Case Study : My Medical Surgical / Oncology Unit

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?

Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).

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 nurse-patient ratios have been a controversial topic facing nurses for decades. Nurses, patients, physicians, nursing organizations, researchers, hospitals, federal government, and state governments have opposing views in regard to mandatory nurse-patient ratios. Those that support the idea of mandatory nurse-patient ratios believe that there would be an improvement in quality of patient care, decreased nursing shortages, increased job satisfaction, decreased client hospitalization, and increased nurse recruitment (Pamela Tevington, 2012). Groups that oppose mandatory nurse-patient ratios believe that mandatory staffing laws ignore factors such as the level of care a patient requires from a nurse, treatments, length of hospitalization, improvements and differences in technology, the expense of an increased nursing staff, and nurse experience and education (Tevington, 2012).

Primarily, it is crucial for health care organizations to focus on ensuring safe and quality patient care, as well as improved job satisfaction by enforcing an optimal and adequate nurse-to-patient ratio and creating innovative and long-term strategies through a collaborative effort. In order to ensure the safety of patients and nurses, state-mandated safe-staffing ratios are necessary. Adequate nurse staffing is key to patient care and nurse retention, while inadequate staffing puts patients at risk and drives nurses from their profession. As baby boomers age and the demand for health care services grows, staffing problems will only intensify. Consequently, safe-staffing ratios have become such an ever-pressing concern. In 2004, California became the first state to implement minimum nurse-to-patient staffing ratios, designed to improve patient care and nurse retention. Subsequent studies show that California’s program measurably improved patient care and nurse retention.

The American Nurses Association supports a legislative model in which nurses are encouraged to create staffing plans specific to each unit. This approach will aide in establishing staffing levels that are flexible and can be changed based on the patients needs, number of admissions to the unit, discharges and transfers during each shift (“Nurse staffing plans,” 2013). This model will assist in keeping the unit staffed appropriately and organized in need of a change during each shift. Without an organized plan like this, a nurse may be required to take on a new admission and already have too big of a workload.

Mandatory staffing ratios have been suggested as a way to meet nursing staffs’ concerns of high nurse to patient ratios. Mandatory staffing ratios are used as a way to reduce workload and patient mortality and are aimed at addressing the perceived imbalance between patient needs and nursing resources. (American Nursing Association, 2014). However, issues have been raised on applicability of staffing ratios since it could lead to increased costs without the guarantee of improvement in the quality of health care and could also lead to unintended consequences including unit closures, limited infrastructural development and limited access by patients (American Nursing Association, 2014).

healthcare organization accrediting bodies, and to maintain credibility with patients and peers alike, must adhere to the National Patient Safety Goals. As stated by Ulrich and Kear (2014), "Not only are nurses responsible for providing safe patient care, we are also responsible for creating an environment in which others can provide safe patient care, and for being the last line of defense when needed between the patient and potential harm. Having a deep understanding of patient safety and patient safety culture allows nurses to be the leaders we need to be in ensuring that our patients are always

Dr. Linda Aiken is the leading researcher in nursing staffing rates within the United States (Kerfoot & Douglas, 2013). She suggests that each state follows California’s example of conducting research to determine a minimum staffing ratio and making it a law (Kerfoot & Douglas, 2013). The California legislation enhanced nurse staffing in hospitals across the state and improved the patient care results of millions of patients (Kerfoot & Douglas, 2013). After the bill went into effect, job satisfaction increased, and the nursing shortage ended (Kerfoot & Douglas, 2013).

It is not a secret that for many years there has been a detrimental nursing shortage in the United States. Factors that contribute to the unfortunate decrease in availability of nurses and other health care professionals can be attributed to a shortage of nursing school instructors which impacts enrollment into nursing schools, and many in the health care profession are nearing retirement age. The need for health care continues to steadily increase as the baby boomer generation ages. In order to meet these demands, there has to be adequate staff in the workplace. After an extended amount of time dealing with unsafe staff to patient ratio it has come the time to take action and devise solutions rather than letting patient care suffer. After comparing a variety of possible solutions, the most feasible was to create and implement a clear updated set of regulations, and formulate a law to enforce the same. The proposed solution will address the ineffectiveness of current health care staffing regulations, propose a law that will enforce safe staff to patient ratios, mandate that all parties involved in developing health care laws be members of the health care field themselves, and work to maintain a strict continuous reassessment phase to ensure that all changes remain beneficial. With the help of the entire health care community the implementation of this proposed solution will create a dramatic decrease in adverse patient outcomes while increasing patient and staff

