Patient Care Case Study

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?

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).

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).

Since the original plan for SNF stay was 21 days, which is the total number of the days paid by Medicare Part A 100%, there was going to be no out of pocket pay from the patient’s side if there would have not been a UTI acquired. Objective findings show that the UTI was due to poorly performed evidence-based protocol process in the urinary catheter maintenance and fitting. This cost the patient to start paying money ($144.50/day x 14 days as explained before) out of her pocket for cause that was not inevitable. Not only did the patient have to suffer being weak, having and infection and missing on her rehabilitation program, but she had to also pay for each extra day that she had to stay there for a fault that was not hers. It is clearly not only a failure of the SNF’s operational system, quality of care and healthcare professionals’ performance, but also of the governmental support which directly penalizes the patient for

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

It allows for better patient care, safety of the patient, and quality of care. Being modeled after an already approved and successful California law this bill for Florida can help to reduce healthcare cost for the patient, hospital, and state. This also help to reduce hospital acquired illnesses and accidental deaths. We all deserve the best of care when ill, and unfortunately not having a stricter nurse-patient ratio allows for mistakes and a lesser quality of care may be given.

Martin’s journals stated that adequate staffing levels have been shown to reduce mortality rate by more than fifty percent. Staffing levels in nursing care are attributed to poor quality of care, more adverse reactions and leads to higher rates of job dissatisfaction and burn out rates. Inadequate staffing make it harder for the nurse to ethically abide by their requirements of providing patients with nonmaleficence and beneficence. There is an umbrella of people that are affected in different ways due to the understaffing. Patients and their loved ones are affected due to less quality of care as there is less amount of time allotted for everyone, with research showing that an increase in different medical emergencies such as Shock, Cardiac arrest, and Urinary tract infection are

For the past decade, nursing staff patient ratios have been a widely controversial debate as to whether it should be mandated by law across the United States. Studies have shown nurse-staffing levels are a critical component of determining patient outcomes. Advocates supporting minimum staffing levels argue that it can ensure better quality care, better working conditions, positive patient outcomes and improved rates of nursing retention. Opponents who argue that minimum staffing levels may be an issue is due to budgets and reduces management flexibility. This topic was chosen because California remains the only state to require specific minimum nurse patient ratio. It is very interesting to see

Nursing shortages in the United States have left practicing registered nurses (RNs) with strenuous workloads. Such heavy workloads can lead to poor patient outcomes, decreased satisfaction among both patients and nurses, and questionable quality of care, among other things (Cimiotti, Akien, Sloane, & Wu, 2012; Department for Professional Employees, 2014; Duffield et al., 2011). Realizing the potential for error that accompanies such circumstances, efforts are being made to decrease the workload of nurses in hopes of improving quality of care. One such effort, and the focus of this paper, is the implementation of mandated nursing staff ratios. Mandated nursing staff ratios would restrict the number of patients a nurse is allowed to care for at one time (Tevington, 2011). While this idea seems to be a fitting solution, there has been much debate about the effectiveness of mandated nursing staff ratios. This paper will discuss arguments for mandated nursing staff ratios, arguments against mandated nursing staff ratios, and the impact of mandated nursing staff ratios on the profession of nursing as a whole.

When it comes to nurse-to-patient ratio, safety is the number one priority. An article published in the National Nurse journal in 2010 discusses the impact of decreasing the maximum number of patients a specific nurse can safely take care of. At the core of the article’s argument is analysis of Boxer’s effort to introduce the National Nursing shortage reform and patient advocacy act 1031 and the impact it has on the nursing fraternity. According to Smith (2010) “mandatory nurse-patient ratios is that minimum, specific, guaranteed nurse staffing will produce better patient outcomes and alleviate nurse workloads and increase job satisfaction” (Smith, 2010, para. 14). While Senator Boxer is reported not to have enough sponsors for the new bill, the author concludes that passing the legislation will play a critical role in transforming the services offered by registered nurses in the United States (Smith, 2010). Second article that talks about safe staffing levels and mandatory nurse-patient ratios is from the MEDSURG Nursing journal published in 2011. This article assesses the impact of extending the Californian legislation that mandates patient nurse ratio on other states in the United States of America. The author concludes by arguing that passage of regulations that mandate nurse patient ratio promotes the value of the

