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Mandatory Safe Nurse to Patient Ratios There is a constant conflict within the medical community regarding appropriate nurse to patient ratios. (Tieman, 10) By this moment, California has been the first state to pass the Safe Staffing Law (A. B. 394) mandating minimum ratios was enacted in October 1999 in response to legislators' concerns that quality of patient care is jeopardized because of staffing changes implemented in response to managed care. Now, the whole country may learn from the Californian experience: how it was implemented, the tools that have been used and its effects. Nurse-to-patient ratios explicitly mandate the number of patients cared for by a nurse at any one time. While ratio requirements are absolute, requests for waivers may be granted to rural general acute care hospitals.
A. B. 394, 1999 - 2000 Sess. (Cal. 1999). Department Proposed ratio Emergency rooms 1: 4 Medical-surgical 1: 6 Oncology 1: 5 Pediatrics 1: 4 Labor and delivery 1: 2 Post anesthesia 1: 2 ICU/CCU/neonatal intensive care 1: 2 Step-down units 1: 4 (source: web org / can / 12202) Nurses unions, including the California Nurses Association (CNA) and the Service Employees International Union, insist that higher numbers of nurses would improve patient care, consistently favored lower ratios in all units. In contrast, hospital officials around the country are concerned with the increased costs of hiring additional nurses, sought higher ratios. (Tieman, 8) Ultimately, the proposed regulations by states differ significantly from the interest groups recommendations. For example, California State proposed an initial ratio of 1: 6 in medical / surgical units, phasing into 1: 5 after 12 to 18 months. (California Nurses Association, supra note 2) This ratio stands in contrast with the nurses unions recommendations of 1: 3 and 1: 4 and the CHAs proposal of 1: 10. (Mahoney and Gilroy, supra note 1, at 145) The new rule requiring an increase in nurse hiring comes at a time when hospitals in California are already facing a severe labor shortage. Currently, California's nurse supply is among the worst in the nation, with only 544 nurses per 100, 000 people, compared with the national average of 782 per 100, 000. (Tieman, supra note 8, at 8) While Governor Davis has pledged $ 60 million for a nurse recruitment campaign, hospital representatives believe that they will nevertheless be unable to meet the state's requirements by the January 2003 deadline.
While 5, 000 nurses will be needed to meet the ratios, only 2, 500 nursing students graduate each year in California. (Tieman, supra note 8, at 8) Consequently, the hospital industry contends, hospitals may be forced to reduce services, increase wait times for patient care, and close units where there are not enough nurses to meet the standard. Several studies have suggested that higher nurse to patient ratios are associated with improved patient outcomes, affecting both morbidity (illness) and mortality (death). This is considered to be the main rationale for changing nurse to patient ratios. An American Nurses Association study (American Nurses Association, 1997) found that higher nurse to patient ratios were associated with shorter lengths of stay in hospitals and a reduction in complications such as pressure sores, pneumonia, urinary tract and postoperative infections. These results were consistent with a study published in 1993 (Prescott) that suggested that a higher ratio of RNs to other nursing personnel (licensed practical nurses, nursing assistants) was associated with lower patient mortality. In a large-scale study of 589 randomly selected community hospitals, Kovner and Garden (1998) demonstrated that there was an inverse relationship between the number of registered nurses and adverse events following surgery.
In other words, the fewer the registered nurses, the more frequent the complications. Even if such states, as California are able to find nurses to fill the positions, hospitals fear that the cost of additional staff will prove prohibitive. The CHA has estimated that if the current proposal is implemented, California hospitals will spend an additional $ 400 million annually on staffing, with individual hospitals shouldering costs between $ 200, 000 and $ 2. 3 million annually. (Tieman) California Hospital Association spokeswoman Jan Emerson said the association was surprised by the new ratios for telemetry, step down, and specialty units, and was not aware that a lower ratio for 2008 was being discussed. Even more problematic is the increased pressure the tougher ratios will put on the states severe nursing shortage, she said.
We dont know where the nurses will come from, Emerson said. (BNA Health Care Daily Report) On a positive note, Emerson said the latest proposal would give hospitals more flexibility by allowing the use of charge nurses and supervisors to fill in for nurses on breaks, and allow nurses monitoring emergency room radios and triage stations to perform other duties. Under the previous proposal, those nurses would have been restricted to monitoring duties only. (BNA Health Care Daily Report) CNA, which backed the 1999 law requiring the state to set staffing ratios (A. B. 394), praised the new proposal as a significant step toward improving patient care. CNA represents 50, 000 nurses, and has been pushing for statewide staffing ratios for 10 years. (BNA Health Care Daily Report) The finish line is finally near, CNA President Kay Mc Vay said. Every patient should be able to demand and count on receiving the registered nursing care they need, when they need it. (BNA Health Care Daily Report) Meanwhile, SEIU continued to criticize the regulations as not going far enough, fast enough. SEIU said it is launching a postcard campaign during the 15 -day comment period on the proposed regulations, and is petitioning all major hospital systems in California to implement the new ratios before the regulations take effect. (BNA Health Care Daily Report) Patients need safer ratios, sooner, Luisa Blue, president of the SEIU Nurse Alliance, said.
