Mandatory Nurse-Patient Ratios in Pennsylvania - Essay Example

Mandatory Nurse-Patient Ratios in Pennsylvania Mandatory Nurse-Patient Ratios in Pennsylvania A house bill introduced in the last decade insisted that hospitals and other healthcare facilities should develop and implement state-specified, unit-specific, nurse to patient ratios. The major purpose of this healthcare policy is to improve the overall quality of care and to trim down healthcare costs (PASNAP, n.d.). Identifying the relative merits of this healthcare policy, several other states are also considering the enactment of policies that would require hospitals to maintain minimum nurse-patient ratios. According to this house bill, each hospital unit is expected to establish a nurse staffing committee in order to deal with staffing issues. One-half of the nurse staffing committee members should be registered nurses currently delivering direct patient care and the rest of the members may be determined by the hospital administration (ARON, 2013). The committee is authorized by the house bill to consider matters such as competencies of the nurses and patients’ acuity. In addition to nurse-patient ratios, this bill also addresses several other concerns including intensity of care, staff skills mix, availability of support staff in the shift, and the physical environment. Michael and Page (2010) state that nurse staff shortage or understaffing has been a major issue leading to medical negligence, clinical errors, and poor quality healthcare (p.102). To illustrate, a study published in 2002 found that surgery patients in hospitals with high nurse-patient ratios are at 31% increased risk of mortality. Similarly, a report released by the Agency for Healthcare Research and Quality indicated that improvement in nurse-patient ratios can decrease rescue failures and hospital stays. A research work published in the American Journal of Public Health in 2005 (as cited in Conis, 2009) suggested that an improved nurse-patient ratio of 1:4 could save up to 72,000 lives a year. Long working schedules, inflexible work shifts, and work overload often force professional nurses to consider leaving the profession. A recent study by Okrent (2012) indicated that roughly 45% of the nurses planned to make major career changes over the next three years. It is dreadful to note that a significant percent of the current nursing workforce considers professions outside nursing. This adverse situation justifies the need of implementing a nursing policy that would better regulate nurse staffing ratios in the country and thereby contribute to staff satisfaction. Statistical evidences suggest that hospitals incur huge nurse turnover costs in a way that every 1% increase in nurse turnover would result in an annual loss of $300,000 for a hospital. Since the supplementary staff may be from outside agencies in most cases, they could not be employed cost-effectively. It is also identified that temporary nursing staff are often compensated at 25 to 40 percent higher than the average wages of registered nurses (DPE Fact sheet, 2014). In addition, hospitals incur huge expenses in recruiting and filling nursing vacancies created as a result of work overload and worksite stress. In this context, the house bill that introduces mandatory nurse-patient ratios in Pennsylvania can really help the state to cut down its nursing costs. As per the terms of this policy, Pennsylvania hospitals must maintain a minimum nurse-patient ratio of 1:6 in their general medical surgical floor, and this provision is dependent on many other factors (cited in Conis). This improved nurse-patient ratio would assist nurses to reduce their workload significantly. When nurses work with only six patients in a single shift, they would be competent enough to deliver an increased level of care that can fasten patient recovery and promote patient safety. In a professional viewpoint, mandatory nurse-patient ratios are inevitable to manage nurses’ workload properly and to ensure that the nursing staffs are provided with a relaxed worksite environment to apply various nursing strategies and models of care in their work. In addition to promoting the reputation of nursing profession, regulated staffing ratios give nurses enough time to apply evidence-based care practices which could not be possible when working in hospitals with poor nurse-patient ratios. In order to clearly understand the contemporary significance of the policy proposed, it is essential to evaluate the healthcare background of Pennsylvania. The state of Pennsylvania has been facing the issue of growing gap between the current number of RNs providing care and the actual demand for RNs. According to a report by the Health Resources and Services Administration, the state of Pennsylvania is expected to be facing a severe nursing position vacancy level of 41% by the end of 2020 (cited in Conis). The nursing shortage issue in the state is worsened by low number of nursing candidates entering the profession, absence of qualified mentors, an aging workforce, and a