By Carrie Mortrud, RN
I haven’t even finished this article about the American Organization of Nurse Executives, and I’m pretty troubled by it. It’s pretty clear that these researchers are quick to dismiss a solution that would only improve patient safety and the quality of patient care while also giving power to the bedside nurse. I quoted parts of the article here, and I gave you my take below.
“The American Organization of Nurse Executives, a subsidiary of the American Hospital Association, says that it doesn’t support mandated nurse staffing ratios because staffing is a complex issue composed of multiple variables.”
Staffing is complex and ratios may not guarantee safety but it will be closer to providing safety than how the hospitals do things now. Every patient is different, but we already categorize them to admit them, to find them a surgeon, to assess them for physical therapy, and to CHARGE them. We SHOULD at the very least be able to find a way to provide staff to care for them appropriately when they are in the hospitals!
Some experts say fixed staffing-ratio laws do not take into account the demands of unique patient populations that differ from facility to facility.“
Hospitals never purposefully overstaff. They purposefully understaff and choose not to call in extra staff in urgent situations by relying on nurses to “make do.” What’s funny to me is hospitals staff by a ratio now. They rely on staffing grids/matrices/ratios to create nurse staffing budgets for the year. This is how every monthly schedule for nurses is built. The staffing department assess patient census and determines how many nurses are necessary. THIS IS a mathematical ratio already. The key is this ratio is too often unsafe. The hospital NEVER has an issue “going below the grid” when it benefits them but rarely goes above to benefit the patients. This means too often they respond to nurses who request more staff (because nursing acuity and nursing intensity deems the nurses need more staff) with comments such as “nope, can’t give you more nurses, unless you take more patients.”
?”There is not enough research evidence to indicate how effective fixed staffing ratios are at improving patient outcomes.“
When patients don’t get turned for an entire 24 hours, it’s because there wasn’t enough staff. No licensed nurse would ever intentionally decide to leave a patient lying on a bed pan for an entire day. It happens because there’s not enough properly trained staff assigned to the unit to give the cares the patients needed, were admitted to receive and paid for.
“Following the CMS’ decision to place the hospital on “immediate jeopardy” status, Hazard ARH complied with the agency’s recommendations to conduct staff education on wound care, update policies for tracking patient-care issues, and improve education and communication during shift changes. Its immediate jeopardy status was lifted in May.”
The classic solution for the hospital to avoid punishment or get a “get out of jail free” card is to blame staff, i.e. educate the staff. I doubt the staff didn’t know they shouldn’t leave a diabetic on a bedpan for 24 hours. NOT one recommendation from CMS was to increase the number of nurses or nursing assistants caring for the specific number of patients. The solution was to come up with a tracking form, educate the staff on what protocol is and improve communication. It’s pretty hard to communicate with someone who isn’t there. If you are the only nurse, you can’t tell the ghost nurse to go turn the patient in 5123.