To RNs, what are your thoughts about the mandated nurse-patient ratio?

Nurses Activism

Published

I am a nursing student in Leadership class. My group has to write a persuasive paper topic "mandated nurse-patient ratio." I live in California, where we have mandated nurse-patient ratio. On the surface, we think the ratio is a good idea, but our professor does not agree with us. After some research, we learned some set backs about the mandated ratio. We are also required to interview nurses. The problem is that we mostly got a positive response about the ratio, and we are supposed to be writing a paper against it. Many people we interviewed said that it is important to have it mandated. We need more opinion on this. Do you suggest other method of ensuring reasonable patient loads if it is not mandated? We propose our thesis that it should not be mandated (it can serve as a guideline but should not be mandated).

All input is appreciated! By sharing your opinion, the input will be used for our paper, kind of like an informal interview.

Thank you!

Up Vote Up Vote ×
Specializes in Emergency & Trauma/Adult ICU.

Hint: As you have no doubt researched the history of the CA legislation ... what groups opposed it? Why? What were/are their conclusions regarding implementation of legally mandated nurse-patient ratios? In what publications might these points of view be published? That is where you'll find data to support the viewpoint you are required to present.

Up Vote Up Vote ×

How can a professor be against mandated nurse-patient ratio? How can any nurse? Look... on the floor or anywhere, management (whatever form) will try to push as many patients, tasks .... whatever, no matter what patient acuity (how sick they are and numerous tasks you need to do to keep patients well) ..... as possible to meet this " productivity quotient". You really don't know as a rookie nurse right now what you're about to get into. You will run... and it is hard.. and you will ask yourself why your professor was against mandated nurse-patient ratios. I don't see any semblance of leadership that is pronurse these days. I think most nurses get into "leadership" in the hospital in order to get off the floor and then it it seems their job is to keep other nurses down in order to keep their jobs and not be forced back into the hell they help foster. nice.... I don't see any ... and I mean any... decisions that help take tasks off the plate of a nurse and actually make logical systematic sense for any modern, profit making institution! You'd think as old as an institution as hospitals are, they'd have their crap together. Such bad leadership! Nurses don't necessarily make great accountants or leaders. A large misconception is that a management level job is what one defines as success as a nurse. If you suck at, please don't do it. Also, if you're a money grubbing, labor driver to impress your boss or get a promotion to leadership or bonus.... pfff.... it's noticeable. I hope this was helpful. IT SHOULD BE MANDATED BECAUSE IF IT ISN'T PEOPLE CRUNCHING THE NUMBERS WILL MAKE YOU HAVE AS MANY PATIENTS AS POSSIBLE UNTIL THERE IS AN INCIDENT. Hope you're not that nurse.... hope I'm not either.... ask anyone on this website....

Up Vote Up Vote ×
Specializes in Med Surg.

I would suggest looking at outcomes. I'm not in CA, but I think I've read on here that some facilities were just paying the fine rather than abiding by the mandated ratios, which would make the legislation useless. I could be wrong on that, though. There are always unintended consequences, could those be the reason your professor opposes them?

Up Vote Up Vote ×
Specializes in Cardiac, ER.

I have never worked in a state with mandated ratios. Over the many years that I've been doing this, I have learned, without a doubt, that the number of patients I can safely care for depends on the patients! Arbitrarily assigning a "safe number" is silly. I used to work in CCU, we usually had a 2:1 ratio. I could easily care for 4-5 post angio patients who received PTCA w/stents, no complications, few other comorbids. Now give me the pt who coded in the cath lab, had emergency CABG, is now intubated and on multiple drips, is a poorly controlled DM with wound care and a crazy wife who can't do anything herself and expects me to care for both her and her husband and I'm back to 1:1!!

I remember a time when we gave our pts an acuity and staffed accordingly, that was time consuming and didn't always work, but at least it seemed logical.

Up Vote Up Vote ×
Specializes in Critical care, tele, Medical-Surgical.

Your professor needs to be intellectually honest.

Patients are admitted to the hospital because they need nursing care.

When nurses have too many patients all aspects of nursing care cannot be done.

Subtle signs and symptoms can be missed because the nurse is busy with so many other patients.

The patient's condition is discovered too late.

Hospital nurse staffing ratios mandated in California are associated with

lower mortality and nurse outcomes predictive of better nurse retention in California

and in other states where they occur.

http://www.nursing.upenn.edu/chopr/Documents/Aiken.2010.CaliforniaStaffingRatios.pdf

JAMA Network | JAMA | Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

You could use the hospital associations past and current statements and actions. They sued the State of California for making the ratios effective at all times. The California Hospital Association contended that the assigned nurse is responsible for all assigned patients even when in the cafeteria with another nurse "covering" his or her patients.

http://www.businesswire.com/news/home/20040526005823/en/California-Nurses-Association-Hails-Court-Decision-Uphold

You can find information on the hospital's reasoning. They claim that staffing by mandated minimum ratios would put them out of business.

In California hospital profits have increased every year except 2008. They are higher now that ever before.

D.C. Hospital Association: http://www.dcha.org/

Up Vote Up Vote ×
Specializes in Critical care, tele, Medical-Surgical.

In every hospital where I've worked they have a "matrix" or "Core Staffing". That is their ratio. I remember as many as 30 patients per RN as thematrix with specific numbers of LVNs, nursing assistants, and a secretary.

The hospital association proposed a ratio of 1:10 with 50% LVN for medical-surgical units. Because they expected another nurse to "cover" breaks that would mean that one RN could be responsible for 20 patients while a colleague went to lunch.

