Introduction
Continuing changes witnessed in healthcare has occasioned an increased awareness particularly on the quality of care in the hospitals offering acute care services. The rising demand for quality care from the patients has ushered in a paradigm shift in the management of nursing staff in the hospitals. While it is not easy to quantify the contribution of high number of nurses on improving efficiency in the delivery of healthcare, the opposite has occurred especially when the hospitals employ fewer nurses (Hurst, 2002, p. 23). It is important to ensure that a constant ratio of nurses to the patients is maintained in order to enhance the achievement of positive outcomes. This research paper will discuss the facts, history and legislative regulation affecting the nursing work environment. In addition, a discussion of the controversial aspects concerning the various stakeholders in nursing and a personal opinion of the nursing ratios will occur.
Facts about nursing ratios
The identification of an effective staffing mix has become elusive and in contention owing to the various dynamics involved in staff management. Staffing levels has continually become a headache to the local management owing to the variations in the workload and resources at the institutional level (Berliner, Kovner, & Zhu, 2002, p. 65). The nursing ratio usually refers to the number of patients taken care of by one nurse. This traditional approach has come under intense pressure from the newly introduced standardized and mandatory approach that requires the staff to patient ratio to be maintained at a certain level. The mandatory approach utilizes the nurse: bed ratios and largely the nurse to patient ratios. Mandatory approach has brought a paradigm shift in the staffing whereby decision-making is removed from the local levels thereby requiring compliance with preset standards from a higher authority such as national or state governments. The procedures for increasing workload coupled with the need for improvement in efficiency has occasioned widespread review of staffing levels in many health systems (Scottish Executive Health Department, 2004, p. 65).. Majority of studies denote the application of systematic approach based on workload assessment unlike the reliance on historical levels and largely on professional judgment (Hurst, 2002, p. 54). Mandatory nurse ratios have failed to produce a single solution to the problem of staffing levels in the wards.
History of the nursing staff ratios
The state of California became the first state to introduce mandatory staffing levels thus achieving a low nurse to patients’ ratio in the US. Although quantification of the efficacy of the approach is not easy, the government and the nurses association has eventually agreed to utilize a more flexible form of the mandatory approach (Buchan, 2005, p. 240). Although the initial attempts to introduce ratios occurred in 1999, application of the legislation took effect four years later owing to the disagreement on the ratio of nurses and patients. After conclusive agreement on the specific ratios, implementation of the ratios took effect on January 2004 hence requiring California hospitals to hire nursing staff depending on the standards set by the department of health services (Berliner et al, 2002, p. 64). The decision to introduce this legislation was brought about by the growing crisis occasioned by the effects of managed care and other market based decisions that encouraged outflow of staff from public hospitals. In view of the looming nursing shortage, the California Nurses Association embraced legislative action to enhance the staffing levels in the public hospitals. While differences on the correct ratios persisted, the cost savings and the overall quality improvements occasioned by the nursing ratios influenced and hastened the efforts directed toward the embracement of the policy (Buchanan et al, 2004, p. 23).
Efficacy of legislative action
Legislative action has become imperative in ensuring the compliance with policies in healthcare. Policy changes coupled with enactment of legal frameworks to guide their implementation have helped the Californian state to achieve much on the nursing ratio front. Citing significant increase in salaries, the employers were reluctant to implement the recommendations. However, the legislative framework in Australia and California and court ruling forced the hospitals to comply with the stipulated nurse patient ratio. The Australian Industrial Relations Commission passed a resolution that saw the establishment of ratios in Victorian hospitals in 2000 and 2001(Buchanan et al, 2004, p. 23). The enforcement of the legislation in both California and Australia pulled back nurses to the restructured public health institutions. In addition, the need to offer refresher programs for nurses resulted in improvement of healthcare delivery in the long term. Although the legislative actions against violations of the ratios are generally weak, the level of compliance has constantly improved over time owing to their vulnerability of the managers to civil suits occasioned by poor service delivery to patients. More importantly, the legal provisions led to sobriety in the labor market owing to the improvement in working conditions and environment (Mason, Leavitt & Chaffee, 2007, p. 76).
Controversy surrounding the nursing ratio
The enactment of the nursing ratio elicited heated debate from the concerned stakeholders mainly due to the financial implications. Majority of the stakeholders were critical of the policy since its formative stages. The coming into force of the policy has brought more controversy particularly on its implementation (Mason, Leavitt & Chaffee, 2007, p. 76). The need for continuous compliance with the required ratios at all times has made its implementation a difficult task since a nurse must be assigned to patients at all times. Differences between employers, government and the nurses association with regard to actual numbers to be hired also occurred. The persistence and demand for better care by the consumers has put them at odds with the health care institutions (Cowen, & Moorhead, 2001, p. 90).
Reflection
The expansion of the nurse patients’ ratios to New Zealand and other states in the United States acts as an important gesture of the applicability and cost effectiveness of this approach. Taking into consideration the success in terms of improvement in patient care and overall satisfaction of the nurses, the ratios confers holistic benefits to the health care sector (Cowen, & Moorhead, 2001, p. 34). The implementation of the nurse patients’ ratios not only bolsters the employment of nurse but also encourages their retention and eventual workforce stability. The propensity of leaving the profession or terminating employment greatly reduces owing to the reduction of workload and satisfaction occasioned by conducive working environment. The fact that the approach is standardized makes it easier for local institutions to integrate it in their systems without necessarily involving several processes. More importantly, its easiness to understand and simplicity in terms of implementation makes it a viable approach particularly for less established healthcare systems.
Conclusion
The cost effectiveness offered by its simplicity of the nursing ratios allows the health systems to direct vital resources into the core areas. The nurses’ patients approach enhances the development of the nurses by allowing them to integrate best practices with efficiency thus resulting in safe and effective patient care. In fact, the method need embracement in nursing practice since it reduces nurse burnout while encouraging their retention in the health systems.
Reference List
Berliner, J., Kovner, C. & Zhu, C. (2002). Nurse Staffing Ratios in California: A Critique of the Final Report on Hospital Nursing Staff Radios and Quality of Care. Washington DC, USA: Services Employees International Union Nurse Alliance.
Buchan, J. (2005). A certain ratio? The policy implications of minimum staffing ratios in nursing. Journal of Health Services and Research Policy, 10(4), 239-145.
Buchanan, J., Bretherton, T., Bearfield, S. & Jackson, S. (2004). Stable but Critical: The Working Conditions of Victorian Public Sector Nurses in 2003. Sydney: Australian Centre for Industrial Relations Research and Training, University of Sydney.
Cowen, P., & Moorhead, S. (2001). Current issues in nursing (6th Ed.). St. Louis, MD: Mosby Elsevier.
Mason, D., Leavitt, J. & Chaffee, M. (2007).Policy & politics in nursing and health care (5th Ed.) St.Louis, MO: Saunders Elsevier
Hurst K. (2002). Selecting and Applying Methods for Estimating the Size and Mix of Nursing Teams. Leeds: Nuffield Institute for Health.
Scottish Executive, Health Department. (2004). Nursing and Midwifery Workload and Workforce Planning Project. Edinburgh: Scottish Executive. Web.