November 07, 2011
Mandated nurse-to-patient ratios are a controversial topic in healthcare. In this practice, state laws are established that require a certain level of staffing within a particular unit. Organizations such as hospitals must balance income with expenditures, and nurses and patients may be affected by these decisions. Mandating ratios is one attempt at ensuring nurses’ workloads do not exceed what is needed for adequate patient care. However, these ratios are not without consequences. This paper explores both sides of the issue, presenting arguments in support of and opposed to mandated ratios. Throughout this paper you will see the pros and cons of nurse to patient ratio and at the end you should be able to make a personal and educated decision for this very important topic that will affect you or someone you know at some point in your life. As Ms. Smith, a Registered Nurse with ten years experience in the orthopedic unit, entered the floor, she was alarmed to see that one of her coworkers had called in sick. In this 30-bed unit, the typical staff to patient ratio was 1:9 or 1:10, a ratio borne out of necessity due to funding cuts and decreases in Medicare reimbursement, as well as shortages in the pool of nurses. Ms Smith knew right then it was going to be a long stressful night because not only did she have to take care of her normal ten patients she would now have to take on about fifteen, five more than normal. Ms. Smith, after reviewing patient information, walked toward the room of her first patient on this night, an elderly gentleman recovering from a hip replacement earlier that day. Although it was after 11:00 PM, a time when most patients would be sleeping, five of her patients had received prosthetic joints that day and required additional care, particularly related to pain management. While talking with the first patient, Ms. Smith could hear another elderly woman down the hall screaming for assistance, the alarm sounding on an IV pump in the room
next door and another nurse calling for help as one of her patients fell while trying to get out of bed. Feeling stressed over her inability to give each patient what she believed was an adequate amount of her time and the various crises arising by the minute, Ms. Smith contemplates finding another job in a less busy and stressful environment. Unfortunately, this is what typically happens to almost all nurses on a daily basis and it creates an enormous amount shortages because the nurse is overwhelmed and stressed out to the point of quitting.
Various states have enacted different legislation regarding mandated ratios. Fifteen states and the District of Columbia have addressed this issue in some capacity, the majority of them requiring the creation of a committee to assist with staffing decisions. The state of California was the first state to require specific minimum nurse to patient ratios at all times. Enacted in 1999, this legislation requires specific ratios in all units, unlike some other states which have mandated ratios for a few specific units. In 2006, the state of Florida enacted similar laws requiring minimum staffing requirements for nursing homes. As of 2010, the states of Illinois, New Jersey, New York, Pennsylvania, and West Virginia have also proposed legislation mandating staffing ratios (American Nurses Association, 2010). Unfortunately there are still too many states that have not enacted any laws or legislation that will help the ratio between nurses and patients. On a good note there are various nursing organizations have adopted official position statements on this issue. For example, the American Nurses Association (ANA) (2010) proposed that hospitals should set staffing plans based on patient acuity and numbers, nurse skill and experience, support staff, and technology, rather than a legally mandated ratio. This...