The debate to find the perfect balance of nurse to patient ratio continues between healthcare workers and legislators. According to an article in Modern Healthcare magazine, “Got enough nurses?” Nurse groups cite a Kentucky case to support push for staffing ratio laws,” nurses attending to a dozen or more patients at a time is “physically impossible” (Rice, 2015). Rice reports statements made by Gerard Brogan, lead nursing practice representative for the California Nurses Association, Pamela Cipriano, president of the American Nurses Association, American Organization of Nurse Executives, a subsidiary of the American Hospital Association, Jan Emerson-Shea, vice president of external affairs for the California Hospital Association, Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Doctor Christine Cassel, CEO of the National Quality Forum, Bonnie Castillo, director of the Registered Nurse Response Network for National Nurses United union, Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, discussing research and other insights into the hardships of large nurse to patient ratios. As nurses continue to research and present data to contest the high patient to nurse ratios, hospitals push back with confronting data and research; both unable to reach an agreement.

When someone is hospitalized, they are often in their most vulnerable state. Whether you are the fearful individual being hospitalized, a concerned loved one, or the compassionate care provider, ensuring the patient receives the best possible care throughout their stay is a substantial concern. When receiving care and trusting a facility with the health of the individual involved, wouldn’t it be assumed that the amount of attention and level of care received would be unwavering throughout the nation? Would it be surprising to you to find out that the patient’s outcome may be different depending on in which state they are being cared for? Depending on the state in which the care is being received, there may not be a limit to how many other patients your nurse is assigned to, thus, limiting time and energy that nurse has to spend with each individual. While this fact is a scary one, there is evidence that thousands of lives could be saved if hospitals across the nation would implement change and mandate nurse to patient staffing ratios.

Understaffing has become a major problem throughout our country, being that it often results in leads to unsafe conditions,avoidable death and injuries, and the possibility of a nurse being unhappy with his or her job.At the point when nurses are compelled to work with such high nurse - to -patient proportions, patients are exposed to death ,diseases, harm, or get sent home too early without sufficient training about how to deal with their ailment. A major reason for the understaffing of hospitals and specialized care home is for the simple fact that it is more cost efficient.Laws regarding how many nurses should be required per unit varies from state to state.Studies have been undertaken to correlate nurse understaffing and nursing fatigue. Those studies have uncovered that these two issues adversely affect the nature of care given to an individual which is the, patient to nurse ratio and operational expenses in facilities such as hospitals and specialized care facilities.For an example a national study that was published in a recent JAMA-Pediatrics issue and funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative and the National Institute of Nursing Research reached the conclusions that an obscure amount of neonatal intensive care units, or NICU’s, throughout the country provide adequate quantities of nurses to meet national rules and that the units administering to the most children are additionally the most understaffed, putting the wellbeing of fundamentally sick infants at risk.One of the study authors were Eileen Lake, who is a nursing professor and associate director of the Center for Health

Despite many efforts to improve staffing numbers, there is often still a staff shortage among staff in hospitals and acute care settings. While the most obvious solution to short staffing is to hire more nurses, there are also other ways to make staffing more effective. A patient acuity tool is a staffing instrument that can be used to decide how much time and attention each individual patient requires. By knowing the acuity level of each patient, charge nurses can decide how many patients each nurse can be assigned to at a time. This essay describes the way a patient acuity instrument improves healthcare outcomes by promoting patient-centered care and improving on key nurse competencies including teamwork and collaboration, quality improvement, and safety measures.

Safe nurse staffing is vital to every individual in the community. Social media and networking can be used to involve more personnel into the effort. Support of all healthcare personnel is very necessary to make the bill a law. The New York state Nurses Association (NYSNA) can be the platform to initiate this effort. The American Nurses Association (ANA) website can be used to write to the representative you chose to help you pass this law. This information needs to be shared with as many nurses. Public awareness of the staffing situations by having rallies and giving out flyers on reports of hospital surveys that shows need for increase skilled nursing staff is important to gain public support. Encourage everyone to write letters showing support for safe staffing. A webpage set for sending letters with a prewritten letter will encourage more people to back you in this process. Have easy access for sending letters to different representatives or senators by simply providing the web-address in the flyers or/and medias like face book pages. The NYSNA is able to represent the efforts for changing the bill with the support of