Nurses: “The Last Mile� to the Patient

[arthurbaird0]

Supply chains and other service industries, like telecom, worry about "the last mile" the final step in delivering a product or service to customers. Like other industries, healthcare must connect most meaningfully to the patient, and the nurse is always part of (if not the sole manager of) that last mile.” The analogy of the last mile defines a deeply rooted issue about nursing's criticality (and that of other direct caregivers, like LPNs, CNAs, etc.). The last mile” for hospitals in a new and rapidly changing environment may be the difference between keeping the hospital open or closing it down. And the cost of not addressing this last mile” issue is perhaps the biggest threat healthcare organizations/hospitals (HCOs) face.

One proposed method for closing that last mile of improving patient care while maintaining a reasonable workload for nurses has been to legally mandate nurse-to-patient ratios. There are growing numbers of legislative efforts, both state and federal, moving toward mandated ratios to ensure nurses aren't overloaded and patients are well cared for. To date, California is the only state with legislative authority to regulate nurse-to-patient ratios. But California is generally regarded as a bellwether of healthcare policy, so mandates are surely on their way across the US.

Certainly, nurse-to-patient ratios hold the potential to improve quality and reduce overburden. But such an approach, by itself, is flawed because it only reduces the number of patients the nurse has to work with without a concomitant reduction in the chaos that often characterizes their scandalous working environment.

The National Bureau of Economic Research in Cambridge, Massachusetts, published The Effect of Hospital Nurse Staffing on Patient Health Outcomes,” in which they concluded that patient outcomes did not disproportionately improve with the introduction of nurse-to-patient ratios.” NBER's report did suggest that there may be complementarities between nursing inputs and other (possibly unobserved) inputs and policies that lead to better patient care. Thus, improved nurse staffing might be crucial in improving patient care, but only in combination with other elements.” In other words, just changing nursing ratios alone will not achieve the desired benefits for the working environment of nurses or, most significantly, the quality of care that patients receive.

In the currently swirling whirlwind of overburdened nurses, about 5 percent of the nation's 2.7 million registered nurses have left the profession. Various estimates for future departures run at the 25 percent level. Some of this reduction will be due to retirement, but research indicates that nurse burnout,” as a percentage, is a serious risk to the future of healthcare. In a recent study of 40 hospital units, more than one third of nurses reported they intended to leave their position within the next year, citing emotional exhaustion” and lack of personal accomplishment,” two key indicators of nurse- burnout. And as growing evidences has shown, nurse-burnout dramatically influences how satisfied patients are with their care.”