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Disagreement Over Optimal Nursing Staff Ratios Continues

NursesIn an ongoing disagreement, nursing unions and their supporters believe that the number of patients per nurse during inpatient hospital care is a major indicator of the quality of care provided in a hospital. The current argument involves staffing in critical care areas such as intensive care units where the norm has been a one nurse to one patient staffing ratio or at worst one nurse for two patients. The decision on number of patients per nurse is based on the severity and acuity of care required on the individual patient.

The state of Massachusetts passed a law mandating this staffing ratio in critical care areas as of September 2014. Hospital lobbying associations dispute the need to staff at this ratio. The state of Minnesota was supposedly conducting a research study to answer the question of the relationship between how many patients a nurse was caring for and quality but only one of the State’s 39 hospitals cooperated by providing support and data.

The ratio of nurses to patients in critical care areas and emergency areas is one question but the same question applies to care on the general medical and surgical floors. When I first started practicing in 1979 the ratio stood at four patients per nurse. That figure has ballooned to 5 – 8 patients per nurse today with the patient population being older, sicker and more complex. In those days the nurses worked an 8 hour shift. Today’s staffing schedules have nurses working fewer days but working 12 hour shifts. There are those experts who believe that most of the errors in care and medication that occur in a hospital setting occur in hours 9 – 12 on a nurse’s shift. The extra day off created by working the longer hours is well appreciate by staff on the 12 hour schedules, but is it as safe for patient’s as the eight hour shift?

As a practicing physician in a community hospital it is very clear to me that the quality of care provided in a hospital is directly related to the quality of the nursing service provided. Having quality and experienced doctors is important but not nearly as important as caring and experienced nurses. They are the eye s and ears of the medical staff when the doctor is not at the bedside. They are the ones who first become aware of a problem or recognize a change in the patient’s condition and have an opportunity to sound the warning. When they are asked to care for too many patients it limits their time and exposure to the patient’s clinical situation.

On a daily basis the public is bombarded with advertisements from hospitals and hospital systems touting the excellence of care they provide. How many patients think to ask about the number of patients per nurse? How many philanthropic individuals think about donating towards an extra nurse per shift instead of a bricks and mortar type donation like a piece of equipment or a room or object? The improvement in care with an extra nurse per shift may be far more significant than a remodeled waiting area in the emergency department.




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