Mandatory Nurse-Patient Ratios Policy - Assignment Example

Mandatory Nurse-Patient Ratios policy Mandatory Nurse-Patient Ratios policy Introduction Nursing staffing policies have been attracting different stakeholders in the medicine sector in a great way. Regulations governing and monitoring the working environment have raised a great concern to patients, nurses, physicians, nursing organizations, medical unions, researchers, hospital managements and both federal and state government. According to Douglas (2010), mandatory nurse-patient ratios are still the most controversial issue that is affecting wide range of stakeholders in the nursing sector. Currently, there are many debates globally concerning the application of the Nursing Ratios in hospitals to staff nurses in different units. The policy was first implemented in the California legislature through the passage of the Bill 394. Stakeholders such as the Institute of Medicine, California Hospital Association, California Nurses Association and the Service Employees International Union combined efforts and contributed jointly to development and implementation of the nursing policy. These associations contributed significantly in the policy formation process to address a number of factors. Factors addressed comprised of inadequacy of nurses in hospitals, registration of nurses, poor results from nurses and poor patient care services (Tevington, 2011). Health care stakeholders believed that the policy would solve problems experienced in the healthcare sector. In addition, they believed the policy would increase desired patient outcomes, increase recruitment of nurses, decrease shortages of nurses and increase job satisfaction (Unruh, 2008). Currently, many legislatures in the world have adopted the nursing policy and others are still adopting the policy. Purpose of the policy Mandatory Nurse-Patient Ratios Policy was developed for several purposes. The nursing policy was developed in order to develop an appropriate and specific ratio of nurses to patients that would be adopted by hospital to ensure that there are adequate nurses. In addition, the policy focused on improving the patient results in hospital through employment of registered and licensed nurses in different units in hospitals (Tevington, 2011). Scope The Mandatory Nurse-Patient Ratios Policy has a wide range of users and participants. According to Douglas (2010), users of the Mandatory Nurse-Patient Ratios Policy consist of patients, physicians, nurses, healthcare unions, medical researchers, nursing organizations and associations and state governments. The policy affects nurses, patients and hospitals directly and physicians, health unions, medical researchers and nurses-based organizations were affected indirectly. Definitions Registered nurses- these are nurses with valid government licenses allowing them to work in different units in hospitals. Contract nurses: Nurses working under agency to provide nursing services to patients in various health care units. Intensive Care Unit/ Critical care Unit- a special unit of health care center or hospital that is responsible for providing intensive care medicine. Nurse-Patient Ratios: quantitative relations between the number of nurses and the number of patients. Mandatory overtime- requirement of additional working hours set by the employing agency or an employer beyond the agreed working time. POLICY In intensive care units (ICUs), staffing ratios that are the ratio of one nurse-care provider to patients have been standardized for about 30 years. In almost all ICU, one registered nurse (RN) attends to two patients. The idea of setting standard ratios agreed in 1990. Since then, many states have considered the nurse patient ratio policy, as well as alternative staffing solutions for all hospitals. This gives an update on mandated nurse staffing ratios and alternative approaches for hospitals (Wallis, 2013). Shift work of nurses is one of the issues that have been addressed by this policy. Nurses work with shifts of about eight to 12 hours and there are different types of shifts the nurses can be scheduled to work. They can either be allocated to work in the day, evening, night or combination of both. A recent research that was conducted on randomly selected nurses found that most of the nurses had long working hours of around one hour every day. The extra working time was an average of 55 minutes longer than scheduled each day. It was revealed that most of the respondent claimed to work6 to seven days a week (Kane RL, Mueller C, Shamliyan T, Duval S, 2007). These long working hours were attributed to procedural and medication errors. However, the age of nurses, hospital sizes and the unit the nurses worked in did not affect errors that they made. There were also risks that were connected to nurses working overtime. Nurses who rotated shifts had a higher possibility of getting involved in automobile accidents or other injuries. It is clear that among the nurses who worked in the intensive care department in the night shifts many of the change had depression and poorer global sleep than nurses who worked on the day shift. The results of staffing policies show that the length of nurses’ shifts should be no more than 12 hours and a law should be implemented to prevent work hours exceeding 12 hours according to the policy. Also requiring nurses to work rotating shifts should be curtailed (Tevington, 2011). Contract nurses are another problem that affects nurse staffing ratio policies. One descriptive study indicates that non-salary benefits do not motivate nurses and higher salary paid to agency nurses do not motivate hospital nurses. The same survey revealed that the agency nurses worked in the evening and night shifts and during weekends due to motivation. However nurse managers do not see nurse business as a cost effective way, but using agencies reduces overtime. The hospital should use the register nurses and those who are licensed according to the policy. They should also consider the number of patients who are in their intensive care units (ICUs) and allocate nurses in the ratio of one nurse is to two patients (Tevington, 2011). Hospitals can also use internationally educated nurses. The policy can help in the