As of 2016, there are no federal laws governing the number of patients assigned to each nurse inside medical establishments. This may soon change as studies show that mortality rates can be substantially decreased by reducing the workload of nurses. Assigning them to fewer patients allowed them to perform better and achieve healthier outcomes. These have prompted a campaign to establish a safe ratio with the goal of improving the national standard of health care.
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Safe Ratio Recommendations
Bills have been filled to ensure an adequate number of nurses in the US health system. One of them is the National Nursing Shortage Reform and Patient Advocacy Act. This bill requires facilities to have enough registered nurses for each unit at all times. The calculations must be based on established minimum nurse-to-patient ratios. It creates a standard that must be followed across the country. The other part of this bill calls on nurses to act in the interest of their patients at all times. The primary sponsor of the bill is Senator Barbara Boxer of California. It was introduced in March 2015.
There is also the Safe Nurse Staffing for Patient Safety and Quality Care Act sponsored by Rep. Janice Schakowsky of Illinois. This bill also aims to enhance the quality of care in medical facilities by setting strict standards for nurse-to-patient ratios. It was introduced in Congress in March of 2015 as well. Both bills have a long way to go before they can be passed into law. The Title 42 of the Code of Federal Regulations, on the other hand, deals with public health. This set of rules and regulations compel hospitals participating in Medicare to maintain adequate nursing staff. There must be enough licensed nurses and other healthcare workers to provide patients with timely care.
States with Staffing Laws
At the state level, numerous places have already passed staffing laws to address this issue. These include California, Illinois, Ohio, New Jersey, New York, Washington and many others. There are also seven states that now require hospitals to have dedicated staffing committees to craft plans and policies. California is among the most active in this endeavor. It is currently the only state which actually stipulates minimum ratios through laws and regulations. These have to be maintained at all times. Meanwhile, Massachusetts passed a law specifically targeting the Intensive Care Units. There should be one nurse for every critical patient. Nurses may take care of up to two relatively stable patients.
Formula for Safe Nurse to Patient Ratio
There is a simple formula to compute the ideal proportions. The primary factors include the productive direct patient care nursing hours and the length of each working day. Each day can be assumed to last 24 hours for facilities which are always open and allow overnight or long-term stays. Simply divide the former by the latter. The quotient will represent a safe ratio that hospitals should strive to meet.
Nurse to Patient Ratio — Best and Worst
A number of studies have been conducted to learn the effects of staffing on patient outcomes. According to reviews, having one nurse per four patients produced the healthiest results. This seems to be the ideal target in most scenarios. Of course, there may be places that require more such as the ICU as recognized in Massachusetts. On the other end of the spectrum, it appears from the research that having only one RN looking after eight people produced poor outcomes. When nurses are spread even thinner, the results get even worse. It is clear that the number should be limited for the sake of the patients.
Observations Regarding Ratios and Mortality Rates
A higher ratio has been consistently linked to a reduction of in-patient mortality. According to a study of over 1.2 million medical admissions, the death rate is about 35.2 per thousand. When it comes to surgical admissions, the rate stands at 8.9 per thousand. It was found that the rate was up to 20% lower in places where nurses were assigned to care for 6 or fewer individuals. This is compared to facilities that were understaffed, forcing the nurses to care for 10 or more at a time. Their time and attention were divided to too many cases.
When it comes to the surgical wards, the researchers saw a 17% reduction in death rates whenever the proportion of RNs to patients was higher than average. On the other hand, the patients who stayed in wards that were poorly staffed exhibited an alarming 31% rise in mortality. No person would want to be placed in this kind of situation. It was also noted that the hospitals with the worst staffing numbers had increased mortality rates between 26% and 29%. If people knew about these statistics, then they might certainly reconsider their decision to be admitted in such healthcare facilities.
Correlations between Quantity and Quality
A study involving 168 hospitals in Pennsylvania had a number of interesting findings. It concluded that nurses did well looking after four patients or less. On the other hand, giving them more work leads to undesirable consequences. For instance, the odds of death rose by 7% for every additional person on their workload. The risk of burnout increased at an even higher rate with 23% per new patient. It also decreased their job dissatisfaction by 15%. Meanwhile, educational level pushes mortality rates down. Every 10% rise in staff with BS degrees results in a 5% plunge in patient deaths.
According to the national statistical data, the benefits for the patients go beyond mortality. They also spend less time in intensive care units because they are able to recover quickly. Increasing the ratio by one per patient can lead to a 24% reduction in ICU stays. The same phenomenon has been observed in surgical units. In these places, the drop in hospital stay is as high as 31%. Giving each patient an additional hour with a qualified RN leads to a plunge in cancer risk by 8.9%. Increases in staffing also result in a proportional decrease when it comes to pneumonia incidents.
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