The conflict between nursing unions and hospitals over the staffing ratio is not a new one. Nurses want more specific regulations on how many patients there are per nurse, per shift, and hospitals are at best, vague in their response and reactions. Currently, only 13 states have laws and/or regulations in regards to the number of patients per nurse and the ANA (American Nurses Association) is pressing for more. Per the ANA website, a Federal regulation stipulates that hospitals must have “an adequate number of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed.” This is ambiguous, nor does it account for the number of patients that need more specialized care or the increasing number of hospital admissions. Usually, better nursing care means a lower risk of re-admittance—therefore, increasing the numbers of nurses should be a priority. Additionally, hospitals that employ an increased number of nurses assume a lower risk for mistakes. Fatigue is an important piece of evidence at the forefront of the nurse’s arguments: for both the nurse AND the patient. In a USA Today article, Pam Cipriano, President of the ANA cites, “If a nurse is fatigued, it is possible that a mistake could be made or someone could forget to pass along an important fact, or the person could be more on edge when dealing with patients.”
An increased amount of information is being researched and released in terms of nurses themselves getting hurt on the job—due to fatigue, long hours and lack of adequate staffing. In an ongoing investigation, NPR has a new series entitled, “Injured Nurses,” in which it reviews the cause of nursing injuries. It has focused specifically on moving patients; however there could be a link between not enough staffing and/or other nurses to help and why the injuries are happening.
The hospitals’ rebuttal to the claims? There just isn’t enough conclusive evidence to confirm one way or the other that an increased nurse-to-patient ratio would improve patient outcome. Hospitals are hesitant to adopt new policies for an increased amount of staff when the outcome of patients is not directly linked. It’s also difficult to say that on any given day or night you will absolutely need a specified, pre-determined number of nurses on staff, which obviously would affect the hospital on a greater monetary scale, ie, their bottom line.
And thus, here we are. The debate rages on and will continue to do so until more empirical evidence is provided and percentage of positive patient outcomes begins to decline with the ratio of nurses-to-patients cited as the reason why.
It’s hard to believe that hospitals could disagree, but just like any diagnosis—you can’t find a cure until you know for sure what’s causing the problem.
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