This was originally written on the Yes article, we feel it warrants to be placed here especially.
Not one analytical study of staffing committees shows that the method promoted by the ANA is effective at improving patient outcomes or nurse staffing. Which you do note in a paragraph above, thank you, but readers need to really understand the gravity of the inadequacy of that legislation. It looks great on paper and in theory, but the real effect of it greatly lacks.
There is a notion that with mandated ratios that acuity of patients and a nurses skill set cannot be accounted for, but ironically enough, the national nurses study completed by the data we collected and published by the Illinois Economic & Policy Institute and the Illinois Labor & Employment Relations; shows that CA (with ratios) actually accounts for the acuity of patients more than Illinois, a state that has had the ANA legislation since 2007. That legislation is useless.
"47% of nurses in California report that staffing levels are based on the needs of patients in their units compared to just 32% in Illinois" https://illinoisepi.files.wordpress.com/2019/09/pmcr-with-ilepi-do-nurse-staffing-standards-work.pdf
There are mixed results from California, true enough. This can be attributed to methods of data collection and study design and have been acknowledged as so by Aiken. An aspect for people to know, having read several articles (including anti ratio) that explain how California did not have a significant need for an increase in nurse staffing numbers. It has especially been noted in the Kaiser facilities that most of them were already at the legislated level before the law went into place. Therefore, if you look at before and after, you may not see a significant difference depending on data collection and hospitals used in the studies.
When common sense tells us that improvement should occur on such a fundamental topic such as staffing, and some (not all) research contradicts that, we must ask why did those results that don't make sense occur?
Could it be that by statistically correlating items that did not always have a difference, such as falls and bedsores (again mixed results), in with items that have significant findings, such as failure to rescues, resulting in a decreased overall significant result has skewed significant results? Failure to rescues is statistically significant in almost all, if not every study that I have read, even ones that are anti-ratios. Death of a failure to rescue is significant and warrants not being calculated in with other nursing measurements just to decrease the overall significance.
It is no secret that our professional organization does not support real safe staffing legislation. They only support the fantasy "staffing committee" and the acuity method. And don't get me wrong, having nurses participate in the process is a good thing (if it actually happens and acuity needs to be part of staffing; but there needs to be a cap on the amount of patients nurses can be forced to take at one time. Most hospitals have demonstrated that they will only do this after being forced.
Staffing should be well enough that one call out does not result in unsafe staffing, contingency plans should be in place for unexpected events within reason. It should not be considered unreasonable to have break/resource nurses on units so that nurses are not watching two assignments when someone goes on break. Most hospitals in California have made it work successfully and hospitals there are making Millions-->Billions. So what if it is less than they would like. When CEOs are making Millions (and they are) along with other shareholders.... why do we care that they would make a little less in return for safe staffing? The fact is, even if CA hospitals are below the rest of the nation, they are still thriving.
In the article against having mandated ratios, it is discussed how EDs in CA wait time increased. That was found in a hospital that refused to hire staff (because they did not want to spend money, documented in the study). Therefore, they went against the law because they did not want to invest in nursing staff. This is an obvious purposeful outcome from the hospital's manipulation. Yet, there are also studies where hospitals did increase their staffing for the law, and the results show wait times decreased. So basically, we are supposed to concede to what a hospital's responsibility is because they purposely did not staff as they should have? Instead of penalizing them for refusing to abide by the law, safely staff, and provide care in a timely manner we should say no to having a safe patient limit?
NO.... plain and simple. That should not be the response. We absolutely should hold them accountable.
If anyone would like to contact their legislators to support real safe staffing legislation, you can do so at https://www-nursestakedc-com.filesusr.com/html/6004d0_2ed35ee2fb8ab9833cd60448c91cb3af.html#/
It is time to implement evidence-based practice into holding hospitals accountable for their responsibility... safely staffing.
To see world-renowned Linda Aiken Ph.D. discuss this as she has researched it for over two decades:
To the author, thank you again for including our movement, getting nurses to discuss the issue, and allow for the education of what nurses need to be advocating for.
