Editor's
Note
Staffing
ratios
Be
careful what you wish for
Carol Bradley, MSN,
RN, California Editor
December
4, 2000
In some
fashion, I have spent my 26-year nursing career intimately
involved in the delivery of acute inpatient hospital-based
nursing care. Despite all the changes in health care, the
basic approach to providing patient care has remained pretty
much the same since I began my career in 1974.
Although
patients today are similar to patients I cared for 25 years
ago, there is a much higher concentration of acutely ill
patients, and they are hospitalized for a much shorter period
of time. In other words, many patients I took care of are
simply not in the acute care hospital today.
I worked
the same shifts, took reports in the same manner and worked
with the same basic types of "unlicensed assistive
personnel" (orderlies and nursing attendants back then)
that exist today. Even in the ’70s, matching patient care
requirements to nursing resources was a constant challenge,
and it is even truer today.
Today’s
struggles with this same challenge have brought us to the
subject of staffing ratios. Unfortunately, California has
been thrust into the glaring spotlight with this issue.
To the nurses of this state, I admit to having mixed feelings.
On one
hand, legislated staffing ratios may be a fair and just
punishment for the rare hospital (and I do believe that
it is extremely rare) that is ignoring or abusing its moral
and legal responsibilities to quality patient care by grossly
understaffing for financial benefit. However, it is unfortunate
and damaging to hospitals and nurses that the debate on
staffing ratios has left the public with the impression
that this is a common, everyday occurrence. On the other
hand, I see nurse staffing ratios as a great threat to the
continued viability of nursing as a profession. This may
sound a little melodramatic, but let me make my argument:
Staffing
ratios give some important and undeniable messages that,
as a nurse, I know are untrue and demean what nursing is
all about. First, all nurses are not created equal, and
neither are all patients. Nurses have spent years trying
to educate others, especially CEOs and CFOs, about the unique
needs of different patients (with the same diagnosis) and
the differing needs of professional nurses evolving from
novice to expert. Staffing ratios ignore these and other
important variables that we all know affect the real workload
of nurses. Be honest: It is not really all about numbers.
From
the perspective of self-determination, staffing ratios,
at least in the legislated, regulatory form, give the impression
that nurses are not able to handle their own power and ability
to influence, that they will rely on third parties or external
mechanisms to achieve what they need and deserve. Staffing
ratios remove responsibility and accountability. They make
us all look weak and passive.
On a
more practical side, in a time of shortage, demand for nurses
can have some positive influences in achieving improvements
that are important to nurses. As evidence of the shortage,
we already see closed beds and limited services, but also
a renewed interest in issues important to nurse retention
and work environment. With ratios, the impact of the shortage
will be exaggerated and will negatively affect the potential
for positive change and the employment and income of nurses.
The
greatest fear of nursing leaders is that those "minimum"
ratios will become the expected norm as financial pressures
continue. The process of ratios has negated the normal justification
of our staffing methodologies.
Last,
I believe that the great majority of hospitals and their
executive and board leadership members are deeply committed
to ensuring quality nursing care. They value it and know
it is the singular issue in patient satisfaction with hospitalization.
I also think that we as nurses care about the same things;
we just need to find a way to solve our problems other than
with staffing ratios.
