Nurse to Patient Ratios

1. Tanya Bengali UCF NGR6723 Spring 2012 Nurse to Patient Ratios The impact on work environment & quality of care

2. History & Background: • The significance of nursing to delivering high-quality health care has been identified since the beginning of nursing practice (Mason, Leavitt, & Chaffee, 2012). • For the past two decades, nurses have reported that there are not enough nurses in hospitals to provide high-quality care (Aiken et al., 2010). • In the past decade, high-quality empirical research found a consistent relationship between licensed nursing staffing and the quality of patient care (Mason, Leavitt, & Chaffee, 2012).

3. Identification of the Problem • Patient safety is compromised and medical errors increase when nurses are understaffed (Mason, Leavitt, & Chaffee, 2012). • Nurse burnout and job dissatisfaction (precursors of voluntary turnover) increase as nurses’ workloads increase (Aiken et al., 2010). • Costs associated with turnover and unsuitable staffing have a significant impact on the economy (Mason, Leavitt, & Chaffee, 2012). In Florida alone, the Florida Center for Nursing found that the cost of turnover for LPNs to RNs exceeded $1.6 billion in fiscal year 2006 to 2007 (Florida Center for Nursing [FCN], 2008).

4. Why is unsuitable staffing still happening? • If there is no standard in place regarding fixed minimum nurse-to-patient ratios, there is always going to be debate about what constitutes appropriate staffing to meet the needs of budgeting, patients, and nurses.

5. Role of the Nurse Leader: • Find a staffing solution that provides high-quality care and avoids excessive voluntary turnover from nurse burnout due to job dissatisfaction

6. Alternative Solutions: • A requirement that hospitals develop & implement nursing staffing plans with input from direct care nurses • Mandated reporting of staffing ratios to the public or a regulatory agency • Establishment of fixed minimum staffing ratios (Mason, Leavitt, & Chaffee, 2012)

7. Selected Solution: Mandated Staffing Ratios • California is the only state to have implemented a law establishing fixed minimum staffing ratios • This regulation has been shown to improve patient outcomes at an acceptable cost • Perhaps by following in California’s footsteps, we will see the same improvements in Florida (Mason, Leavitt, & Chaffee, 2012)

8. Why Fixed Nurse-to-Patient Ratios Work: • Reduces patient mortality and adverse patient events • Enables nurses to spend more time with patients, while substantially promotes retention of experienced RNs • Increases job satisfaction, and improves quality of care • Significantly lower nurse burnout and job dissatisfaction (Aiken et al., 2010)

9. Implementation Plan: • Identify a Florida based hospital to pilot the California mandated nurse-to-patient ratio • Capture baseline measures of patient outcomes, nurse job satisfaction, burnout, and quality of care along with key financial indicators • Implement the new standard for a given period of time and monitor the pilot program to ensure compliance • Re-assess the metrics at the end of the pilot and compare them to the baseline measurements

10. Plan for Evaluation: • Compare inpatient mortality and failure-to-rescue (FTR) with the pilot hospital’s baseline figures and other similar facilities during the given period • Survey nurses in each unit of the hospital on working conditions before and after the implementation of the California mandated nurse-to-patient ratios • Survey patients after discharge about their quality of care during a time period with and without the implementation of the California mandated nurse-to-patient ratios

11. Conclusion: • Should this evaluation demonstrate positive outcomes, the hospital could leverage the pilot data to propose new state regulation requiring Florida hospitals to implement minimum nurse-to-patient staffing plans for specified patient care units

12. References: Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J., Spetz, J., & Smith, H. L. (2010). Implications of the California Nurse Staffing Mandate for Other States. Health Services Research, 45(4), 904-921. doi:10.1111/j.1475-6773.2010.01114.x Florida Center for Nursing. (2008). The economic benefits of Resolving Florida’s nursing shortage. Retrieved from www.flcenterfornursing.org/files/Econ_Benefits.pdf. Mason, D.J., Leavitt, J.K., & Chaffee, M.W. (2012). Policy and politics in nursing and health care (6th ed.). St. Louis, MO: Elsevier.