The Fight Over Nurse-to-Patient Ratios Continues
"People over profits" has become a rallying cry for nurses who feel current hospital staffing practices are damaging to patient health and safety. This is especially true for #NursesTakeDC, a grassroots organization whose members led a march on Washington, D.C. this past April. While nurses continue fighting for federally mandated nurse-to-patient staffing ratios, progress is slow around the country.
A busy shift might not seem dangerous, but for some patients it could be the difference between a full recovery and a patient's death. Each additional patient on a nurse's roster can increase medical complications by 17%. Once a nurse is caring for four patients, each additional patient added to her or his care roster can increase mortality rates by 7%.
Research continues to link patient outcomes to nurse staffing levels. Many nurses know this, live this, and deal with the stress of having too many patients and not enough time.
Outside of negative patient outcomes, understaffing can also take a huge toll on nurses. About one in five nurses burns out within the first year of getting her or his license thanks to stressful work conditions. At two years, the ratio of nurses who opt to walk away from the profession rises to one in three.
The pitfalls of mandated ratios
Of course, not everyone is on board. Some hospital leaders are concerned about the added cost of new staff as well as accidentally conflicting with mandated minimums in the event of an emergency. In an interview with The Washington Post, the nursing director of Washington Hospital Center, Sue Eckert, expressed concerns in cases where nurses are late to work or call in sick.
With mandatory ratios, nursing directors might have to choose to violate the law when moving nurses between units to deal with short-term shortages. The Illinois Hospital Association suggests ratios may be too broad for different hospitals and worries about the availability of nurses for new positions.
While short-term emergencies and broad ratios may be legitimate concerns, we know many nurses are available and ready to answer the call.
Staffing ratio laws nationwide
Federal regulation requires hospitals participating in Medicare to have an "adequate number" of nurses. They don't actually specify what that number is, so the regulation’s actual effect is negligible.
While a national standard for nurse-to-patient staffing ratios does not currently exist, Congress has received several bills to change that. In February 2018, a bipartisan pair of congressmen introduced an amendment to the Social Security Act to the Senate and the House, but has stalled out in committee. While it does specify staff ratios, it focuses mainly on "certain Medicare providers" and not the entire country.
Nurse staffing laws vary by state. Currently only 14 states have any kind of law relating to staffing ratios.
- California is the only state requiring a minimum nurse-to-patient ratio by any unit.
- Massachusetts has ICU-specific ratios depending on the patient's stability.
- Minnesota requires a single chief nursing officer to develop core staffing plans with "input from others."
- Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington require staffing committees for hospitals.
- Illinois, New Jersey, New York, Rhode Island, and Vermont require hospitals to publicly report or disclose staff ratios.
Whether it comes in the form of state or federal regulations, safe staffing ratios are key to the health and well-being of patients and their nurses.