Joanne Metroplos, RN, MPH
Lead Organizer, Nurse Alliance
Whenever the word “ratio” comes up in relationship to staffing, strong opinions dominate the discussion. So we were excited to have Ingela Dahlgen and Kathy Hughes, nurses from our SEIU Nurse Alliance of California, come to our March Delegate Assembly and share the facts about the California staffing ratios. Minimum staffing standards (or the mandated ratios that limit the number of patients an RN cares for) have been in place in California for nearly a decade. And yet, we see strong opposition to a similar staffing guarantee in our workplaces. Both the testimony of these nurses and several major research studies support the efficacy of ratios as a way to improve the quality of care and save lives.
Myth: California nursing ratios are rigid and ignore differences in patient acuity.
Fact: The ratios are not fixed. Rather they specify the maximum number of patients a nurse may be assigned. Patient classification systems are required, and additional staffing must be assigned based on patient acuity.
Myth: California hospitals cut support staff, increasing the workload of RNs.
Fact: Staffing for patient care that does not require a license is determined using the patient classification system. To ignore this system would be a violation of the law.
Myth: Implementing ratios would cost the hospitals too much.
Fact: Using evidence-based RN-to-patient ratios not only saves lives, but also is cost effective, as it reduces hospital-acquired infections, lengths of stay, adverse events and staff turnover. Several studies have illustrated a business case for quality and increasing the number of nurse hours at the patient’s bedside*.
Myth: There is no evidence that the California ratios improve care.
Fact: At least one major comparison study recently showed that nurse staffing ratios mandated in California are associated with significantly lower mortality. However, the key to saving more lives in hospitals is associated with the ability to not only have better staffing ratios, but also that the ratios are guaranteed and enforceable**.
Many hospitals are ignoring our 2008 Washington State Staffing law, and implementing unilateral decreases in staffing. While we support efforts to cut costs, quality patient care remains the top priority. Staffing ratios may not be the perfect solution to all staffing and patient care challenges, but they provide a necessary legal standard and a counter to market forces that do not put the patients first.
*Needleman “Nurse Staffing in Hospitals: Is There a Business Case for Quality?” Health Affairs 25, no. 1 (2006): 204-2211.
**Aiken“Implications of the California Nurse Staffing Mandate for Other States” www.nursing.upenn.edu/…/Aiken.2010.CaliforniaStaffingRatios.pdf