Different hospitals have been adopting different nurse staffing systems depending on different factors. Ratio staffing involves specific RN-to-patient ratio. For instance, 1:2 is a ratio whereby one nurse is assigned to two patients. It has been the core supportive element of RN staffing, but it is rigid because it does not allow for acuity. In October 1999, California was the first state to enact mandatory staffing ratio legislation, which requires minimum, specific, licensed nurse-to-patient ratios for all acute care hospitals (Zimmermann, 2002). This legislation was sponsored by the California Nurses Association. The peak of a nurse’s concern over adequate staffing reached the public, and forced staffing changes for the better. Other states followed suit, introducing bills pertaining to staffing initiatives in their state legislatures.
Minimum ratios for critical care units were already in effect (Perrin & McGhee, 2008). These included hospital, intensive care units and operating rooms. Initially, management of hospitals could staff nurses across units in a flexible manner. A controversy arose regarding the effectiveness of the mandated staffing ratios legislation. This essay analyses the merits and demerits of mandated staffing ratios compared to acuity-based, flexible matrices established, through collaborative governance processes.
Mandated staffing ratios are said to limit hospitals’ flexibility in staffing. They prevent management from customizing staffing levels to patient needs. Besides, technology advanced hospitals may have difficulties in substituting technology for nurses appropriately. Opponents of the mandated staffing ratios have expressed their fears that the minimum staffing ratios would become the average staffing ratio, as hospitals may be tempted to reduce their staffing to the lowest level required by the legislation (Perrin & McGhee, 2008). The legislation is not empirically supported because previous data of staffing for best practices hospitals does not uniformly indicate that hospitals which are rated highly for quality of patient care have richer staffing than other hospitals (Perrin & McGhee, 2008). Therefore, critics of mandated staffing ratios argue that it is not clearly evident that legislating staffing ratios enhances patient care.
In Massachusetts, the Massachusetts Nurses Associations argues that the safe RN staffing bill in California is working, though they cannot demonstrate that patient outcomes have improved. Negative consequences have not occurred for the health care system, and a positive effect has been seen on the nursing profession from the mandated ratios (Perrin & McGhee, 2008). There had been no hospital closures in California. In addition, hospitals did not find it as tedious as they estimated, to meet the staffing ratios for the two and half years since the staffing ratios came into effect (Perrin & McGhee, 2008).
Proponents of the mandated minimum ratios claim that RN staffing had fallen behind the needs of the increasing severity of hospitalized patients, and higher RN ratios will increase patient safety and quality of care (Feldstein, 2013). They also argue that minimum legislated ratios will not become the maximum, but rather the best hospitals will exceed such standards and the worst will be forced to stop assigning eight or more patients to the medical surgical nurse (Dunham-Taylor & Pinczuk, 2010). They believe that failing to set minimum standards will not be impossible because of the shortage, but rather poor staffing is a cause of the shortage, and will continue until staffing is fixed.
Another drawback of the mandated staffing ratios is that staffing levels are determined by the government, away from the bedside. Given that it is only the hospital management that understands health care requirements in its units, it is controversial for the government to determine staffing levels, when the government officials do not have the slightest idea of hospital units. Also, mandatory staffing ratios represent a legislation that will take long to achieve the needed changes because they must go through legislation (Zimmermann, 2002). The minimum levels may become the standardized maximum for most hospitals, leading to deterioration in patient outcomes in hospitals and units where patients are many.
It may be difficult to achieve an agreement concerning what the optimal staffing level should be, among various nursing organizations. Also, the government assumes that a nurse is a nurse. Therefore, it bases the staffing ratios on mere numbers. This may be a misguided focus because the emphasis should be on patient outcomes, and not on mere members. It should be noted that having mandated staffing ratios does not guarantee the outcome of adequate staffing because staffing needs can change instantly, as a patient rapidly deteriorates. As far as different nurses are concerned, staff characteristics such as experience level, influence the patient load that a specific nurse can handle adequately differ significantly (Zimmermann, 2002). Besides, ratios may increase hospital costs (Feldstein, 2013).
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