Why Are Staffing Ratio and Physician Hour Laws Used

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Nurses are essential to the delivery of health care. There are many reasons why nurses should have a patient-to-nurse ratio. It is expected to have a positive effect on outcomes and reduce adverse events and complications. In addition, reducing personnel costs and overhead costs could be beneficial. To err is human, according to the Institute of Medicine. A nurse-to-patient ratio of 1:3 should be recommended in teaching hospitals and a care-to-patient ratio of 1:5 in general hospitals. As a senior nurse, you are also expected to ensure that nurses receive the necessary training and expertise to ensure safe and effective patient care. New Jersey Nursing Staffing Trends by Specialty (2008-2015). Hospital staff ranged from 4.3 to 10.5 patients per nurse (P/N) and an average of 6.3 P/N. After adjusting for potential confounders, each additional patient per nurse for surgical or medical patients was associated with a higher probability of hospital mortality [odds ratio (OR) = 1.13, P = 0.0262; OR = 1.13, P = 0.0019], longer length of stay (incidence rate ratio = 1.09, P = 0.0008; Incidence ratio = 1.05, P = 0.0023) and higher probability of readmission after 30 days (OR = 1.08, P = 0.0002; OR = 1.06, P = 0.0003). If hospitals were staffed at the 4:1 P/E ratio proposed in the legislation, we conservatively estimated 4370 lives saved and $720 million over the 2-year study period in shorter stays, thus avoiding readmissions.

Proponents of mandatory patient staffing point to research that indicates a link between nurse workload and patient mortality and morbidity. Two studies in particular have been used to support the development of state and federal laws. The first, a study of 799 hospitals in 11 states, found a higher prevalence of infections such as pneumonia and urinary tract infections, failure to help, and cardiac shock or arrest when nurses` workloads were high (Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). A second, widely accepted study examined the relationship between staffing 168 hospitals in Pennsylvania in 1999 and mortality rates of some surgical patients. Researchers reported that for each additional patient assigned to a nurse, the probability of dying for a patient under the care of that nurse increased by seven percent (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002). These results were the main arguments in favour of establishing specific staffing-to-patient ratios. Lunney, M., Delaney, C., Duffy, M., Moorhead, S., & Welton, J. M.

(2005). Promotion of standardized nursing languages in electronic health records. Journal of Nursing Administration, 35, 1-3. These legislative efforts raise a number of questions. First. There is little evidence that specific nurse-to-patient ratios improve safety or quality. There is little evidence that specific nurse-to-patient ratios improve safety or quality. For example, a study of California hospitals before and after the introduction of mandatory quotas showed an increase in costs, but no improvement in the quality of care (Donaldson, Bolton, Aydin, Brown, Elashoff, & Sandhu, 2005). Statutory staffing relationships between nurses and patients also create an unfunded mandate, as the current payment system treats care as a fixed cost that is the same for all patients, regardless of the actual amount of care provided to a patient (Welton, 2007; Welton and Harris, 2007). These costs, coupled with hiring more registered nurses needed for the higher mandatory quotas, are not offset by additional payments to hospitals.

This bill would require, but would not fund, that new mandate. Arguments for and against mandatory staffing between nurses and patients have now been advanced and will be discussed below. In this case, due to a shortage of nurses in the intensive care unit, each nurse present had to care for more patients than usual. Nursing researchers have long studied the relationship between registered nurses, skill mix, and inpatient outcomes (1-3), a line of research that gained further momentum with the publication of an Institute of Medicine (IOM) report in 1996 on nursing in hospitals. (4) Ground-breaking studies have shown that an increase in the number of registered nurses caring for patients, as well as their training and experience, leads to fewer complications, less morbidity, fewer medication errors and lower costs. (5-8) Nursing management is an integral part of human resource management in hospitals, health systems and other health care facilities. The ability of a nurse to care for several patients at the same time is perhaps the most important consideration. There is growing evidence that units with the highest staffing levels have fewer missed care and incidents.

According to the federal government, the nurse-to-patient ratio is not regulated. Only two states have laws that explicitly prescribe certain conditions. There is no easy way to predict the census and the severity of a day or shift in the hospital. Six standards for nurses have been developed by the American Association of Critical Care Nurses. But the change came at a price. It is clear that a hospital cannot increase the nurse-to-patient ratio unless it hires more nurses first. In 2004, then-Governor Arnold Schwarzenegger dramatically increased funding for nurse education programs. Hospital systems, for their part, have increased nurses` salaries and benefits to attract and retain more nurses. To date, the average California nurse`s salary has risen to $100,000 plus benefits, according to the California Hospital Association. This alarming statistic, which comes as no surprise to medical professionals, is not surprising given the low level of care in the Philippines.

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