieved from https://www.tha.org/HealthCareProviders/Issues/Workforce/Buerhaus-Harm%20in%20Mandatory%20Ratios.pdf

Dorning, J. (2014, April 4). Safe-Staffing Ratios: Benefiting Nurses and Patients. Department for Professional Employees. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/safe-staffing-ratios-benefiting-nurses-and-patients/

Furillo, J. (2012, September 26). State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction | AHRQ Innovations Exchange. Agency for Healthcare Research and Quality. Retrieved from http://innovations.ahrq.gov/content.aspx?id=3708

Welton, J. (2007, September 1). Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. The Online Journal of Issues in Nursing. Retrieved from http://www.nursingworld.org/