significant percent of the nursing population that is about to retire in the coming decade. Studies suggest that approximately one in four of Pennsylvania’s RNs would like to work outside the healthcare field so as to get rid of the increased work stress associated with the nursing profession. Many nurses left the profession when they were asked to work even more hours. The mandatory nurse staffing ratios in Pennsylvania was introduced on the basis of the realization that nurses constitute an integral part of the healthcare system. Regulators identified that implementing mandatory staffing ratios was essential not only to enhance patient safety but also to promote the welfare of the nursing staff. Since the issue of nurses leaving the profession was directly linked to their work overload, the mandatory nurse-patient ratio was expected to play a notable role in staff retention. The campaigners of this policy claimed that safe staffing would improve the overall worksite environment and patient care. In the words of Robinson, Jagim & Ray (2004), nurses would be satisfied in their job when they work under a safe-staffed environment, and this relaxed workplace situation can markedly contribute to staff retention in the long term. The American Nurses Association (ANA) realized that its previous strategy to cut down nursing budgets would hurt the interests of patients as well as nurses. Nurses who worked overtime were vulnerable to health problems such as hypertension, musculoskeletal disorders, psychological stress, and depression. As a result of such health problems, nurses were forced to stay away from the workplace for many days and the situation led to many ethical dilemmas and care delivery issues. Another research by Virtanen, Ferrie, Singh-Manoux, Shipley, Vahtera1, Marmot, et al (2010) found that there is a positive relationship between overtime work and the incidence of heart disease. The new health policy was competent enough to eliminate those barriers to nursing entry and to add value to the overall efficiency of the healthcare system. Since the proposed policy assured nurses enough time to assess their patients and to apply evidence-based care, the Pennsylvania Association of Staff Nurses and Allied Professionals supported a quick enactment of the policy. Later it was identified that this nursing policy greatly contributed to increased rate of staff retention and enhanced patient safety. It is good to see that the policy has been enacted in the state of Pennsylvania in a short span of time and most of the planned outcomes were realized. The official websites of the Pennsylvania Association of Staff Nurses and Allied Professionals and the state’s other regulating bodies demonstrate the progress of the policy implemented. Based on the evidence from Pennsylvania, many other states in US have taken measures to implement mandatory nurse-patient ratios in their jurisdictions. Undoubtedly, implementing mandatory staffing ratios would assist the overall US healthcare system to cut down its unwanted health expenditures like reimbursement costs and to improve the welfare of the nursing profession. Furthermore, it is a potential way to meet the worksite interests of the nursing population and hence enhance staff retention. From the above discussion, it is also clear that this policy change would persuade more candidates to enter the nursing profession and thereby make the health delivery effective. References ARON. (2013). Pennsylvania Introduces Safe Staffing Bill. Retrieved from http://www.aorn.org/News.aspx?id=25678 Conis, E. (2009). Legislating Nurse Staffing Ratios in Pennsylvania. Department of Behavioral Science and Health Education, Rollins School of Public Health, Emory University. Quality Improvement, HR Training/Capacities. Retrieved from http://www.hpm.org/en/Surveys/Emory_University_-_USA/13/Legislating_Nurse_Staffing_Ratios_in_Pennsylvania.html DPE fact sheet. (2014). Safe-Staffing Ratios: Benefiting Nurses and Patients. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/safe-staffing-ratios-benefiting-nurses-and-patients/ Michael, P & Page, C. G. (2010). Management in Physical Therapy Practices. US: F.A. Davis. Okrent, D. (August 27, 2012). Healthcare work force: Nurses. An Alliance for Health Reform Toolkit produced with support from the Robert Wood Johnson Foundation Alliance for Health Reform. Retrieved from http://www.allhealth.org/publications/Cost_of_health_care/Nursing_Toolkit_FINAL_8-27-12_111.pdf PASNAP. PA Safe Staffing Bills. Retrieved from http://www.pennanurses.org/pac/pa-safe-staffing-bills/ Robinson, K. S., Jagim, M. M & Ray, C. E. (2004). Nursing Workforce Issues and Trends Affecting Emergency Departments. Topics in Emergency Medicine, 26 (4): 276 – 286. Virtanen1, M., Ferrie, J. E., Singh-Manoux, A., Shipley, M. J., Vahtera1, J., Marmot, M. G & 2 and Kivimäki, M. (2010). Overtime work and incident coronary heart disease: the Whitehall II prospective cohort study. European Heart Journal: 2-8. http://eurheartj.oxfordjournals.org/content/early/2010/05/04/eurheartj.ehq124.full Read More