See page 11: Final Statement of Reasons

The link is from this page: http://www.cdph.ca.gov/services/DPOPP/regs/Pages/N2PRegulations.aspx

Up Vote Up Vote ×

All I know is with health care reform and family. Nurses. Doctors law enforcement. Everyone is lawsuit happy.people sue to much. Life is up and down. Hospitaks admin looks at numbers. Nurses look for patients. If we stand up for each other then it makes us a target from admin. We push for pt. A md can get mad. I got 15 more years to go. I made it past the other crises hope I mm ake past this.

Up Vote Up Vote ×
Specializes in Public Health, L&D, NICU.

I am from the South, where nursing is probably at its worst (as far as how we are treated), but I did several stints as a traveler in California. Let me tell you, working in California seemed like heaven. Yes, I worked hard, but there was always a limit, and at least I got to eat every shift. If ratios aren't mandated, then the hospital gets to decide. If it's up to the hospital, it all comes down to revenue. Their attitude is to just add it to the nurse. I've had a manager try to justify to me why I could take a 4th laboring patient, "Well, she wants to go natural, so you won't have to do all the extra stuff with the epidural!" Yeah, she wants to go natural, so she'll need me even more than the others will! I worked on a unit where they were asking nurses to work totally alone with help on call. You couldn't make them see that it didn't matter if the call nurse "only lived 5 minutes away," if someone came in with a prolapsed cord, I couldn't dial the phone for help with my toes. Being forced to work alone was what finally caused me to part ways with my first hospital. God forbid they call in another nurse, though, because that costs money, and to a nurse manager, money is GOD, the patients are just an unfortunate side note.

I've worked with mandatory ratios, and without, and I can say without a doubt that the care is better if hospitals are forced to a certain level of staffing.

Up Vote Up Vote ×
Specializes in Med-Surg.

I don't understand why your professor is against mandated nurse to patient ratios. Have they or their family never been in the hospital? Mandated nurse to patient ratios are needed because hospitals will not do it on their own. Nurses and other staff are only viewed as a "labor" cost and always an area that can be cut. I had a CNO admit that nurse to patient ratios saved her from being forced to cut the nursing staff. Patients are sicker and moved out of the hospital faster than ever before. Nurses are constantly required to do more, faster and better. Yet if we make a mistake , the hospital is immediately pinning all the blame on the nurse. Ratios are critical to us being able to provide safe care. Every day I fight to enforce the ratios because every day my manager is trying to send us home or work us short . Those that say there are downsides of the ratios are either lacking in knowledge of the ratio law or dishonest. Ratios are a minimum , hospitals can increase staff and yet they do not. Well they do when JACHO , Magnet or the state come for a visit. Ratios are cost effective and save lives! Remember , way too many patients still die from medical errors, failure to rescue , etc. Nurses are there for the patients while hospital management is still all about the bottom line $$$$$$$$$

Up Vote Up Vote ×
Specializes in Critical Care.

Sorry but your professor is just plain wrong! It's ridiculous that he expects the students to write a paper against something that is a good thing both for the patients and the staff. Unfortunately without mandated ratios too many hospitals try to save money by understaffing which is bad for both patients and staff. It is unsafe for the patient and leads to burnout and high staff turnover!

The only unintentioned consequence I'm aware of is some hospitals cutting ancillary staff such as CNA's and others threatening they will have to close over the cost of hiring more RN's. As far as I'm aware this hasn't been the case. Not to say some hospitals haven't closed, many have and this due to not enough paying patients due to lack of insurance or high levels of medicaid patients. What galls me is how many hospitals systems CEO's are making millions of dollars while pushing for no raises or even pay cuts for the staff such as what recently happened in Florida.

The only real downside is that I've heard there is a 47% unemployment rate among new grad RN's in CA because the hospitals are now fully staffed and apparently there is a lot less turnover since working conditions have improved. You may have to relocate to another state to get a job. I hear Texas has job openings!

Up Vote Up Vote ×
Specializes in Geriatrics, Home Health.

I got my copy the December 2013 MARN newsletter today. It's published by the MA Association of Registered Nurses, the MA branch of the American Nurse's Association. I was quite surprised to find an article on the front page by the MARN president opposing the MNA's efforts to put nurse-patient ratios on the ballot. He called it "a threat to nursing autonomy." I have to wonder how long it has been since he has worked on a floor.

Why would nurses choose to take away their autonomy? Why would nurses follow the orders of people outside our profession?

MNA has a strong financial base garnered from the membership fees of mandatory membership in the collective bargaining unit. Do you want your money to be spent in an effort to take away your power to determine your daily nursing assignments?

Bringing this ballot initiative forward will instill confusion and fear for the public; a public, who consistently rates nurses as the most trusted profession. The public wants to know that if they enter the health care setting that the decisions made about their care are being made by qualified professionals rather than a ballot initiative.

In the midst of the ongoing debate on health care reform, the last thing the general public needs is a tactic that is harmful to the nurse-patient relationship. MNA’s ballot initiative is not good for nurses or patients! It undermines the autonomy of the nursing profession and suggests that we are not capable of managing and negotiating our own professional relationships. We are not well served by working under static, inflexible and unscientifically founded formulas that keep us from creating an authentic relationship with our patients and their families.

An article on page 5, by a staff nurse, says pretty much the same thing.

Up Vote Up Vote ×
+ Add a Comment