How Nurse to Patient Ratios Affect Patient Care
A long-standing debate over nurse to patient ratio heated up to the boiling point on June 10, 2010, when 12,000 nurses from the Minnesota Nurses Association walked off the job for 24 hours. Although nurses in other states engaged or threatened to engage in work action, the Minnesota strike was, as reported by ABC News, deemed the largest nurse job disruption in the history of the United States by union organizers.
At the heart of the issue is nurse to patient ratios. As with any debate, there are two sides to every controversy. Much action has been focused on this concern, but both sides have yet to reach definitive agreement.
The American Nurses Association (ANA) advocates safe staffing protocols, wherein nurses are involved in developing safe staff plans in conjunction with hospital committees that take into account the number of patients, the illness severity and the experience level of nurses and support staff. ANA appeals to members to join the effort to bring about these changes.
The ANA bluntly states it believes low nurse to patient ratios contribute to longer hospital stays, less than optimal outcomes and increased risk of death. It further notes nurse burnout, high turnover and disillusionment are a direct result of nurse understaffing. The ANA website contains testimonials from nurses describing their anguish at their lack of ability to provide compassionate and adequate medical ministration to patients, some in critical care situations, due to lack of staff.
Mandatory staffing ratios were legislated in California in 2004. According to the California legislation, hospital ratios are as follows:
- One nurse for every 2 patients in intensive care, critical care, neonatal critical care, post-operative recovery wards and critical care emergency patients
- One nurse for every 4 patients in ante-partum, labor, post-partum, pediatric, emergency wards
- One nurse for every 5 patients in medical and surgical wards
- One nurse for every 6 psychiatric patients.
Step down healthcare centers have similar regulations, with the exception of one nurse for every 3 patients. Otherwise, patient to nurse ratios for various departments are as above.
A study performed by the University of Pennsylvania, and entitled "Implications of the California Nurse Staffing Mandates for Other States" reveals these mandatory requirements enable nurses to spend more time with patients, provide superior medical care and save patient lives. It notes that, if other states adhered to California's mandatory nurse to patient ratio, between 11 and 14 percent more patients would survive, changes in medical conditions promptly noted and potentially thousands of lives saved annually.
The Journal "Medical Care" published a mortality risk study by the University of Michigan which concluded a higher nurse to patient ratio deceased the death risk by 7.5 percent. Emergency room delay research published in the "Archives of Internal Medicine" (November, 2009) discovered just 75 percent of emergency room patients were attended to within recommended times, leaving 25 percent of patients with unreasonable waits, and these delays could increase the rate of mortality in hospitals.
Opponents of mandatory nurse to patient ratios consist primarily of hospital associations. The California Hospitals Association, in its opposition to implementation of mandatory requirements, asserted the regulations were too stringent to enforce. For example, a nurse taking a washroom break must be replaced by another nurse for the duration of the first nurse's absence.
The Association stated it is impossible to guarantee every minute of the day every department or ward could comply with the regulations. The Hospital Association also stated emergency room waits would become untenable if the 1 to 4 nurse to patient is imposed.
Hospitals claim that, at the end of the day, the bottom line of revenues is inadequate to accommodate the number of nurses which they would need to employ if regulations, such as California's, become mandatory nationwide.
Common sense dictates a higher nurse-to-patient ratio can only result in better care for patients, improved patient self-care after discharge through pre-discharge education and, of course, a higher quality of life for nurses who will remain in a vocation they chose from a true compassion to help suffering human beings.
