We will have a new President tomorrow. And our nation has been buzzing with the anticipation of “change.” When it comes to change, health care reform tops the list of many commentators and consumers. Many Americans are calling for cost-effective and fair access to quality health care. At the same time, our country is experiencing a shortage of both nurses and primary care providers. How can we provide quality access amidst a growing shortage of health care professionals? Is new legislation the solution to these problems? Some nurses believe that the answer can be found in universal nurse-patient ratio laws, such as those currently mandated by the state of California.
As health care professionals, nurses stand in a unique position. We perceive health care from both sides—as consumers and providers. In addition to this inside perspective, nurses constitute a huge portion of health care expense and personnel. Whether at the bedside, or working in a clinic or other setting, nurses are at the front line of health care.
Most nurses are keenly aware of the pervasive realities related to the growing nursing shortage. We witness, daily, stress and burnout among new and seasoned nurses. We watch, helplessly, as our peers struggle amid heavy workloads and face daunting documentation requirements. We are often too busy with our own struggles to assist our colleagues in theirs. No wonder so many nurses are leaving the bedside for less stressful environments. Some are leaving the profession altogether. But when nurses leave the bedside, the problem is exacerbated. Fewer nurses are left to carry the load and, consequently, the load becomes greater. Yet, since instituting the nurse-patient ratio law, advocates state that California RNs are entering the workforce and staying longer at the bedside. Do you think that this is the solution?
Obviously, ratio requirements need to be adjusted to account for health care settings (med-surg, pediatric, ER). They must also address acuity levels as well as the mix of new-grads to seasoned nurses. Most importantly, like minimum wage requirements, minimum nurse-patient ratio requirements must be used as floor parameters, and not as ceilings.
Whether or not ratios hold the answer to our current health care crisis, there are many other nursing concerns that must be addressed. For instance, how can nurses ensure that they get their breaks? How can they be sure that they have adequate ancillary staff, such as CNAs? Oftentimes, nursing assistants are used as “sitters” for disoriented patients, taking the assistants off the floor and leaving nurses to perform double duty. And, if hospitals are required to meet nurse-patient ratio requirements, will they be forced to cut back on nursing assistants and other ancillary staff?
These concerns are vital to recruiting and retaining nurses. They are also essential to ensuring that consumers have safe, quality access to health care. Nurses are the backbone of our healthcare system. We cannot provide quality access to health care in a system that breaks the spirits and backs of our care givers. Does your facility base staffing on nurse-patient ratios or acuity levels? Please share your thoughts and experiences.