NURSING AND HEALTHCARE

Nursing and Healthcare

Nursing and Healthcare

Identifying and maintaining the appropriate number and mix of nursing staff is critical to the delivery of quality patient care. Numerous studies reveal an association between higher levels of experienced RN staffing land lower rates of adverse patient outcomes. With such nebulous language and the continued failure of Congress to enact a quality nursing care staffing act to date, it is left to the states to ensure that staffing is appropriate to meet patients' needs safely. Massive reductions in nursing budgets have resulted in fewer nurses working longer hours, while caring for sicker patients. (Shirley et. al. 2010)

In a survey of almost 220,000 RNs from 13,000 nursing units in over 550 hospitals and a response rate of 70%, nurses reported to ANA that: 54% of nurses in adult medical units and emergency rooms do not have sufficient time with patients; overtime has increased during the past year with 43% of all RNs working extra hours because the unit is short staffed or busy; and that inadequate staffing affected unit admissions, transfers and discharges more than 20% of the time. (Beverly et. al. 2010)

The benefits of increased RN staffing has been demonstrated. Each additional patient care RN employed (at 7.8 hours per patient day) will generate over $60,000 annually in reduced medical costs and improved national productivity. 1 This is only a partial estimate of the economic value of nursing omitting intangible benefits of reduced pain and suffering of patients and family members; the risk of patient re-hospitalization; benefits to the hospital such as improved reputation, reduced malpractice claims and payouts, and reduced compliance-related costs; and improved work environment that results in reduced turnover and risk of injury. Nurses therefore, have requested the assistance of elected officials on the state and federal level to protect patients by holding hospitals accountable for the provision of appropriate nurse staffing through legislative or regulatory means. Three general approaches to assure sufficient nurse staffing have been utilized at the state level. The first is to require and hold hospitals accountable for implementation of nurse staffing plans, with input from direct care nurses, to assure safe nurse to patient ratios are based on patient need and other influencing criteria. The second approach is for legislators to mandate specific nurse to patient ratios in legislation or regulation.

A third approach is that of requiring facilities to disclose staffing levels to the public and /or a regulatory body. The prescriptive approach of legislating mandated fixed ratios does not accommodate for changes in patients' needs, available technology, and the preparation and experience of staff. What may be established through legislation today as an appropriate minimum nurse to patient ratio may be obsolete by the next shift or two years from now. Disclosure of staffing plans without evaluation and recourse for inadequate levels are futile. The American Nurses Association (ANA) supports a legislative model in which nurses are empowered to create staffing plans specific to the unit and patient population and to which ...