Nurse-to-patient Ratio Staffing - Research Paper Example

Nurse-to-patient Ratio Staffing al Affiliation) Nurse-to-patient Ratio Staffing Legally man d nurse to patient ratios is a controversial topic in healthcare. In this profession, there are state laws that require a certain level of staffing for each particular unit. Hospitals must balance their revenues with expenditures and patients and nurses are affected by these decisions. Mandating ratios is one attempt to ensure that a nurse workload does not exceed the needed level for adequate patient care (Conway, 2008). However, these essential ratios are not without consequences. Ratio advocates argue that fewer staffing levels are appropriate for patient care, better working conditions and higher rates of nurse retention. Those who oppose, claim that ratios will affect hospital budgets and reduce management flexibility in addressing patient’s needs. The paper will research the problem in both sides, having arguments opposed and in support of mandatory ratios. I will use survey data, interviews and original research to support both sides. Introduction Nurses have an integral role in the systems of health care. State-mandated safe-staffing ratios will be important to ensure both patient and nurse safety. Adequate staffing is a way to nurse retention and patient care while lack of staffing can endanger patients and can pull the nurses away from their profession (ANA, 2011). However, staffing can also increase budgets and affect the management flexibility in dealing with patients problems. Does the nurse to patient staffing ratios affect the hospital performance positively or negatively? Since 2004, many states have had legislations that address safe-staffing nursing concerns. As of December 2013, more than 13 states had adopted regulations or enacted legislation to address nurse staffing. A total of seven states require their hospitals to begin staffing policy committees. Five states need public reporting or disclosure of staffing. Other eleven states started staffing legislation only in the first two months of 2012 (ANA, 2011). When the year was ending, 16 states enacted regulations or laws on nurse’s mandatory overtime. Most prohibit hospitals from wanting overtime with the exception of public health emergency. Nationally, the action of legislation was put forth with the aim of giving nurses influence in staffing levels shaping. Unfortunately, under the 113th congress passing the safe staffing legislation, it proved to be difficult in 2013-2014. ANA supported the legislation of safe staffing introduced in 2013 in the house, as of 2014 the Act of Registered Nurse Safe Staffing still exists committee. The Act requires Participation of Medicare in hospitals to implement plans on staffing nursing services that are provided by the hospital. The plans will develop through coordinating nurses with the unit needs (ANA, 2011). In April 2013, National Nursing Shortage Reform and Patient Advocacy got introduced by Senator Barbara Boxer. The bills amended the Public Health Act to create registered nurse-to-patient direct care staffing ratio needs in hospitals and other health facilities. In May 2013, Jan Schakowsky introduced Nurse Staffing Standards aimed at the Patient Safety and the Quality Care that would start federal staffing ratios in every hospital. In addition, it would restrict mandatory overtime to emergency times. Impacts of staffing Staffing improves the workplace and patient care. California was the first state to execute minimum nurse-to-patient staffing ratios. It targeted to improve nurse retention and patient care. Various studies show that the program improved the nurse retention and patient care. According to the study of 2010 by the University of Pennsylvania researchers, around twenty-nine percent of California nurses went through high burnout. It at a minimum compared to 36 percent of Pennsylvania nurses and New Jersey 34 percent nurses. The study also realized that 20 percent of California nurses reported not to have satisfaction with their jobs. It was also a minimum number compared to 29 percent and 26 percent in Pennsylvania and New Jersey (Linda, 2010). Within 30 hospital days, the nurse staffing ratios for California had a minimum likelihood for in-patient death than in New Jersey or Pennsylvania. There were also few chances of death due to failing to respond well to the symptoms in California. In addition, California had 13.9 percent and 10 percent fewer deaths due to surgery than New Jersey and Pennsylvania. To add with, according to Linda staffing study in 2007, an increase to a single registered nurse per patient influenced the 24 percent minimum record on reduction of the spent time in the I.C.U. There was also a 31 percent reduction in time spent in of surgical units. In the long-term, patients in care facilities with more direct nurse had acute care hospitalizations; few pressure ulcers and urinary tract infections. The Journal of Hospital Medicine discovered that minimum staffing legislation affects uninsured and poor patients. The hospitals with Medicaid and uninsured patients are very likely to be above minimum nurse-to-patient ratios compared to low proportioned hospitals with Medicaid patients (Conway, 2008). Safe-Staffing Ratios can keep Nurses in profession. Safe-staffing ratios can be a good way to retain nurses who have experience. It can also lure those nurses who left the hospital or field to come back and attract learners in school to join the field. Most researchers have discovered that factors like mandatory overtime associates with the intention of nurses to stay in their profession. Reports indicate that many nurses depart their positions in hospitals after working for one year. Therefore, when