How have mandated nurse staffing ratios affected hospitals? Perspectives from California hospital leaders
ABSTRACT In 1999, California became the first state to pass legislation mandating minimum nurse-to-patient ratios. Regulations detailing specific ratios by type of hospital unit were released in 2002, with phased-in implementation beginning in 2004 and completed in 2008. These ratios were implemented at a time of severe registered nurse (RN) shortage in the state and a worsening financial position for many hospitals. This article presents an analysis of qualitative data from interviews with healthcare leaders about the impact of nurse staffing ratios. Twenty hospitals (including public, not-for-profit, and for-profit institutions) representing major geographic regions of California were approached. Twelve agreed to participate; semistructured in-person and telephone interviews were conducted with 23 hospital leaders. Several key themes emerged from the analysis. Most hospitals found it difficult and expensive to find more RNs to hire to meet the ratios. Meeting the staffing requirements on all units, at all times, was challenging and had negative impacts, such as a backlog of patients in the emergency department and a decrease of other ancillary staff. Hospital leaders do not believe that ratios have had an impact on patient quality of care. Findings related to nurse satisfaction were mixed. Increased RN staffing improved satisfaction with patient workload, but dissatisfaction with issues of decision-making control (e.g., decisions on when best to take a meal break) were taken out of the nurse's hands to meet ratio requirements. Further research should continue to monitor patient outcomes as other states consider similar ratio regulations. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, high-quality care.
Full-textDOI: · Available from: Joanne Spetz, Sep 28, 2015
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- "Research regarding ED staffing requirements has arisen from a number of countries (including Australia, UK, USA, Canada, South Africa, Germany, Israel, Hong Kong, Kuwait, Oman, Korea and Taiwan); across a variety of professions (nursing, medical, allied health); and across a variety of settings (metropolitan and rural environments). Four major areas of research emerging from these countries regarding ED staffing include: (i) descriptions/profiling of existing workforce arrangements (Hobgood et al. 2005, Bennett et al. 2007, Drescher et al. 2007, Hwang & Cheng 2007, Lyneham et al. 2008, Nixon 2008, Paw 2008, Kalish & Leo 2009); (ii) predictions of future workforce requirements (Camargo et al. 2009, Sullivan et al. 2009, Mueleman et al. 2010, Jelinek et al. 2011); (iii) descriptions and evaluations of current and new models of staffing arrangements (Robinson et al. 2005, Sinreich & Jabali 2007, Geelhoed & Geelhoed 2008, Chapman et al. 2009, Dreyer et al. 2009, Wai et al. 2009, Chan et al. 2010, Hu et al. 2010, Callander & Schofield 2011); and (iv) developments and applications of specific tools used to inform workforce numbers (Ghosh & Cruz 2005, Crouch & Williams 2006, O'Brien & Benger 2007, Korn et al. 2008, Sucov et al. 2009, Ahmed & Alhhamis 2009, Gedmentis et al. 2010, Williams et al. 2010). Common to most of these research reports is the realisation that adequate staffing in the ED is imperative in order to meet patient safety needs and health service key priority indicators. "
ABSTRACT: To describe and compare standard practice with a revised, assisted method for calculating emergency department nursing workforce requirements (using the emergency nursing workforce tool, ENWT) within 27 Queensland public hospital emergency departments (ED). Despite the presence of several methodologies used for staffing calculations, there is a necessity to refine measures of emergency department complexity and workload to determine appropriate staffing in order to meet patient safety needs and health service key priority indicators. A descriptive comparative study design was employed. Of the 27 ED nurse unit managers (NUM) invited, 18 (67%) participated. No significant difference was noted in the full time equivalent (FTE) nursing requirement when standard vs. new (ENWT) methods were compared. The ENWT was more efficient (i.e. timely) and had better predictability than existing methods for calculating FTE nursing requirement. The methodology underpinning the ENWT may be useful to apply or adapt to settings other than the ED (e.g. intensive care, operating room) and disciplines within the ED other than nursing (e.g. medicine, allied health, porterage) to inform staffing requirements. Findings from this research can be used to inform ED managers and health service planners regarding a standardized approach to calculating emergency nursing workforce needs.Journal of Nursing Management 07/2013; 22(8). DOI:10.1111/jonm.12063 · 1.50 Impact Factor
Article: Ratios—If It Were Only That Easy[Show abstract] [Hide abstract]
ABSTRACT: Health care staffing is a complicated arena, and nurses are in the best position to assure a good match between the problems being addressed and the solutions being adopted. Why would nurses want to hand over their power to make staffing decisions to the government? Perhaps what got us into the situation of asking government to intervene in the world of health care staffing is the inability of management and staff to work together effectively to design the most effective approach to staffing. The business side and the quality/safety side of health care must work in harmony. Collaboration between nursing and finance is perhaps the most important formula for success. The challenges before us in health care staffing are big, but they will never be solved by the application of symptom-level solutions.Nursing economic$ 01/2010; 28(2):119-25. · 0.80 Impact Factor
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ABSTRACT: California is the first state to enact legislation mandating minimum nurse-to-patient ratios at all times in acute care hospitals. This synthesis examines 12 studies of the impact of California's ratios on patient care cost, quality, and outcomes in acute care hospitals. A key finding from this synthesis is that the implementation of minimum nurse-to-patient ratios reduced the number of patients per licensed nurse and increased the number of worked nursing hours per patient day in hospitals. Another finding is that there were no significant impacts of these improved staffing measures on measures of nursing quality and patient safety indicators across hospitals. A critical observation may be that adverse outcomes did not increase despite the increasing patient severity reflected in case mix index. We cautiously posit that this finding may actually suggest an impact of ratios in preventing adverse events in the presence of increased patient risk.Policy Politics & Nursing Practice 08/2010; 11(3):184-201. DOI:10.1177/1527154410392240