Mandated Staffing & Working Hours for RN's - Essay Example

 Fewer medication errors and other mistakes are made when nurses are not overtired or when facilities are not understaffed.

      This would appear to be an advantage for many nurses.  Younger health care workers value time with their own children and families.  There is said to be less incidence of burn-out and mental fatigue that is so common in the nursing profession. “Proposed minimum, nurse-to-patient staffing ratios, such as those enacted in many U.S. States, are intended to address a growing concern that patients are being harmed by inadequate staffing related to increasing severity of illness and complexity of care” (Welton, 2008).  This initially seems an appropriate solution for both staff and patients, in terms of health and well-being.

       However, mandated nursing staff minimums increase administrative costs to many facilities,

with little or no additional reimbursement from insurance companies and managed care.  Without additional funds, facilities are limited in spending.  This can affect the pay rates of nurses, who may forego raises and bonuses.  Other areas of the budget may be affected as well.  New equipment and areas such as Information Technology may be affected as well.  Nurses and other staff may work harder to accomplish the same goals, as there is little money for updating patient record systems and for adding new diagnostic tools.  “Mandatory ratios, if imposed nationally, may result in increased overall costs of care with no guarantees for improvement in quality or positive outcomes of hospitalization” (Welton).  Patients may not get the best care with outdated

equipment such as monitors and IV pumps in use.  Outdated equipment may need more frequent

repair and is more likely to fail.

      Outdated patient charting or records systems require more time to be spent on documentation, taking time away from patient care.  In order to cut costs, facilities may cut back on other staff as well.  Nurses aides and orderlies, transportation workers, housekeeping, and unit clerks are often vital to keeping each shift running smoothly, helping nurses to care for patients on schedule.  With less support staff, nurses must perform many of their tasks as well as their own.  Again, nurses feel the brunt of the mandates as they must balance more responsibility.  Patients lose out with less contact from nursing staff, who may have to mop a floor or order supplies for their unit.

      When mandated or regulated nurse staffing occurs, often the nurses are the ones to suffer, not only in workload but in salary as well.  In order to remain competitive, facilities may go ahead and invest in more modern equipment or newer systems, reducing the budget for salaries. over time, this results in nursing shortages and high nursing staff turnover. Patient care is again lost in the turmoil.  Most anyone would agree that they would rather see a loved one cared for in a hospital where nurses are more plentiful, well-paid and happy, than overworked, tired, and fearful that a mistake will be made.  The New Mexico Organization of Nurse Executives (NMONE) “recognizes recent research that demonstrates a positive relationship between appropriate nurse staffing and its impact on patient outcomes, safety of patients and nurses, nurse physical and psychological health, and nurse satisfaction” (NMONE).  The organization also indicates that there is a concern for nursing errors, due to fatigue.  It believes that mandated ratios are not the only solution to staffing. 

      In a 2004 to 2006 study of mandatory nurse staffing ratios in California, results indicate that mandates did not improve patient care.  “Anticipated improvements in nursing-sensitive patient outcomes were not observed” (Bolton, et al, 2007).  The study mentioned above, along with other examples, reinforces the view of the NMONE, that mandated staffing ratios is not the solution to better working conditions and better patient care.  Neither is mandated overtime.  However, as the risk of staffing shortages occurs, combined with mandated ratios, the likelihood that nurses will be required to work overtime increases.  As budget cuts are often made in support staff, the increased workloads of nurses require additional time for completion of all duties within a shift.

      While each facility or state government may dictate the number of staff, this solution can only work if nurses are compensated competitively and facilities are not forced to make choices in which important services to cut.  A better solution is to develop a separate billing for nursing hours, rather than for hospital rooms or facilities.  A system that bills the patient based on the level of care required, separately from other services, may allow the mandatory staffing ratios to improve conditions for patients and nurses alike.  The NMONE recommends “a planning process that takes into account the number, skill mix and experience of nursing personnel, the acuity of patients and the complexity of their care, the availability of support staff, available technology, and the physical environment of a given nursing unit.”

     Additionally, when nurses are compensated fairly, it is less likely that a facility will be forced to impose mandatory staffing minimums.  Less attrition of nursing staff will occur.  Many will be more likely to work voluntary overtime, within limits.  Facilities will be able to maintain adequate levels of support staff as well, allowing nurses to concentrate on the duties and skills for which they are trained.  Facilities receive a much better value for the money spent when nurses use more of their highly developed skills.  Patients are also likely to fare much better, receiving at least a minimum standard of care.