Topic Identification
A shortage of nurses remains a serious problem for many facilities, and providing the required level of care is not always possible. Depending on the units, Congress approved specific correlations between nurses and patients to ensure the safety of patients and nurses in different healthcare settings. One nurse is recommended for one patient in trauma, two patients in critical care, three patients in emergency departments, four patients in acute care, five patients in rehabilitation, or six patients in postpartum (“Nurse staffing standards for hospital patient safety and quality care act of 2021,” 2021). These staffing ratios become contingent when severe cases or unpredictable situations emerge, provoking new barriers in nursing development, including a lack of resources, burnout, negative images, and poor involvement.
Rationale
Understanding patient-to-nurse staffing ratios is essential in any hospital because nurses need enough space and resources to develop their skills. According to Lasater et al. (2021), staffing is a primary predictor of nursing care, life-saving, and care cost reduction. Still, not all hospitals report and publicly disclose information about nurse staffing ratios, decreasing the relationship between staffing and care quality (de Cordova et al., 2019). The rationale for this issue selection is to obtain as much credible data as possible and clarify the connection between nursing staff and patient safety through legal, financial, and ethical factors.
Scope and Standards
The American Nurses Association (ANA) is one of the well-known contributors to the scope and standards of nursing practice. It is expected to create safe nurse staffing due to its importance to the whole system. Assessing the current healthcare system, the staff shortage negatively affects care quality and patient/nurse satisfaction. The authors believe that public reporting promotes informed decisions among patients and helps nurses recognize organizational problems that lead to additional costs and errors (de Cordova et al., 2019; Lasater et al., 2021). To ensure adequate nurses for all patients in need of care, evaluating patient outcomes and environmental factors, as the main standards of nursing practice, is required.
Impact on Nursing Issues
Legal Implications
Several laws and regulations exist to establish safe nurse staffing ratios. Each state has specific standards to be followed, and those regions without clear mandates have to hold appropriate ratios depending on available resources and patient databases. For example, in New York, the Safe Staffing for Quality Care Act defines a range of 4.3 to 10.5 patients per nurse (Lasater et al., 2021).
ANA recommends measuring staffing by working hours and skill mix and increasing public reporting systems, following the examples of Illinois, New York, Texas, and Oregon (de Cordova et al., 2019). Licensed practical nurses, certified nurse assistants, and registered nurses should keep up with care standards defined in the Nurse Practice Act and other federal laws to define negligence and malpractice liability. People who do not get enough information about staffing issues can trigger lawsuits even if they do not face a problem directly. The Federal Civil False Claims Act allows the Federal Office of Inspector General to initiate a case related to low staffing issues among licensed nurses in a hospital that might lead to injuries, bedsores, and lethal outcomes.
Ethical Implications
Nurses have to protect the rights of their patients and follow the ethical aspects of care based on autonomy, justice, non-maleficence, and beneficence. For example, the ANA underlines that patients should be the primary commitment of all nurses (de Cordova et al., 2019). However, if nurses work long hours and take additional shifts, they question the patient’s non-maleficence and beneficence. The correlation between inadequate staffing ratios and ethical implications is evident because nurses cannot ensure their professionalism and development under the pressure of the increased number of patients.
Aspects of Finance
In nursing, specific economic and financial implications related to staffing issues affect the quality of care and cooperation between healthcare providers and patients. When a hospital cannot hire the required number of nurses and follow the ratios established by the law, medical errors, poor support, patient dissatisfaction, and readmissions emerge. The example offered by Lasater et al. (2021) for New York hospitals proves that implementing a nurse-patient ratio of 1:4 could lead to $720 million and 4370 lives saved in two years. Most patients can avoid readmissions and decrease the length of hospital stays, which automatically leads to low rates of medical errors and improved nurse staffing ratios.
Quality Patient Care
Nursing staffing ratios determine the quality of care offered in hospitals and the outcomes that patients might achieve. This issue proves the importance of a consensus between nurses, their leaders, and patients because even slight changes may provoke unpredictable shortages. Lasater et al. (2021) reveal that nurse staffing legislation would effectively solve the nursing shortage problem and improve the quality of care because all resources will be fairly distributed. It is not hard to realize that if a nurse is responsible for a large number of patients simultaneously, it is impossible to ensure high-quality care for all patients equally.
Nursing Safety Challenges
Various initiatives exist to identify and solve nursing safety challenges in American hospitals. The most common problems include work overload, injuries, emotional burnout, and errors that affect the relationships between nurses and patients. Cordova et al. (2019) analyze the connection between healthcare safety and staffing ratios and find that higher nurse staffing reduces complications, infections, and hospital-related mortality. It means that nurses with a limited number of patients to serve can control the environment and focus on various factors that affect nursing safety. Thus, it is correct to believe that adequate staffing is one of the solutions to predict safety challenges.
References
de Cordova, P. B., Pogorzelska-Maziarz, M., Eckenhoff, M. E., & McHugh, M. D. (2019). Public reporting of nurse staffing in the United States. Journal of Nursing Regulation, 10(3), 14-20. Web.
Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Anusiewicz, C. V., Martin, B., Reneau, K., Alexander, M., & McHugh, M. D. (2021). Is hospital nurse staffing legislation in the public’s interest? An observational study in New York State. Medical Care, 59(5), 444-450. Web.
Nurse staffing standards for hospital patient safety and quality care act of 2021. (2021). Congress. Web.