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Running head: A POLICY WHITE PAPER ON MANDATED NURSE-PATIENT RATIOS

A Policy White Paper on Mandated Nurse-Patient Ratios


Braydon Bird
Dixie State University

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A POLICY WHITE PAPER ON MANDATED NURSE PATIENT RATIOS

Mandated Nurse-Patient Ratios


The profession of nursing offers its licensed members the ability to seek out
employment in a large number of different nursing specialties. These specialties include
positions in critical care, acute care, rehabilitation, long term care, education and
surgical to name a few. While each of these nursing fields can be drastically different
the majority of nursing specialties require their nurses to implement treatment,
administer medications, ensure patient safety, and monitor patient conditions. These
tasks require a great deal of knowledge, energy, and time from the nurses providing
them, and depending on the State, and unit/specialty a nurse may find themselves
responsible for 1 to upwards of 40 patients at any given time. With such a large disparity
in staffing ratios and a multitude of evidence showing improved patient outcomes with
lower nurse-patient ratios it is a wonder that such ratios are not only more closely
monitored but also more regulated. Currently the decision regarding appropriate nursepatient ratios in most states lays with the employing facility having the only federal
regulation stating that a facility that participates in medicade must
"have adequate numbers of licensed registered nurses, licensed practical (vocational)
nurses, and other personnel to provide nursing care to all patients as needed (TS,
2015). Such vague language from a federal mandate allows for abuse of staffing ratios
and decline in the level of patient care and patient outcomes in many facilities. While
some states have taken action by requiring staffing committees, and disclosure of
staffing ratios, only California has mandated required staffing ratios based on patient
condition and unit. This policy white paper will discuss some of the advantages,

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A POLICY WHITE PAPER ON MANDATED NURSE PATIENT RATIOS
disadvantages and obstacles such policies provide as well as methods to implement
and manage such policies.
While the highest nurse to patient ratios are most often seen in long term care,
and rehabilitation facilities, it is reported that many nurses in acute care settings also
find themselves attempting to provide care to a number of patients which they deem
unsafe based on patient condition and acuity. Many of these nurses feel that due to
these ratios patient care, and thus, patient outcomes suffer. A study published in The
Journal of Professional Safety showed evidence in the reduction of falls, and inpatient
acquired conditions (such as pressure ulcers) by up to one third when staffing ratios
where determined by a nurse driven staffing committee rather than a board of directors
for the facility. (TS, 2015) In addition it was shown that nurses working in facilities with
higher nurse-patient ratios showed greater job satisfaction, less feelings of burnout, and
longer terms of employment allowing for a more experienced nursing staff. (ANA, 2016)
In contrast to the benefits of higher nurse-patient ratios some point out that the
additional cost on employers to staff at higher levels will ultimately be paid for by the
patients and their families, and have the most detrimental effects on those living in longterm care settings which have historically utilized a much lower staffing ratio. Although I
was unable to find any study which directly compared the cost of additional nursing staff
in relation to the costs saved in the prevention of falls, errors, infections etc, the
relationship seems to be implied. (Mark, 2013)
Another factor which should be considered in the implementation of mandated
staffing ratios is the availability of trained and educated registered and vocational
nurses to fill the required positions. Nationally many states are in high demand for such

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A POLICY WHITE PAPER ON MANDATED NURSE PATIENT RATIOS
staff and the demand is projected to grow. According to the Bureau of Labor Statistics
the current employment rate for registered nurses is expected to grow by 19% through
the year 2020. This growth does not account for the influx in required staffing which
would be needed should mandated or monitored staffing ratios be enforced. (BLS,
2016).
I would suggest the following steps be taken in order to solve the problem of
nurse-patient ratios

Federally mandated ratios for critical and acute care settings, with set

patient criteria to determine acuity.


Requirement for facilities to obtain nurse driven staffing
committees/councils to determine appropriate staffing ratios in other

patient care settings.


State and Federal requirement for the public disclosure of staffing ratios

for all facilities providing patient healthcare, or assisted living.


State regulatory personal to routinely monitor and enforce patient care,
and nursing staffing with the ability for anonymous reporting or unsafe

care or staffing situations.


A set public timeline (i.e. five years) in which healthcare facilities can begin
to acquire and train additional staff needed to meet guidelines.

I believe that the need for mandated and monitored nurse-patient ratios is long
overdue and while many facilities already ensure safe and appropriate staffing ratios
the ability to abuse the ratios, and in-turn decrease patient care and outcomes exists.
There for it is my proposal that both state and federal agencies need step in and set
minimal guidelines to ensure that the safety and posterity of the population requiring this
facilities is taken care of appropriately.

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A POLICY WHITE PAPER ON MANDATED NURSE PATIENT RATIOS

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A POLICY WHITE PAPER ON MANDATED NURSE PATIENT RATIOS

References
TS. (2015). Higher nurse-to-patient ratios reduces injuries. The Journal of Professional
Safety, 60(7), 17-24.
Nurse Staffing. (n.d.). Retrieved April 11, 2016, from
http://www.ANA.org/MainMenuCategories/Policy-Advocacy/State/LegislativeAgenda-Reports/State-StaffingPlansRatios
Mark, B. A., Harless, D. W., Spetz, J., Reiter, K. L., & Pink, G. H. (2013). Californias
minimum nurse staffing legislation: results from a natural experiment. Health
Services Research, 48(16), 435-454.
Occupations with the largest projected number of job openings due to growth and
replacement needs, 2012 and projected 2022. (n.d.). Retrieved April 12, 2016,
from http://www.bls.gov/news.release/ecopro.t08.htm