the nurse-to-patient ratio regulations got implemented in January 2004, California Nursing Board had many applicants from other states. That year, nursing license application plummeted by more than 60 percent. By 2008, registered nurse vacancies at California increased by 69 percent (Linda, 2010). In 2010, Aikens study suggested that both nurse managers and nurses agreed that the legislation of ratio improved retention and recruitment of nurses. It also reduced the nurse workloads and the quality of care. Safe-Staffing Ratios have no burden on hospital’s finances. Even though some safe-staffing critics say that mandatory nurse-to-patient, ratios give hospitals high operational costs, the majority research shows that the program is cost-effective. High temporary nurse staffing levels and high turnover rates raise the average cost per inpatient care and entire operating costs. Safe staffing also improves the performance of nurses and rates of patient mortality reduce staffing costs, turnover rates and liability (McCue, 2003). The Journal of Health Care Finance study reports that the growth of nursing staffing increases a hospital’s operational cost, but the overall hospital profitability does not decrease. In addition, a 2009 study reports that increase of an additional 133,000 nurses to the workforce of the hospitals across U.S. would result to $6.1 billion medical savings, reducing the care cost of patients. It does not include increased productivity when nurses assist patients to recover quickly. The ratios also minimize additional costs of staffing agencies and supplemental nurses, as nurse retention increases with safe staffing (McCue, 2003). It is typical if hospitals minimize their burned-out nurse proportion from 30 percent to 10 percent. According to the study of the University of Pennsylvania, hospitals can prevent 4,160 annual cases of the most common two hospital-acquired infections. Hence, save more than $41 million. Linda Aiken states that it costs hospital more income if they do not spend on income. Understaffing can cause expensive Human Resource Issues Nursing profession demands force many nurses to ruminate part time nursing to other alternative careers. In 2011 survey, about 45 percent of the nurses who were in the survey had plans to make changes in their career in the following one to three years. One-third of the surveyed nurses consider careers, which were outside nursing. American Association of Colleges of Nursing argues that the average nurse’s cost-per-hire is about$2,820. Other studies estimate that the overall cost per nurse’s turnover is about $65,000. The hospital is expected to lose an estimate of about $300,000 annually for every nurse turnover percentage increase (ANA, 2011). The employers mostly use supplemental nurses in filling nurse staffing gaps temporarily as a way to enforce mandatory overtime. The temporary nurses are mostly in hospitals with inadequate resources and poor staffing rates. The temporary nurses represent between 5-15 to hospital nursing staffs. Supplemental nurse staff becomes expensive mostly when they form outside agencies. Hospitals pay approximately between $250,000 and $400,000 on services provided by staffing agencies for each one million dollar used on temporary-nurse staffing. The temporary nurses have their compensation at between 25 percent and 40 percent rates, which is above the average wage for nurses. Therefore, an increase of cost can further contribute the permanent nurse’s resentment (Linda, 2010). Therefore, an increase in temporary nurse percentage reduces the quality of care to the patient. Hospitals that have less than 5 percent temporary nurse staffing report few patients and few hospital-acquired infections compared to those with over five percent temporary nurse staffing. The nurse work-related injuries percentage is also significantly high in hospitals with more than five percent temporary nursing staff. Understaffing can endanger the patients and nurses American Nurses Association states that massive reduction in nursing related budgets combined with increased nursing shortage challenges have led to few nurses that work long hours and care for patients. The situation distracts care and influences the nursing shortage through creating an influential environment from the bedside (ANA, 2011). Long working hours and inadequate staffing can affect the health of the nurses (ANA, 2011). It increases the risk of having musculoskeletal disorders, cardiovascular disease, hypertension and depression. In 2012, 11,610 of registered nurses had suffered MSDs incidents, resulting to a median rate of about eight days far from work. Among all healthcare technical occupations and practitioner, 65,050 of them had an illness and nonfatal occupational injuries that needed a median seven days far from work (ANA, 2011). The cardiovascular health of the nurses suffers due to working long overtime and over shifts. In a 2010 research, it shows a clear trend between heart disease incidents and frequent overtime work. The workers reported an overtime of about three to four hours daily hence, 1.6 times most likely to get cardiovascular health disorders (ANA, 2011). Many nurses also had complaints about the current workloads that lead to burnout. Burnout symptoms are irritability, fatigue, headaches, insomnia, weight gain, back pain, high blood pressure and depression. Researchers state that every added patient above four per nurse has 23 percent burnout growing risk and 15 percent job satisfaction decrease. In August 2012, estimated one-third of nurses had an emotional exhaustion of about 27 percent that is a high burnout according to medical standards (Linda, 2002). Apart from occupational hazards, a result of