Strong, safe and enforced ratios will help hospital patients get the nursing care they should expect. (BNA Health Care Daily Report) So how will the hospitals institute changes in the nurse to patient ratios? A research indicates that savings from the rule will offset the costs of hiring new nurses. First, the CNA explains, improved ratios will improve care and decrease patient length of stay -- an estimated savings of $ 2 billion per year for California hospitals. Second, the CNA asserts that hospitals will reduce costs by having to hire fewer temporary registered nurses (RNs), a practice that generally costs around $ 10 more per hour than permanent staff. Finally, the CNA points to the exorbitant costs of recruiting new RNs and maintains that increased nurse satisfaction under the new scheme will likewise lower these expenditures. (California Nurses Association) Additional questions surround the states strategy for enforcing the rule. With patient volumes fluctuating, often rapidly, throughout the day, compliance with the ratios may be difficult to evaluate.
DHS has stated that it will inspect hospitals after it receives a complaint from a patient or a nurse indicating a violation. Consequently, nurses unions have begun to train nurses to police the hospitals for violations. Any violating hospitals will be put on notice by DHS and required to create a plan of correction to remedy the staffing shortage. Penalties - as yet undetermined - will be imposed on facilities failing to comply. Both CNA and SEIU are backing bills pending in the state Legislature that would establish enforcement procedures once the ratios are in place. Both bills would require DHS to conduct unannounced inspections of hospitals to ensure they comply with the ratio regulations, and set fines for noncompliance. (BNA Health Care Daily Report) A.
B. 253 by Assemblyman Darrell Steinberg (D) is sponsored by CNA and would provide for fines of $ 1, 000 a day for noncompliance with the ratio regulations or a plan of correction. Fines would increase to $ 5, 000 a day if a violation stems from a prior correction plan in the same hospital unit. A. B. 253 was scheduled to be heard in the Senate Health and Human Services Committee July 2. (BNA Health Care Daily Report) S.
B. 1005 by Sen. Joseph Dunn (D) is sponsored by SEIU and would impose fines of $ 50 per bed per day on hospitals found to be out of compliance with the ratios. Hospitals with more than 100 beds would face minimum fines of $ 5, 000 a day. S. B. 1005 passed the Assembly Health Committee July 1. (BNA Health Care Daily Report) Stiff penalties and unannounced inspections are the key to enforcing these ratios, Blue of SEIU said. Hospitals should be fined for putting patients at risks, and the state must be able to inspect hospitals without giving them time to hide problems with temporary staff or equipment. (BNA Health Care Daily Report) The work environment of nurses, the largest segment of the nations health care work force, needs to be substantially transformed to better protect patients from health care errors, says a new report from the Institute of Medicine of the National Academies.
The report calls for changes in how nurse staffing levels are established and mandatory limits on nurses' work hours as part of a comprehensive plan to reduce problems that threaten patient safety by strengthening the work environment in four areas: management, work-force deployment, work design, and organizational culture. No one or two actions by themselves can keep patients safe, said Donald M. Steinwachs, chair of the committee that wrote the report, and chair, department of health policy and management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. Rather, creating work environments that reduce errors and increase patient safety will require fundamental changes in how nurses work, how they are deployed, and how the very culture of the organization understands and acts on safety.
We present a comprehensive plan to address all these areas. While California is the first state to pass a law on mandatory safe nurse to patient ratios, other states are currently considering similar legislation. Massachusetts, Rhode Island, Ohio, and Florida all have minimum nurse staffing bills on the floor. In addition, Oregon passed a bill in June of 2001 that requires its acute-case hospitals to work with nurses to develop appropriate ratios. Although several bills are gaining momentum, the judicious policymaker would be wise to wait and see the financial toll that such a rule will have on the California hospital industry. California will analyze the impact of the law over the next five years, at which time the merits of an explicit rule could be better evaluated.
Caution is particularly important when the value of lower nurse-to-patient ratios remains unclear. While nurses groups assert that the new staffing requirements are justified by improvements in patient care, studies analyzing the effect of minimum staffing ratios are largely inconclusive. While practitioners hope that data from the California experiment will provide conclusive evidence supporting their position, others doubt that researchers can effectively isolate the impact of staffing changes from other advances in the hospital environment, such as technology. References California Nurses Association, Ratios to Halt RN Exodus, available at web exodus.
html Final Mandatory Nurse Staffing Ratios Boost Requirements for Three Units BNA Health Care Daily Report, July 3, 2003 Mahoney and Gilroy, supra note 1, at 145. DHS must adopt the regulations in accordance with licensing and certification regulations in [subsection] 70053. 2, 70215, and 70217 of Title 22 and [section] 1443. 5 of Title 16 of the California Code of Regulations. A. B. 394, 1999 - 2000 Sess. (Cal. 1999). L.
Schiff, Staffing Ratios Proposed in California - But Still Not Final, RN, 65 (2002) J. Tieman, Counting Down: California Lawmakers Face Staffing Ratio Deadline, Modern Healthcare, December 24, 2001 J. Tieman, But Does It Work? Measuring Effect of Staffing Ratios Could Be Tough, Modern Healthcare, March 4, 2002, at 10.
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Research essay sample on Mandatory Safe Nurse To Patient Ratios