reduction of the nursing shortage. The internationally educated nurses add up to 3.7 percent of the registered nurses population. This move would help to meet the required nurses to patient ratio in the United States hospitals. Internationally Educated Nurses (IENs) should be treated fairly equally without discrimination. The policy would motivate the internationally educated nurses to feel obliged to give their services to patients. Integration of the internationally educated nurses in the intensive care units with United States educated nurses is mandatory for the purpose of formulating organization policy. Understanding the composition of this demographic group may lead to effective integration allocation of nurses who are educated other countries. Hospitals can also embrace the use of part timer nurses. In cases of emergencies, the part timer nurses can be called to assist the full timer nurses perform the duties. Observation reveals that the policy would ease congestion and also should ensure that the nurse to patient ratio policy (Wallis, 2013). However, there are many limitations of the nurse to patient ratio policy. Patients are not all alike. Their needs are also individually independent. Some patients who are in critical condition may require maximum supervision from the nurse. Therefore, an individual nurse to supervise a single patient may dispute the nurse to patient ratio. There are many different nursing units. Even those with the same area of specialty are not alike. Some can work under intensive disease while others cannot. Nurses’ area of specialty fully depends with person’s personality. Allocating a nurse who cannot work under intensive conditions may be an uphill task to him or her and, therefore, may not be able to deliver quality services to the patients (Mitchell, 2010). Each hospital is different with many variations, for example, the area. These variations may affect their staffing. Some hospitals area may be in rural areas where there is unavailability of nursing skills. In such an instance, it may be cumbersome for hospital to meet the mandatory nurse patient ratio. The nurse resources are not equivalent with respect to training and education. Equipping training facilities for nurses is another problem, since some are better than other than others; therefore, some may deliver quality services that other. Nurses with better resources in education and training may handle offer quality services to the patients compared to the rest (Tevington, 2011). The policy also focused on the nurse overtime. Working time of ICU nurses has currently raised discussion among different stakeholders in the healthcare sector. According to Bae (2013), the working schedule of nurses in most hospitals extends beyond the regular working schedule. Research carried out in several hospitals show that a large number of nurses work beyond the normal working time limit every day. For example, research conducted by U.S. hospitals show that, forty percent of registered nurses in United States work for long hours, usually more than 12.5 hours in a 24-hour period. In addition, these nurses resume working quicker than their expected time. A report by National Sample Survey of Registered Nurses (NSSRN) show that nurses in many hospital, in United States work for more than 40 hours in every week. (Bae, 2013) Some hospitals have set mandatory overtime to their nurses in different units. Mandatory overtime refers to the requirement set by an employer or employing agency to extend the standard working hours by a specified or unspecified hours. Mandatory overtime includes call hours or emergency hours which exceeds the regular working hours of a nurse. Many hospitals use overtime facility where some nurses are unavailable to attend to working in the upcoming shift. Overtime is also used as a way of covering employment gaps where nurses are inadequate to attend to patients (Danielle M. Oldsa, Sean P. Clarke, 2010). Working overtime especially for ICU nurses have negative effects. First, nurses lack sufficient resting time that is basic for each and every person. Lack adequate resting hours may result to inefficiency of nurses in their service to patients. In addition, overtime may result to fatigue, deficits in performance, pain and restlessness to nurses. Nurses may also make errors make inaccurate justification that result to poor performance and negative patient satisfaction. The Mandatory Nurse-Patient Ratios Policy ensures that nurses work within the normal working schedule of 8-12 hours in a 24 hour period. The policy ensures that nurses provide high quality services to patients and their working conditions are favorable (Bae, 2012). In conclusion, establishment and implementations of the Mandatory Nurse-Patient Ratios Policy in California has contributed to the rapid adoption of similar policies in different parts of the world. The adoption and incorporation of some aspects of the policy in other countries are associated by the benefits discussed above. According to Tevington (2011), legislatures in other states have adopted the policy effectively. These states include New York, New Jersey, Vermont, Illinois, Texas, Rhode Island and Nevada (Tevington, 2011). References Bae, S.-H. (2012). Nursing Overtime: Why, How. CNE Series, 61-68. Bae, S.-H. (2013). Presence of Nurse Mandatory. CNE series, 59-63. Danielle M. Oldsa, Sean P. Clarke. (2010). The Effect of Work Hours on Adverse Events and Errors in Health Care. NCBI Resources, 153-162. Kane RL, Mueller C, Shamliyan T, Duval S, Wilt T. (2007). Nursing Staffing and Quality of Patient . Evidence Report/Technology Assessment No. 151, 49-67. Manjlovich, M. (2009, March). Seeking staffing solutions. Retrieved from American Nurse Today: http://www.americannursetoday.com/article.aspx?id=4964&fid=4922 Mitchell, P. H. (2010). Nurse Staffing – A Summary of Current Research, Opinion and Policy. A report of the Ruckelshaus Center Nurse Staffing Steering Committee, 6-20. Tevington, P. (2011). Mandatory Nurse-Patient Ratios. California: Medsurg . Wallis, L. (2013, August). Nurse–Patient Staffing Ratios. Retrieved from American Journal of Nursing: http://journals.lww.com/ajnonline/Fulltext/2013/08000/Nurse_Patient_Staffing_Ratios.17.aspx Read More