Finally, the Real Scoop About Staffing Ratios

For over a decade now, nurses in Massachusetts and other states have been lobbying for legislation that would mandate safe nurse to patient staffing ratios for hospitalized patients. For these nurses the kind of safe staffing ratios enacted in California in 1999 and implemented in 2004 has been the benchmark. Industry groups like the Massachusetts Hospital Association (MHA) have insisted the California law has not helped patients and that the public should not support staffing bills in other states. Their message to patients and the public is “ trust us and we’ll look out for you.” In spite of dozens of studies documenting that contemporary hospital staffing patterns are linked to patient mortality and preventable complications – hospitals continue to insist that there is no need for either government mandated nursing workloads.

Well just in time for this year’s Nurses’ Week, a major research study has documented the direct connection between California’s staffing ratios and reductions in patient deaths and complications.

The study in question is entitled “Implications of the California Nurse Staffing Mandate for Other States” and appeared in Health Services Research – a prestigious scientific journal. www.nursing.upenn.edu/chopr/…/Aiken.2010.CaliforniaStaffingRatios.pdf
Its authors include a rock star like line-up of the most prominent nursing workforce researchers in the world – like Principal Investigator Linda Aiken and co-investigators Sean Clarke, Joanne Spetz, Douglas Sloane and Linda Flynn. These highly respected academics are by no means mindless boosters of either ratios or the unions that have promoted them as a solution to widespread hospital understaffing. Yet these academics conclude that ratios save lives.

This conclusion is the result of a comparison of nursing workloads and patient outcomes in California and New Jersey, and Pennsylvania – states that have no limits on the nursing workload. California legislation mandates a one to five RN to patient load -on medical surgical floors and 1-4 on specialty floors like oncology. In fact, researchers found that many California hospitals actually had better nurse to patient ratios than were mandated by law. With California as the benchmark researchers collected data on the nursing workload and patient mortality in New Jersey and Pennsylvania. While 88% of medical-surgical nurses in California cared for five patients or less on their last shift, that was only true of 19 and 33 percent of medical-surgical nurses in New Jersey and Pennsylvania respectively.

In those states nurses, on average, care for one or two more patients per shift. Turns out that just one extra patient makes a very big difference. With California style ratios in force, the researchers concluded, there would have been 10.6 percent fewer surgical deaths in Pennsylvania and 13.9 percent fewer in New Jersey. Even managers and chief nurses in California agree that staffing ratios positively impact patient outcomes as well as nurse retention. Which is why the authors argue that “outcomes are better for nurses and patients in hospitals that meet a benchmark based on California nurse staffing mandates whether the hospitals are located in California.”

This research comes out at a particularly critical time for nurses and patient care. Because of the lingering recession, more RNs who left thr workforce because of exhausting patient loads have been forced back into active duty and hospitals been able to declare that the “nursing shortage” is over.. In reality, there’s still a problem because many institutions – like Boston Medical Center and Tufts –are using the economy as an excuse to lay off nurses.

Four years from now, just as RN baby boomers begin to retire in greater numbers, the Patient Protection and Affordability Act of 2010 will kick in. When it does, 31 million Americans who’ve gone without primary care and preventive services will suddenly get health insurance and many of them will end up in the hospital. Laying off nurses and increasing their workloads, –which hospitals are free to do in the absence of legally mandated staffing ratios– is no way to pave the way for this huge influx of patients. As hospitals administrators function more like bankers on Wall Street hedge fund managers, can we afford to let them go unregulated. What we also can’t afford is the persistent myth that ratios are not in effect today. In fact, hospitals already operate on the ratio system. It’s the get-away-with-whatever-you-can ratio system. Hospitals staff according to ratios now. These ratios, however, are determined neither by what the patient needs, or scientific evidence on the connection between nurse staffing and patient care and the ignorance of many in the so-called C-suite (CEOs, CFOs and COO’s) of the importance of nursing care.

The people who now determine how many patients a nurse cares for are the kind of people a nurse manager recently told me about. She was fighting for an appropriate budget for her nursing staff and wanted to staff with an appropriate nurse-to-patient ratio. Many of her nurses had been there more than five years. In her budget meeting, the CFO of the hospital, she said, insisted that ” a nurse is a nurse, is a nurse, is a nurse. A nurse who’s been in practice for more than five years brings no more added value than a new nurse, he insisted. With this kind of disinformation passing as fact it’s no wonder we’re in the situation we are in in health care and nursing.