California Legally Mandated Nurse to Patient Ratios Research Paper

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Introduction

As of now, at least fourteen states across the country have legislations on safe staffing. Although California is among the fourteen jurisdictions, it is unique in the sense that its legislation includes a nurse to patient ratio clause. The allowed ration of patients to nurses is five to one. Half of the remaining states mandate hospital boards/ committees to set the nurse to patient rations in their hospitals, while five other states require hospitals to disclose their staffing ratios publicly (Abraham). Staffing ratios are important especially when the ratio is set by the state such as is the case in California.

This is because when states do not set standards as is the case in most states across the country, facilities usually get short-staffed. In other cases, nurses get overworked and exhausted leading to high staff turnover in health facilities, poor health outcomes, and compromised patient safety. A recent survey by Kronos Incorporated showed that nearly ninety percent of nursing staff want to leave their current work station because they feel they are overworked (Abraham). Other surveys and studies are showing that in places where nurses are way fewer than patients, patients are losing their lives especially in ICU wards.

Despite the clear risks and dangers of having more patients than available nurses can handle, hospitals and other health facilities are pushing back claiming that not enough studies support the need for them to employ more nurses. They also argue that not many nursing staff are available for hiring anyway so even if they decided to hire more people their argument is that they would not find enough people (Abraham). However, states are not relenting. More states have expressed their intention to set a standard ratio or at least to ask hospitals to disclose their nurse to patient ratios publicly. It is the argument of this paper that all states should use the California law as a model to set official nurse to patient ratios that should be strictly adhered to so as to avoid the many ills of having way fewer nurses than patients.

Proponents’ arguments

California enacted a state legislation in 2004 that in brief stated that for every five patients there should be one nurse. This law essentially set the limit. It necessitated more nurses to be employed to ensure that there are enough numbers to provide patients with the quality healthcare they need. Different limits were, however, set for different health facilities. For example, in an operating room, the ratio was set as one nursing staff per patient, while for psychiatric wards the ratio was set at one nursing staff for every six patients. Lastly, for emergency rooms and pediatric rooms, the limit was four patients per nursing staff (Terasawa).

It has been argued that the California state legislation improves health outcomes, is cost-effective, and has led to high turnover rates because of increased opportunities for nurses. It has also been argued by those who support the inclusion of the ratios in law that the annually increasing number of graduates will fill in the opening positions. In other words, highly skilled nurse graduates are helped to find work by the legislation, while shortages are also simultaneously filled by the nurses so they do not exist for long. Between 2004 and 2008, the vacancies for registered nurses reduced by sixty nine percent. This shows that no expected shortages were experienced after the enactment of the law and that vacancies have reduced courtesy of the fact that more nurses are filling in the opening positions faster (Abraham).

Proper staffing is important for the delivery of quality healthcare. Staffing levels should definitely be flexible and they should also take into account other factors including resource availability, unity layouts, experience levels of available staff, transfers during shit, admission numbers, and patient needs.

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Laws like the one in California have set the standards for optimal staffing, however, new legislations can improve it to make it more comprehensive so that it can take into account factors such as availability of support resources, nursing unit layout, physical design of health facilities, expertise of available staff, number of admissions, number of discharges, patient condition, and so on (Lippincott Solutions). As more and more jurisdictions focus on quality/ value care, proper nurse staffing is expected to be key towards the implementation of related policies since nurses are often at the forefront of providing health care services. Optimal nursing levels can achieve not only better healthcare but also better patient outcomes and better job satisfaction levels.

Those who support the setting of nurse to patient ratios in legislation argue that such laws usually improve the care quality provided. They argue that this was the effect in hospitals in the state…

[…… parts of this paper are missing, click here to view the entire document ]

…the California nursing numbers statute will have a negative impact on the quality of care delivered by burses in the state. The statute helped improve conditions and helped reduce the number of unlicensed staff. It improved the personnel skill mix in the state by also increasing the number of registered nurses employed by the state. And research studies show that the more registered nurses present in healthcare the better the healthcare outcomes (Driscoll et al., 6-22).

One of the most repeated arguments by opponents of mandated nurse to patient ratios is that hiring more nurses will cost more. However, this is not the truth. Already the majority of hospitals in California have got nurse to patient numbers in above the minimum limits introduced by the California statute. Only 41 percent of observation units and 15 percent of labor units and operation rooms did not have the required compliance (“Mandated nurse-to-patient staffing…”). This means that it would not cost the out of compliance hospitals much more money to get the right number of nurses for all their units. Moreover, hiring of more nurses would reduce the expenses on traveling nurses and registry nurses and the funds spent on them could be spent on the wages of the new staff nurses.

Conclusion

As it is evident in the arguments in this paper, states across the country should use the California model to form statutes for the purpose of established minimum patient to nurse ratios. Since California enacted its minimum patient to nurse ratios for various hospital units and scenarios, they have recorded better healthcare outcomes and higher staff job satisfaction scores. It is clear from the opponents’ arguments that not everyone agrees that staff nursing minimum ratios ought to be out in law. Some think it is unnecessary to do so, while others think that there are better ways of addressing the challenges that the minimum mandated staff nursing ratios intend to address. However, the arguments are neither here nor there. They do not attack the actual ills which minimum nurse staffing ratios aim to cure: nursing shortages and lower patient outcomes due to the shortages. Ensuring that the optimal number of staff are available in hospitals countrywide will help to significantly improve patient outcomes, to improve the quality of healthcare and to avoid avoidable negative outcomes e.g. patient falls and lack of satisfaction. It….....

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