Mandating nurse patient ratios
After six months of research, discussions, tests and recommendations, new whiteboards are being put in place in units on the East and West banks.
“We researched how other hospitals designed and used their whiteboards and gathered feedback from patients and their families as well as staff members,” Kay says.
Fairview Ridges Hospital’s pediatric unit adopted the University of Minnesota Amplatz Children’s Hospital format, which represents best practices for communicating with children and families.
In those rooms, the whiteboards flip, presenting the adult information on the opposite side for times when that format is needed.
But, mandatory staffing ratios alone cannot ensure safe, effective patient care.
In fact, this is the position that both the American Nurses Association (ANA) and American Organization of Nurse Executives (AONE) have taken.
“Research shows that those tools are not necessarily helpful for all patients, and it isn’t a good method of pain management,” Kay explains.
Working with Deb Drew, advanced practice nurse leader in the Pain Management Center, Kay and Nicky learned that setting a pain management goal by asking the patient, “What is the pain stopping you from doing? If a goal for the patient is to be up and walking and the pain is preventing that from happening, it needs to be noted and treated.
This report shall be presented to the chairs and ranking minority members of the Health and Human Services Committees in the House of Representatives and the Senate by January 15, 2015.” “At this point, available studies do not prove causal relationship, or indicate that changes in patient outcomes are solely the result of nurse staffing decisions; they also do not identify points at which staffing levels become unsafe or begin to have negative effects on outcomes.” Further, the report states: “While the literature has demonstrated the correlation between nurse staffing volumes and certain outcomes, it has not yet established an increase in nurse volume will inevitable product [sic] changes in outcomes – or the pretense of a causal relationship. “…there have been no randomized controlled trials or studies using random assignment of nurse staffing levels to certain hospitals to study patient outcomes.For example, the acuity of the patients, the level of nursing experience, the unit layout, the technology used, the support staff available and the patient churn within the unit are all important factors that cannot be accounted for with mandated ratios alone.The ratios might provide a starting point for the development of a staffing plan or serve as a minimum level of staffing.But the nursing unions backing the bills have grown increasingly powerful in statehouses across the country. They argue the bills would strip them of their ability to make basic staffing decisions and be a financial burden.Many nurses and nursing unions say legislation is needed to prevent cost-conscious hospitals from endangering patients by putting too large of a workload on too few nurses.
bag for a patient at the University of Miami Hospital’s Emergency Department in 2012 in Miami.