Define nurse-to-patient ratio. It is the number of patientseach on duty nurse is assigned to care for during a his or her shift. Thenumber varies depending upon the facility, the acuity level of the unit and theactual shift (days, off-shift, etc.). The off-shift ratio is slightly higherthan it is for days because of general healthcare activity and procedures.
Where Did It All Begin?
In 2004, California was the first state to implement minimumnurse-to-patient staffing ratios. They conducted an extensive study comparingstaffing and subsequent workloads in California, New Jersey and Pennsylvania.Today, the nation-wide debate with regard to the acceptable staffing levels foreach patient care unit rages on.
U.S. House and Senate Involvement
Legislation to address nurse staffing has made its way to the U.S. House andSenate.
RN Safe Staffing Act of 2011 (H.R.876 and S.58) investigates the use ofstaffing committees within a hospital to oversee the entire staffing plan.Nurse Staffing Standards for Patient Safety and Quality of Care Act of 2011(H.R.2187) and National Nursing Shortage Reform and Patient Advocacy Act(S.992) impose mandatory staffing ratios. S.992 states that a hospital cannotaverage the number of patients and direct care staff on a unit, cannot requiremandatory overtime and must provide direct care coverage for breaks, meals andother absences from the unit.The Study
Patient mortality and failure-to-rescue (FTR) were examined in theCalifornia study. FTR incidents, according to California study leader LindaAiken, PhD, RN, are when, “Hospital doctors, nurses or caregivers fail tonotice symptoms or respond adequately to signs that a patient is dying ofpreventable complications.” She adds that FTR is, “affected by differences innurse workloads.”
The study concluded that by mandating minimum nurse-to-patient staffingratios, hospitals have great potential to improve patient outcomes and improvenurse retention.
The Typical Scenario
Staffing negotiations recently took place at a major medical centerin Boston, MA. The hospital and the Massachusetts Nurses Association narrowlyavoided a threatened strike. Their negotiated contract, loosely translated forthe purpose of this blog, contains guidelines suggesting that, “patientassignments for a single nurse be no more than five on the day and eveningshifts, no more than six on the night shift and 2 in intensive care, exceptunder unusual circumstances.” The hospital “retained the flexibility toincrease patient assignments in some cases.” Keep in mind that thesenegotiations are costly, on both sides. Nurses bear the frustration andpotential loss of work time while the facility bears a steep financial impact;this particular medical center spent .6 million hiring and bringing temporarynurses to Boston so they were readily available in the event of astrike.
Where Do We Go From Here?
Patient safety and quality care must be maintained. Around the country,hospital administrative staff and nursing representatives are workingcollaboratively to reach agreeable nurse-to-patient ratios. State-by-state,nurse-to-patient ratios are being reviewed. The U.S. House and Senate continueto work on nationwide guidelines through four current bills on theiragenda.
Let’s not forget that patient care and patient safety form the true bottomline of this staffing issue.