Standards of care as developed both in local organizations and through state and federal policy are critical to maintaining a safe and high-quality level of patient care. These standards of care are commonly based on evidence-based research or the experience of health care professionals. Healthcare organizations are expected to provide the environment, tools, and resources (both physical and human) to ensure that individual healthcare providers (doctors, nurses) can competently practice care following their responsibilities as guided by law.
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Understaffing is a critical issue in healthcare facilities of all types around the United States. Many have serious quality problems, largely because of staffing levels, with nurses unable to meet the demands of overwhelming patient care. California is currently the only state that mandates staffing requirements by law, with a ratio of 1:2 to 1:4 depending on the department and critical health of the patient. Other states have staffing commissions and report data but often issue simple recommendations. Currently, there is a bill in progress in Congress to create federal nurse staffing legal standards (Blitchok, 2018).
Safe staffing ratios are critical for standards of care required during treatment, providing a range of benefits to both nurses and patients. Both a shortage of qualified nurses and attempts by organizations to cut expenses (as occurred in the scenario with SK) create unsafe nurse-to-patient ratios. This puts patients at a higher risk of infection, medication errors, falls, and adverse events. Reasonable nurse-to-patient standards, such as in California, have demonstrated improved nurse staffing and tremendous improvement in patient outcomes (Livanos, 2018). As the ratio is smaller, nurses have smaller workloads and can identify and respond to any arising issues faster, with fewer patients dying (lower mortality rates) in critical or post-surgical units. Higher nurse-to-patient ratios, both in standards and in practice consistently account for greater failure to rescue (FTR) rates in critical condition patients (Chen et al., 2018). Furthermore, many labor organizations and national nursing associations have advocated strongly for nurse-to-patient ratios as part of the legal standards of care. Higher nurse staffing also improves the quality of life for nurses, reducing dissatisfaction, burnout, and in turn, high turnover rates that cause the issue of understaffing in the first place (Livanos, 2018).
The Nurse Practice Act (NPA) for the state of Florida does not explicitly address any aspects of care concerning staffing, nor is it offering any possibilities for personal responsibility of nurses in a case such as this scenario. The NPA does highlight standards of care that emphasize competence and accountability in all areas of practice that the nurse maybe engaged in, including consistent performance in all elements of care. Furthermore, under the NPA, nurses are expected to demonstrate appropriate recognition, consultation, and intervention when complications arise. These are critical patient standards that apply to all levels of nurses, RNs, and LPNs. Particularly, under the assessment category of practice, nurses are responsible for the timely collection of subjective and objective of the patient’s condition from the patient or their family members (Bushy, n.d.). In the scenario with SK, this process failed to lead to a lack of timely action in terms of diagnosis, implementation of treatments, and evaluation.
It is evident that the standards of care could not be met in the scenario for SK. This is a result of organizational failures most likely, failing to provide enough staff for safe management and provision of care of hospitalized patients. Based on available evidence and records that the hospital continuously failed to meet both its own and research-recommended standards of staffing, thus constraining the ability of nurses to perform their duties under the NPA, the healthcare organization would likely be found liable for damages to the patient.
Blitchok, A. (2018). Proposed federal RN ratios – What you can do about it. Nurse.org. Web.
Bushy, A. (n.d.). Laws and rules governing nursing practice in Florida. Web.
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Chen, Q., Olsen, G., Bagante, F., Merath, K., Idrees, J. J., Akgul, O., … Pawlik, T. M. (2018). Procedure-specific volume and nurse-to-patient ratio: Implications for failure to rescue patients following liver surgery. World Journal of Surgery, 43(3), 910–919. Web.
Livanos, N. (2018). A broadening coalition: Patient safety enters the nurse-to-patient ratio debate. Journal of Nursing Regulation, 9(1), 68–70. Web.