Overview of California's Nurse-to-Patient Ratio Mandate

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-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.

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

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,

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

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).

Many nurses face the issue of understaffing and having too much of a workload during one shift. When a unit is understaffed not only do the nurses get burnt out, but the patients also don’t receive the care they deserve. The nurse-patient ratio is an aspect that gets overlooked in many facilities that could lead to possible devastating errors. Nurse- patient ratio issues have been a widely studied topic and recently new changes have been made to improve the problem.

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).

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

There is a strong correlation between adequate nurse-to-patient ratios and safe patient outcomes (Avalier Health LLC, 2015). Finding an ideal nurse to patient ratio has been a national challenge. In this article, there will be discussion of this problem and possible solutions. We will identify the parties affected most by change, possible opposition to change, steps to minimize those challenges, and ways of measuring possible outcomes of the proposed changes.

National Nurses United. (2015). National campaign for safe rn-to-patient staffing rations. Retrieved July 25, 2015, from http://www.nationalnursesunited.org/issues/entry/ratios

The final bill mandates minimum, specific and numerical nurse-patient ratios in hospitals. For example, a mandated nurse patient ratio of 1:5 was set for medical surgical units and smaller ratios were assigned to specialty units (Tevington 2011). Today, California is the only state with mandated nurse-patient ratios. 14 other states have set laws and regulations addressing nurse staffing in hospitals but they all address the issue differently and have set different requirements (ANA,

I can bear witness to all the different circumstances that qualify one to one nurse patient ratio. At times, due to staffing and patient acuity the nurse patient ratio cannot be helped. Nurse to patient ratio is a problem in the workplace especially in the critical care setting that requires managers and leaders to intervene. To eliminate this problem as stated by McKenna et al. (2011) nurse managers are working together with other staff members in forming a committee called the Nursing Productivity Committee (NPC), which helps to implement safe staffing strategies to ensure best possible patient outcome and improve nurse satisfaction. The NPC, as stated by McKenna et al., found that nurse patient ratio in the intensive care unit (ICU) was

Though, it is stated that finding enough nurses to fulfill this increased need likely would not be challenging. In fact, nursing is the most populated career throughout the realm of healthcare. It is recommended that reviewing staffing ratios in the ICU is necessary to lessen negative patient outcomes and ultimately, making a change in policy (2014).

This research paper discusses the importance of the nurse to patient ratio and how it effects both the nurses as well as the patient. Due to the ratios that the nurse’s deal with everyday there have been certain issues that arise due to these inappropriate ratios. When discussing that patients, they are at risk for nosocomial infections, pressure ulcers as well as medication errors. As far as the nurses they deal with compassion fatigue, stress and burnout which stem from these ratios especially in high acuity areas. Day in and day out laws are being implemented in states such as California which have worked best for both the patient and nurses but they are not arriving quick enough in other states like it should be. If patient and