“Unless the things keeping the nurses awake at night are keeping the execs up too, nothing will change” – Jane Lawless
I have spent close to 10 years in the nursing field, first as an LPN, then as an RN. As a floor nurse, I worked primarily night shift but also spent about a year working day shift. In my years as a floor nurse, the nurse to patient ratios at my facility changed numerous times. I ultimately chose to leave the patient bedside in favor of other pursuits because I was tired – tired of being forced to give sub-par care to my patients, when I desired to do so much more.
While there are a multitude of ways to improve our nursing care, imposing standardized nurse to patient ratios is an excellent way to start. Currently, California is the only state in the US with standardized ratios. That is ONE state out of FIFTY with evidenced-based, safe staffing ratios.
According to National Nurses United, it took nurses in California 13 years to win the battle for the standardized ratios. The standardized ratios have now been in place since 2004; that is 12 years ago, and not one other state has followed suit.
The Registered Nurse Safe Staffing Act was enacted in 2015. This Act requires Medicare-participating hospitals to establish a committee to create staffing plans specific to the units in their facility. The staffing plans should consider the complexity of the patients, the availability of equipment, and availability of nurses, amongst other factors. It also requires public reporting of staffing information.
This is a step in the right direction. According to New York State Nurses Association, the following statistics were noted:
- Hospitals that imposed a 1:8 nurse-to-patient ratio experienced five more deaths per 1,000 patients than hospitals with a 1:4 nurse-to-patient ratio.
- Odds of death increase by 7% for each additional patient that a nurse is assigned.
With statistics as startling as this, this “step in the right direction” needs to take a giant leap towards making ratios standardized.
Since California imposed standardized nurse to patient ratios, there have been various studies performed, many on patient outcomes and nursing satisfaction. For example, I discussed the fact that I left the patient bedside due to being exhausted. In a 2010 study, in California, 29% of nurses experienced high burnout, as opposed to 34% of nurses in New Jersey and 36% of nurses in Pennsylvania. I was also dissatisfied with the level of care I was able to provide; 20% of nurses in California experienced job dissatisfaction, compared to 26% in New Jersey and 29% in Pennsylvania.
In the same study, patient outcomes also improved. California reported almost 14% fewer surgical deaths than New Jersey and 10% fewer than Pennsylvania.
We all know how much the almighty dollar means in health care lately. As it turns out, having extra nurses on staff is actually cost-saving. For example, the addition of one RN job in an ICU equated to a 24% shorter time spent in that unit. An additional RN job on a surgical unit equated to a 31% decrease in time spent on the unit. Long-term-care facilities with additional nurses also report fewer costly complications, such as pressure ulcers and urinary tract infections.
The bottom line – imposing standardized nurse to patient ratios is good for many reasons. It is good for the staff, because as we know, happy staff will equal happy patients (and subsequently improved patient satisfaction scores). It is good for the patients, who will have improved outcomes. It is good for the patient families, who don't have to worry so much about the care their loved ones are receiving. It also is good for the facility itself, as more staff equals less negative patient outcomes – and negative patient outcomes are undoubtedly more costly than the salary of the additional staff.
Click here for National Nurse United's safe staffing petition. Consider signing it and sharing it with friends and family; together we can advocate for our patients and for ourselves.