Nurse-Patient Ratio and Massachusetts Saint Vincent Hospital Strike Essay

Introduction

Nurses are at the forefront of patient care, and their satisfaction with the conditions provided by facilities is vital for the positive outcomes of treatment. Meanwhile, the neglect of this aspect by policymakers and inadequate nursing staff ratios evoke concerns of specialists in the field. The increasing complexity of patient care adds to the problem because of the prevalence of conditions, which require the assistance of advanced employees. In this situation, optimal staffing ratios are essential for the quality of rendered services. The correspondence of elaborated policies alongside the creation of favorable conditions for nursing work contribute to the improvements in the results of their activity (Livanos, 2018). Therefore, this paper aims to present an argument for safe practices for patients by addressing the needs of nurses in terms of their adequate numbers.

Background and Significance

The challenge of the nurse-to-patient ratio and its effects are well-studied phenomena. Scholars confirmed the correlation between nurse workload and care quality based on the evidence from facilities (Qureshi et al., 2019). The current operational policy and design show that the increase in the former’s indicators results in the deterioration of the mechanism of healthcare services provision. The possible outcomes of the neglect of this issue are the worsening reflected by 120% missed care and 20% task‐in‐queue time complemented by 110% cumulative walking distance, and 120% task‐in‐queue for nursing personnel (Qureshi et al., 2019). The researchers also proved that hospital managers could not address these problems, and interventions from third parties are required (Qureshi et al., 2019). These findings relate to the lack of nursing hours since they cover only 50% of all patient needs (Juvé‐Udina et al., 2020). At present, the average missed nursing care is 21%, and ignoring these data means the growing probability that the situation described above will become a reality (Juvé‐Udina et al., 2020). Hence, legislators should address the mentioned gap in the numbers of registered nurses and their working conditions to avoid these consequences.

The methods proposed for the resolution of the inadequate nurse-to-patient ratio are insufficient. The improvements with the use of a patient assignment acuity tool (PAAT) are not feasible without the support of all facilities (Allegra et al., 2019). Therefore, patient safety and nurses’ job satisfaction depend solely on the creation of laws providing for the unity of hospitals throughout the country in implementing such instruments. In turn, the partial introduction of PAAT in women’s health, labor and delivery units might highlight the difference in the outcomes of different medical departments and increase discontent of both employees and patients. The consideration of this aspect of healthcare in the course of debate of legislators has not brought any results yet. The initiative to mandate nurse staffing levels by law faced obstacles in the form of competing needs of participants and the lack of flexibility in stagnant ratios (Livanos, 2018). The absence of actions in this direction leads to strikes, as in the case of St. Vincent Hospital, refusing to negotiate staffing improvements for patient safety (Massachusetts Nurses Association, 2021). In order to avoid similar occasions in other locations, legislators should take measures.

Position Statement

National Nurses United recommends that legislators in all the states elaborate the laws similar to the ones in California for maintaining optimal nursing staff ratios and all public health and healthcare settings adopt the policies. This professional organization of registered nurses in the United States explains its attempts to advocate for the proposed innovation by the benefits they might bring to nurses in the workplace. They primarily include job satisfaction, elimination of the risks of high turnover rates, burnout, and intent to leave the profession (Livanos, 2018). In this way, the proposed measure is efficient in terms of retention and addressing the negative effects of the problem. The support of National Nurses United alongside other organizations serves as a facilitator for making the change, whereas the healthcare facilities prevent their plans from implementation.

The resistance to the shift from the old approach to new methods of addressing the needs of hospital employees and their patients is conditional upon a row of issues complicating their operations in the long run. Thus, the evolving technology and design of works indicate the dynamic environment, which implies the impossibility of introducing the laws providing for strict limits (Livanos, 2018). The estimated costs of the initiative, more than $90 million annually, do not allow considering it possible (Livanos, 2018). Meanwhile, it is important to resolve the conflict of interests for the benefit of all participants in the field since the failure to do so would indicate the inconsistency of healthcare to provide high-quality services. Hence, the measures should cover the identified problems, and they include the following tasks:

• Mandating nurse staffing levels by law while addressing the specified risks separately;
• Creating an instrument of regulating the nursing staff ratios based on the existing tools such as PAAT and the evidence from the hospitals;
• Introducing the instrument in the facilities throughout the country while using the experience of California in establishing these regulations;
• Elaborating a formula for calculating an optimal nursing staff ratio for maintaining the flexibility of hospitals’ operations;
• Providing governmental funding for decreasing the burden of the hospitals and their resistance to change while developing a cost-efficient scheme for managing expenses.

Conclusion

To summarize, the introduction of an instrument for monitoring the nursing staff ratios in the hospitals is necessary for establishing the appropriate quality of rendered services. Meanwhile, the success of this initiative depends on the efficiency of actions of the policymakers in addressing the problems with funding and the lack of flexibility, which is essential for further development of the field. The support of unions such as National Nurses United is also important for making a change, and underpinning it by evidence-based solutions will be beneficial for the outcome of the proposed measures. Thus, mandating nurse staffing levels by law while considering the experience of California and the appropriate instruments alongside the formula for calculating the optimal number of employees is the key to patient safety.

References

Allegra, J., Anca, R., & Ruff, D. (2019). Development of a patient assignment acuity tool to improve equity in assignments, patient safety, and nurse satisfaction in a labor and delivery unit.Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(3), S19. Web.

Juvé‐Udina, M. E., González‐Samartino, M., López‐Jiménez, M. M., Planas‐Canals, M., Rodríguez‐Fernández, H., Batuecas Duelt, I. J.,… & Adamuz, J. (2020). Acuity, nurse staffing and workforce, missed care and patient outcomes: A cluster‐unit‐level descriptive comparison.Journal of Nursing Management, 28(8), 2216-2229. Web.

Livanos, N. (2018). A broadening coalition: Patient safety enters the Nurse-to-Patient ratio debate. Journal of Nursing Regulation, 9(1), 68-70. Web.

Qureshi, S. M., Purdy, N., Mohani, A., & Neumann, W. P. (2019). Predicting the effect of nurse–patient ratio on nurse workload and care quality using discrete event simulation.Journal of Nursing Management, 27(5), 971-980. Web.

Massachusetts Nurses Association. (2021). St. Vincent nurses begin strike today at 6 a.m. as Dallas-based tenet healthcare refuses to negotiate over unsafe patient care conditions.Web.