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.

Linda Aiken Sheds Some Light on the Nursing Shortage

Last month the Health Affairs Blog featured Linda Aiken . Dr. Aiken has been a major contributor to health workforce and outcomes research for the past two decades. She discusses the 7 Myths currently surrounding the nursing shortage as it exists today and as projected in the future.

"Currently, the United States is short an estimated 150,000 nurses. Yet over the next decade, more than 650,000 new jobs in nursing will be created. At the same time, an estimated 450,000 nurses will have retired. By 2020, the nurse shortage is expected to increase to 800,000. I set out to debunk a number of popular myths surrounding the current nurse shortage at a recent meeting convened in Washington, D.C. on the future of nursing. The September 20-21 meeting was sponsored by Health Affairs, the Robert Wood Johnson Foundation, and the John A. Hartford Foundation ."

I agree with Dr. Aiken's assessment that we do not know how to solve the nursing shortage is a myth. We need more support of the education of nurses and the creation of more efficient ways to obtain a BSN. Higher pay incentives for faculty need to be available and nurses should be reimbursed for their services not as viewed as an hospital expense.

I would like add that stronger media representation of nurses should be advocated for similar to the initiatives of The Center for Nursing Advocacy. Many young people today who do not have personal contact with a nurse (social or through the health care system) will get their perception of nursing primarily through the media. Negative and inaccurate images of nurses in the media will deter intelligent men and women from entering the profession and will undervalue our life-saving skills and education.