I received a call from Neely Muratet, RN, BSN; Transition of Care, Nurse at My Care Alabama regarding the patient’s pending discharge from the hospital. The patient has been accepted into Brookshire Healthcare Center, as reported by Neely Muratet, although he will not be discharged until the transportation to and from his dialysis treatment can be arranged. At this time he cannot receive his dialysis at Brookshire because it is a liability issue and they cannot provide transportation to his treatment because his appointment is at 5 AM and they do not provide transportation at that time. Neely reported that the patient will remain at the hospital until this can be worked out, additionally the patient’s status is declining and his kidney’s

Throughout the United States, staffing issues are an ongoing concern which can impact the safety of both the patient and the nurse. Every healthcare facility is challenged with finding optimal nurse-patient ratio to ensure safe patient outcomes. Quality of care and patient safety is related to nurse to patient ratio. In order for care to be delivered safely the number of patients a nurse is caring for during his/her shift should be based on the level of acuity of care. Lowering the nurse to patient ratio will help increase patient safety. Tevington (2011) noted that by decreasing the

The 1990s saw a positive improvement in restructuring the hospital environment and staffing. California has adopted a law that mandates nurse-to-patient ratios in the acute care setting. We propose that that a standardized nurse-patient ratio should be adopted in the state of Texas. This would help with help ameliorate some of the issues our state is facing today. The proposed idea would decrease the expenses that come with increased healthcare mistakes, nurse burnout rates, and the increased risk of malpractice lawsuits. Standardized nurse-patient ratios would affect nursing practice, healthcare delivery, and healthcare consumers positively and in ethical manner. Tevington (2011), stated that mandated nurse-patient ratios, would

Mandating nurse-to-patient staffing ratios may not be the best idea because there is “little evidence that specific nurse-to-patient staffing ratios improve safety or quality” (Welton, 2007, p. 4). Legislation “points to research indicating an association between nurse workload and patient mortality and morbidity” according to a study from 2002 (Welton, 2007, p. 4). The study showed that for every “additional patient a nurse was assigned, there was a seven percent increase in the likelihood of dying got a patient under that nurse’s care” (Welton, 2007, p. 4). On the contrary, the studies that the legislation points to have “several weaknesses”; like how it was only implemented at two hospitals and was done in the 1990s, thus, it is outdated information (Welton, 2007, p. 4). The American Organization of Nurse Executives believed that mandating nurse-to-patient staffing ratios is causing more harm to the health industry because it is “reducing scheduling and staffing flexibility” (Welton, 2007, p. 5). The patient load and acuity is not the same every day; consequently, there needs to be flexibly schedules to be financially appropriate and beneficial to the patient. If you are overstaffed on nurses then the unit is losing more money, because they are paying for nurses to sit around. For example, when a unit is low acuity patients they do not need as many nurses, thus, they may send nurses home; same goes for high acuity patient

Hospitals that staff 1 nurse to less than 5 patients also have a lower incidence of patientfalls, medication errors and nosocomial infections (MacPhee, M., et al, 2006). Improved RN topatient ratios also have a reduced rate of pneumonia, urinary tract infections, shock, cardiacarrest, gastrointestinal bleeding, and other adverse outcomes in acute care settings. Recentresearch indicates that the cost of the RN to patient ratio law is considerably lower than the costof basic safety interventions commonly used in hospitals such as PAP tests for cervical cancerand clot-busting medications to treat stroke and heart attacks. Shorter lengths of stay have alsobeen reported since the ratio laws took place (Needleman, J., et al, 2002)HistoryCalifornia became the first state to mandate minimum nurse staffing ratios. Suggestionsfor nurse-to-patient ratios have been specified in union contracts at hospitals in several otherstates. Since California passed AB 394, related bills were introduced in many other states suchas Massachusetts, New Jersey, New York and Pennsylvania. The cause for staffing ratios was aresult of average patient acuity in the state of California rising and projected increases for acuitylevels to keep increasing through the next 20 years (Institute for Health, 2001). AB 394 mayhave a major impact on demand for nursing personnel, the adequacy of nursing supply and thequality of nursing care provided to consumers. Nursing unions in California