Mandated Nurse-To-Patient Ratios Controversy

FACTS:

The minimum-staffing ratio represents the ratio that is deemed safe for providing quality care to patient. It is very important to establish safe staffing ratios to protect patients. Nurses need assistance from elected officials on state as well as federal levels to have adequate nurse staffing ratios through legislative or regulatory means. Safe staffing ratios is the setting of minimum ratios of staff-patient for each type of care unit, requiring use of patient classification /patient acuity system before adjusting the legislated minimum ratios.

HISTORY:

IN 1999, California passed Assembly Bill 394, which was the first comprehensive legislation in the United States to establish minimum staffing ratios for registered nurses (RNs) and licensed vocational nurses (LVNs) working in hospitals. AB 394 directs the California Department of Health Services (DHS) to establish "minimum, specific, and numerical licensed nurse-to-patient ratios by licensed nurse classification and by hospital unit."

The legislative regulation has had a major impact on hospital reimbursement. In 2008, the medicare-medicaid established new regulations linking Medicare hospital payment to patient outcomes. Eight conditions such as falls with injury and catheter-associated urinary tract infections and other nosocomial infections were cited as conditions that will no longer be reimbursed. Finally, the nation’s increasing nursing shortage, which is partly due to an aging nursing workforce with fewer graduates to replace retiring nurses has affected hospital staffing negatively.

Mandatory staffing ratios also ignore other necessary criteria for adequate staffing decisions, including patient acuity and required treatments, length of stay, team dynamics of staff, physician preferences, environ- mental limitations, variations in technology, and avail- ability of ancillary staff. Finally, mandatory ratios are inflexible and do not allow for the dynamic changing of patient needs that are recognized by