Mandated Nurse Patient Ratios: Does It Save Lives - Article Example

Based on such studies, several changes in nursing management and nurse-sensitive quality measures have occurred like pay-for-performance and healthcare public reporting. Some regulatory interventions like the California's legislation of 1999 mandated minimum nurse staffing ratios to ensure patient safety. However, which is the most appropriate nurse-patient ratio is a much debated topic and the ambiguity is because of varied sources which are available, different levels of outcome analysis, methodological variations like risk adjustment, model specification and variables control (Patrician et al, 2011).

In the US, for the purpose of staffing data, hospital payroll data and American Hospital Association have been used as administrative sources, but these sources do not differentiate inpatient nurses from outpatient nurses and do not differentiate direct care hours from non-care hours (Patrician et al, 2011). Also, daily variability in staffing and shift variability are also not addressed. Another important aspect is that in aggregated staffing data, there will be masking of lower-staffed units and all these limitations are important confounding factors to attribute discrete adverse patient-related events to indicators specific to nurse staffing (Patrician et al, 2011).

Thus, to determine whether nurse staffing influences patient outcomes, it is very important to conduct proper research for evidence based practice. In this study, a short literature review is done to ascertain the association between nurse staffing and patient outcomes or adverse patient events. According to Laskowski-Jones (2011) "staffing decisions shouldn't be made in a vacuum. Sources that can help us plan staffing models or determine appropriate nurse-to-patient ratios include standards defined by professional nursing organizations and regulatory agencies, and benchmarks from the American Nurses Association's National Database of Nursing Quality Indicators.

" Patrician et al (2011) conducted a multihospital, longitudinal study to ascertain the relationship between nurse staffing and adverse patient events that are temporally distinct, in the sense, events which occur during a specific time. the assumption in the study was that adverse events in the hospital occur in the absence of adequate staffing during a particular shift. generally, staffing is scheduled by shift and is adjusted based on worlkload during a particular shift. hence, in this study, shift was selected as a "unit of analysis" for the purpose of investigation of association between staffing and various adverse patient events like falls with or without injury, medication errors, etc.

In this study, it was evident that staffing during a particular shift is related to risk of adverse events and it is not only the number of staffing, but also the skills of the nurses that is important. For example, in this study, it was found that a 10 percent decrease in RN skill mix was associated with 36 percent increase in risk of falls. This study is fraught with some limitations. One is the researchers used incident reports for primary outcome variables and under-reported incidents are thus not included in the outcomes.

Under-reporting can occur because of fear of litigation and also fear of administrative reprisal. Another major limitation is the risk of patient