understaffing, many studies show a relationship exists between poor patient outcomes and inadequate nurse staffing. High nurse-to-patient ratios are linked to growth of medical errors and patient infections, pneumonia, bedsores, cardiac arrest, MRSA and accidental deaths (Linda, 2002). Every added patient to a nurse in the hospital staff leads to the growth of hospital mortality. The study carried out by Centers for Medicare and Medicaid Services in 2008 found out that the bottom 30 percent staffing levels facilities were likely to be one of the worst 10 percent facilities. The worst facilities led to electrolyte imbalances, heart failures, respiratory infection, sepsis and urinary tract infections. Research also shows that the hospitals that perform highly have a culture of the organization that defends acute myocardial infarction improvements efforts in the hospital (Linda, 2002). Long-term patients in understaffed facilities have poor outcome. The outcomes can include weight loss and skin trauma. According to American Journal for infection Control study, high exhaustion levels and large patient loss among nurses is linked to surgical-site and urinary tract infections (Jeannie, 2012). The England Journal of Medicine also examined the correlation between variations of shift-to-shift, day-to-day variations and mortality in unit level staffing. The study shows that the death risk increased to two percent with exposition of patient to shifts with fewer target nurses staffing. In the study, the average patient is exposed to three below target nursing shift staffing that result to six percent high mortality risk. The mortality risk is four percent high if the patient is exposed to a shift of a high turnover (Needleman, 2011). CHALLENGE Mandated Ratio Legislation inflexibility Interviews with the leaders of nursing reveals that they are very dissatisfied with the mandated ratio legislation inflexibility. After the implementation of the mandated ratios, the biggest issues the hospital face is maintaining the needed rations when the nurses are away on official breaks. It is not only logistical headache but also the nurses are not happy due to the autonomy loss on breaks scheduling to fit with patients requirements. The remedies like using agency staff float nurses or charge nurses to represent the nurses during their breaks did not satisfy in terms of administration standpoint or patient safety. Furthermore, hospitals that removed ancillary staffs so that they can pay for more nurses, registered nurses are needed to take the tasks that assistive personnel performed formerly. Hence, another premium dissatisfaction according to the nurses (Jeannie, 2012). According to Laura, the researchers focused on the impacts of mandated ratios of California and its main quality measures since 2004 to 2006. They observed that nurse-sensitive outcome improvements were not there although the nurse staffing and mix of skills were consistent with the increases. No statistically significant patient falls, restraint use or ulcer development trends were there (Laura, 2009). In Australia, the effects of mandated ratios were lower compared to those in California. They also set different day versus night shifts level on most units. Although the impact and implementation are reported to be uneven, some disadvantages have come up. Even though the mandated ratios had 2,650 nurses come back to Victoria health system, the nurses pay raises were reduced to pay the additional nurses (Laura, 2009). Mandated ratios alternative Hospital staffing plans The main alternative to the mandated ratios is for hospitals to have their own customized plans for the staff. The plans can incorporate unique factors to their facilities that cause nursing workload. Theoretically, staffing plans allow nurse-staffing levels adjustments based on the patient acuity, skill mix, staff experience and other experiences. Therefore, staffing plan can ensure that every day, for every shift, on every unit, there is a suitable number of nurses to give safe care (Laura, 2009). Conclusion There are different perspectives on staffing ratios. However, from the research there is the need for appropriate mix of skills and adequate numbers of nurses to give safe care to patients. The objectives of the correct staffing ratios are to develop patient safety and care at the bedside. The correct staffing ratios ensure that there are few instances of complications due to poor care, shorter hospital stays and more satisfied nurses. In addition, the hospitals will retain and recruit adequate nurses improving quality of health care services offered. Therefore, mandated ratios have affected the hospital performance both positively and negatively. References Laura S. A (2009). Nurse Staffing For Safety. Medscape. Oct. 28, Linda A., et. Al. (2010) “Implication of the California Nurse Staffing mandate for other States,” Health Services Research, 45, (4) 21-29 American Nurses Association, (2012). “Safe Staffing: The Registered Nurse Safe Staffing Act,” Retrieved from http://www.nursingworld.org/SafeStaffingFactssheet.aspx Date of Access 11th November 2014 Linda A., et. al. (2002). Hospital Nurse Staffing and patient Mortality, Nurse Burnout, and Job Satisfaction,” The Journal of the American Medical Association, 288 (16) 45-59 P.H. Conway, et. al.,(2008). “Nurse Staffing ratios: trends and policy implications for hospitalists and the safety net,” Journal of Hospital Medicine, 3(3) 89-95 Jeannie C. P, et. al. (2012) “Nurse staffing, burnout, and health care-associated infection,” American Journal of Infection Control, 40 (6) 468-478 Needleman J., et. al. (2011) “Nurse Staffing and Inpatient Hospital Mortality,” New England Journal of Medicine, 362 (11) 446-456 Read More