Health Care Policy : Patient Safety

Since the times when Florence Nightingale took care of patients, there has been a question about what factors affect patient care. One of these factors, nurse-to-patient ratios, has gotten significant publicity over the last several years due to a change in legislation in California. This increase in publicity has sparked many researchers' interest to further evaluate these ratios in connection with patient outcomes and other variables. Through lots of research and analysis there is evidence that a lower nurse-to-patient ratio does reduce the negative patient outcomes in patient care. Some of these

I am writing to you in regard to safe patient ratio bill titled Safe Nurse Staffing for Patient Safety and Quality Care Act. My name is Angelina David and I am a registered nurse and practicing in the surgical intensive care unit. I am also enrolled in the Adult nurse practitioner program to further advance my knowledge in nursing. One thing I have learned is that as nurses no matter what the level of care or which facility you are practicing; patients’ safety is our number one priority. Patients’ safety and their quality of care have improved over the year. However, oftentimes nurses are still placed into a situation where it is unsafe to practice because they are required to care for more patients than it is safe.

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).

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,

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.

In an article published by Applied Nursing Research the authors point out that nurse staffing is related to patient outcomes, “lower levels of RN staffing are associated with higher rates of OPSN (Outcomes Potentially Sensitive to Nursing) in both medical and surgical patients treated in hospitals, U.S. Medicare, and other publically available administrative data” (Duffield et al., 2011, p. 245). The writer of this paper researched 5 relevant articles regarding the relationship between nurse to patient ratio, morbidity, and mortality, every article related similar information. “A systematic review of 102 studies concluded that increased RN staffing levels are associated with lower rates of morbidity and mortality” (Ball, Murrells, Rafferty, Morrow, & Griffiths, 2013, p. 2).

Mandated nurse-to-patient ratios have some flaws to work out. Mandatory nurse-to-patient ratios could increase costs with healthcare costs already hard for many to afford. Welton (2007) stated, “Mandatory ratios, if imposed nationally, may result in increased overall costs of care with no guarantees for improvement in quality or positive outcomes of hospitalization” (p1). According to Welton the cost to the hospital are not covered when these mandates are put in place, leaving the hospital to pick up the extra costs of hiring additional nurses to comply with mandates. Mandated nurse-to-patient ratios do not allow for

Nurse-Patient staffing ratios have created debate among health care professionals for years. Who determines where, when and how many patients a nurse can handle on any given shift? Who determines the acuity of the patients handled by the nurse? Does the floor nurse have a say in what she or he can feasibly handle during their shift? At what point does patient care begin to suffer? These questions and many others have led to federal and state legislation coming to light to better serve the care of a patient. “The varied agendas and the inability of nurses, hospital administrators, and financial experts to communicate toward a single purpose, as well as the complexity of meeting staffing needs, have moved the issue into the political arena (Hertel, 2012, p. 1)”. Several states have already instituted mandatory nurse-patient ratios. While you can debate for or against political involvement, I will look at many factors regarding care and safety of patients.

Patient safety one of the driving forces of healthcare. Patient safety is defined as, “ the absence of preventable harm to a patient during the process of healthcare or as the prevention of errors and adverse events caused by the provision of healthcare rather than the patient’s underlying disease process. (Kangasniemi, Vaismoradi, Jasper, &Turunen, 2013)”. It was just as important in the past as it is day. Our healthcare field continues to strive to make improvement toward safer care for patients across the country.

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.

Currently, there are only 13 states that have addressed these laws and regulations in hospitals: CA, CT, IL, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA. California is the only state that requires specific minimum nurse-patient ratio to be maintained in all units at all times. Supporters for this law argue that it is important to for all states to adapt to these laws and regulations because it can improve quality patient care. Although there are several issues surrounding the idea of mandating nurse-patient ratios, the “American Nurse Association (ANA) endorses staffing systems with requirements that RNs who provide direct patient care have input into staffing decisions and that the level and intensity of care can be reflect in the staffing system” (Manjlovich, 2009). This is very beneficial for many other states that do not want to follow in California’s footsteps, and instead, take another approach.

Currently, there are only 13 states that have addressed these laws and regulations in hospitals: CA, CT, IL, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA. California is the only state that requires specific minimum nurse-patient ratio in all units. Supporters for this law argue that it is important to for all states to adapt to these laws and regulations because it can improve quality patient care. Although there are several issues surrounding the idea of mandating nurse-patient ratios, the “American Nurse Association (ANA) endorses staffing systems with requirements that RNs who provide direct patient care have input into staffing decisions and that the level and intensity of care can be reflect in the staffing system” (Manjlovich, 2009).

Nursing is the powerhouse in the delivery of safe, quality patient-centered care in the healthcare industry. To ensure continued safety of the patient and nursing staff, the issue of inadequate staffing must be addressed. Consequently, patient’s mortality rate has been linked to the level of nursing staff utilized in ensuring an utmost outcome (Aiken, 2011). This paper will outline the issue associated with inadequate nurse to patient staffing ratios in the hospital setting; essential factors such as economic, social, ethical and political and legal affecting the issue will be established; current legislature and stakeholders will be ascertained and policy option, evaluation of bill and the results of analysis will be reviewed.

Nursing has changed over the years due to changing technology, patients, and the new generations of nurses. With change happening each day, nurses are expected to keep up and continue to provide adequate patient care (Porter-O’Grady & Malloch, 2013). Patients are the most important priority in healthcare. They enter healthcare facilities with a problem that needs to be treated, and they expect the best care available. Having proper nurse-to-patient staffing ratios is one way in which patient needs are met. Staffing models have yet to catch up with the change, only one state has mandated patient ratios. It was thought other states would follow in their footsteps but none have. The American Nurses Association supports facilities to make their own decisions regarding staffing based on needs of patients and staff (2013). There are multiple reasons why mandated staff ratios would be beneficial to both patients and nurses. Staffing ratios are difficult to mandate because every facility is different and every patient is different. Staffing varies, as well as patient acuity. Having the correct ratio of staff to give adequate patient care is hard to maintain. Patient safety begins with safe nurse to patient ratios. Even the best nurse will be unsuccessful when overwhelmed with too many patients. This paper is intended to discuss how safe patient ratios are developed and implemented throughout health care systems.

The responsibilities set on nurses has skyrocketed since the profession began in 1854 and little has been done to balance out these increasing demands with its consequences (University of Pennsylvania). Of particular concern is the nurse-patient ratio and although minute, some states have and are considering whether to mandate the ratio or not. To best cope with the increasing demands, nurse-patient ratios in hospitals should be mandated by the state government in order to improve the quality of patient care, reduce patient readmission costs spent by the hospital, and improve nursing staff satisfaction. Whether in favor of regulation or not, it is important for state policy makers to consider the pros and cons of mandating