Hospitals Fight Nurse-to-Patient Ratios, Seek Alternatives To Use Nursing Staff More Efficiently

The Kaiser Family Foundation reported today that "The Wall Street Journal on Wednesday examined how "hospitals are fighting back against efforts to set minimum nurse-to-patient ratios and adopting new strategies to use nursing staff more efficiently" as the U.S. faces "a worsening" nurse shortage. According to the Journal, "an increasing number of states ... are considering legislation to ensure minimum" nurse-to-patient ratios at hospitals, and California already has passed a law mandating ratios in medical-surgical units. Proponents of the ratios say that "forcing hospitals to meet minimum staffing requirements is the only way to ensure patient safety, reduce patients deaths, recruit new nurses, and stop the ones already on the job from burning out and leaving the profession," the Journal reports. However, critics say that the ratios are not flexible enough to allow hospitals to operate safely and efficiently and that certain hospital units could be forced to close if the ratios cannot be met. In addition, opponents of ratios say there is no direct evidence that staffing ratios improve patient care. Pat Rutherford, a nurse and vice president of the not-for-profit Institute for Healthcare Improvement, at a patient-safety conference on Wednesday plans to propose that rather than impose staffing ratios, medical-surgical units should be restructured so nurses spend less time on paperwork, charting, finding supplies and operational problems. The Journal reports that hospitals also are "turning to more sophisticated computer programs and models to help them analyze their staffing needs and allocate nurses on staff more efficiently." In addition, staffing specialists are working with organizations like the American Nurses Association to develop "nurse-staff reporting cards that help hospitals compare staffing levels and patient outcomes with those of other hospitals," according to the Journal. The goal of such comparisons is to ensure that nurses with proper training and backgrounds are in certain units when needed, according to Gina Mumolie, a nurse and vice president of Aon Consulting (Landro, Wall Street Journal, 12/13)."

Dr. Linda Aiken did have supportive research concluding that hospitals with high patient-to-nurse ratios patient experience higher risk-adjusted 30-day mortality and failure to rescue rates. Supportive research needs to be conceived in this area as it is only looking at part of elephant. Individual institutions might benefit from conducting their own analysis of nurse-to-patient ratios and it's impact on quality and outcomes. However, the concept of ratios should not be ignored, besides a decrease in quality care, nurses are more likely to leave the patients bedside if they are burned out and feel powerless to change their work environment. This is a problem that is not easily solved and with each "knot released" there is the potential to create further complications.