Study suggests improved nurse patient ratios don’t equal higher quality of care.
Headlines in the Sacramento Business Journal state
“The first study of the effect of nurse-to-patient ratios on care in California hospitals concludes hospitals have hired more registered nurses, but they’ve had little effect on two areas of care — patient falls and bed sores.”
The findings have sparked contentious dialogue between the American Association of California Nurse Leaders, the American Nurses Association/California, and the local union. Accusations of “cooked data” have come from the union side of the house.
At the end of the day the article describes an emotionally charged issue demonstrating the usual polarizations. Whether or not the data supported by the coalition is accurate and applicable I can not say. Chuck Idelson from the California Nurses Association disputed the study findings stating “it’s a flawed study…”
Irregardless of the study design, data collection tools, statistical method utilized, the irrefutable fact remains that healthcare organizations require not only a minimum number of nurses to care for patients, they also need a concurrent plan to deal with fluctuations in patient acuity. My long standing analogy has always been that five patients with cold symptoms – runny nose, fever, and cough require fewer resources than five patients on ventilators, multiple medications, complex treatments etc. Workload staffing should be more acuity driven than just numbers.
One caveat to this study which may explain the lack improvement in pressure sores and falls may be hidden within the work ethic of the individual nurse. From an objective point of view hospital xyz can have any number of nurses to care for any number of patients, but if no one does the work that is needed, the quality of care remains poor. The reality of nursing is that some days you’re just not up to dealing with it all. A sad commentary for sure, but nonetheless true. The physical and intellectual demands of not just nursing but all aspects of healthcare are daunting. No one in healthcare is working at peak performance every day. Healthcare professionals are tired, both physically and mentally trying to meet the demands of the industry; another fact that requires additional staff both RN and MD to share the burden.
Healthcare organizations must not only look to improving staffing ratios but also help motivate staff to do good work. Several initiatives for physicians have been instituted such as pay for performance programs. Few if any incentives are available to nursing professionals – why is that?
If healthcare organizational leaders are motivated to improve the overall quality of patient care, improve patient safety, and “do it all” within the confines of reasonable budget allocations than a few allowances must be made. Hospitals need to have enough staff to carry out the work. If you want to make an omelet you have to break some eggs. You don’t add water in place of an egg for a bigger omelet.
The utilization of hospital transparency between the organization and the public and between staff provides some motivation. Even the playing field by instituting true collaboration between the different levels of providers – MD, RN, PA, etc. Incorporate the concepts of differentiation with staff evaluations. Finally do what ever it takes to hire good people, and invest in them. Healthcare organizations like any other business have internal and external customers, both have needs, both need to be recognized, and both need to have their needs met. Hospitals can not expect great outcomes either clinically or financially if only one customer base is tended to at the expense of the other.
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
