NCONL
POSITION
The North Carolina Organization of Nurse Leaders (NCONL) believes
that every person deserves access to health care and that its
members have the responsibility to ensure safe practice conditions
for all nurses. NCONL opposes legislated mandated nurse staffing
ratios. Mandated staffing ratios will only serve to increase
the stress on an already overburdened healthcare system and
potentially create a greater public safety risk.
OVERVIEW
Mandated nursing ratios are determined by one staffing variable,
a simple count of the patient population, and fail to factor
in the more important variables, including patients' needs and
complexity of patients' condition, the environment in which
the care is delivered, the education and experience of the nurses,
and the availability of adequate support services within the
acute care setting. Establishing mandatory staffing ratios is
not the answer. Working together with policy makers in seeking
solutions to ensure an adequate supply of nurses and other healthcare
workers is a better approach to address the factors that contribute
to the healthcare crisis in North Carolina and across the country.
The U.S. Bureau of Labor Statistics projects by 2010, the nation
will have a deficit of more than one million nurse.
RATIONALE
Because hospitals provide 24-hour health care and workload is
unpredictable, nurse leaders must have the flexibility to manage
changing patient care needs, while ensuring that competent staff
delivers quality nursing care.
- An
ongoing assessment of patients' needs, rather than an arbitrary
number, formula or ratio must determine staffing. Staffing
decisions require the judgment, critical thinking and flexibility
of nurse administrators, nurse managers and professional
nursing staff who best understand the patients and their
health care needs.
- Great
variability of patient mix exists from hospital-to-hospital.
This mix depends on each hospital's setting. The number
of nurses required to meet the needs of a specific patient
population cannot be based on a formula and must be determined
by a variety of factors including the specific needs of
each patient within an acute care setting.
- This
increasingly dynamic patient care environment requires flexibility
to provide staffing based on patient need, not by fixed
numbers of ratios. Shortened lengths-of-stay and observation
patients add to the complexity of ensuring appropriate staffing
levels to meet patient need, since the number and acuity
of patients can change from shift-to-shift, and hour-to-hour.
NCONL supports evaluation of staffing on an ongoing basis
and making adjustments according to patients needs and level
of acuity.
- Nurses
with varied education and experience bring different skills
to each patient's bedside. Nurse-to-patient ratios do not
consider the impact these differences have in determining
the level of care versus the number of nurses that are needed
to provide that care.
- Outcomes
must be addressed by each acute care facility according
to criteria of regulatory agencies.
REFERENCES
Duff, Susanna (2002) Too Little, Too Late or Enough? Modern
Healthcare August 5, 2002, 6-7; 10.
MONE Position Statement. May 7, 2002
Maintaining Patient-focused Care in an Environment of Nursing
Staff Shortages and Financial Constraints. AACN Nov. 2000.
Blegen MA, Goode GJ, Reed L. Nurse Staffing and Patient Outcomes.
Nursing Research 1998; 47(1):43-50.
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