Nurse Ratio Legislation Needed
American health care is being seriously squeezed by a nursing shortage. The number of aging Americans requiring more healthcare is increasing, while the number of registered nurses is decreasing. Because of the shortage, nurses often work longer hours with much heavier patient loads than they have in the past. Various plans have been proposed to provide sufficient nurse staffing. Many groups, including the American Nurses Association (ANA) are fighting for legislation that would set nurse staffing ratios.
Several studies have shown that inadequate staffing of nurses has a serious, detrimental effect on patient care and health. Inadequate staffing affects not only patient care, but also employee retention by hospitals and clinics. As fewer nurses work longer hours caring for more patients who are more sick, burnout is almost inevitable. Surveys have reported that 23% of all nurses questioned, and 33% of nurses under the age of 30 plan to quit their current job within the next year.
Proposals to regulate nurse workloads include nurse staffing plans, fixed mandated ratios, or some combination thereof. Fixed mandated ratio plans would have a universal number set by legislation. Nurse staffing plans would be more individualized, requiring input from practicing nurses. They would arrive at a ratio based on patient needs and various other criteria. Some combination of these two approaches may be what is needed. Setting nursing ratios might sound easy, however there all different types of units in a hospital, subacute facility or nursing facility that require different levels based on the acuity of the patients and the time of day. In addition, the states and the federal government have to figure out how to pay for these hours without causing harm to patient care.
The ANA maintains that the nurse staffing ratio be set at the unit level and include registered nurse (RN) input. They say such input should include factors such as patient acuity, the experience level of the nursing staff, the skill mix of the staff, what technology is available, and support services available to nurses at each specific healthcare unit. The ANA favors this approach because it is custom tailored to the specific workplace, and is not “one size fits all” legislation. Furthermore, it allows nurses greater empowerment as employees if they are treated as professionals and have direct impact on the decisions made by hospitals and clinics about the quality of healthcare they provide. This is a very encouraging approach to the problem, but nurses cannot provide the dollars necessary to implement this very sophisticated approach to setting staffing levels. Without new dollars, healthcare providers will need to take money from other areas of care and the end result maybe worse patient care, not better.
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