Promises to Keep
Let's prove to patients that they are the priority in the staffing ratio debate

By Carol Bradley, MSN, RN, California Editor
September 24, 2001

Being a nurse first and a NurseWeek editor second, I have been excited, occasionally disappointed, more often amused, but always curious at the strong reactions elicited by various editorial subjects that NurseWeek tackles. We've been accused of being everything from a "liberal, rebellious sham for the unions" to "hospital management-biased, anti-nurse propaganda."

It is a testament to the engagement, interest, commitment and diverse opinions resident in our nursing community. This may bother some, but to me, it is our strength as a publication. We aim to cover every subject with an eye to balance and objectivity. So, good or bad, thanks for caring to tell us what you think.

So let's talk (again) about staffing ratios. In keeping with the purpose of the editorial column, I already have aired my personal philosophical opinion opposing the concept of staffing ratios, which are falsely held out as a "solution" to the nursing shortage. Therefore, I will not spend editorial space repeating myself.

However, as I feared, we keep forgetting to use the word "minimum" in this debate, and I expect that once implemented, the reality of these ratios will create operational chaos from a patient's perspective. The first time a patient is moved from one unit to another just to accommodate a staffing ratio our priorities will prove to have been ourselves and our politics, not our patients. Ah, well. Time will tell.

However, let me take us beyond the implementation of staffing ratios. OK, so they will be implemented, and we will learn to manage our patient care environment with them. For the few hospitals that will spend millions adapting their staffing to meet the new ratios, I am unsympathetic, as it means a whole lot of patients have not been getting enough "nurse" for a long time.

For those hospitals that do staff well, they may make some tweaks, but more than likely will find new constraints and new costs associated with the operational systems to manage under this new regulation. I extend my sincere regrets to these facilities, as they are the ones that have always understood the important link between nurses, patients and the quality of care. They are being punished along with the guilty.

In the end, there is no doubt: We will learn about what is great about ratios (putting a straitjacket on cost-cutting consultants) and what the problems are (complicating patient logistics, bed closures).

However, at the end of the day, even with ratios fully implemented, our real challenges in nursing are not about numbers of patients or nurses. Our real challenge is delivering on our promise.

What perceptible difference will ratios make in the care for patients? Will the difference in four patients vs. seven to eight in our med/surg assignment be measurable in patient outcomes and in patient satisfaction? Will patients in fact see more of their nurses? Will the role of the registered nurse in the direct care of patients be enhanced? If one believes the hype, nurses are just waiting to return to the bedside!

Will we use our extra time with patients to better plan, assess and evaluate care, and educate and support patients and their families? Will nurses' job satisfaction with direct patient care improve markedly? Will overtime be reduced, and will nurses get home in time to tuck kids into bed or see them off to school?

Looking at ratios in the long-term, the real work begins once implementation occurs. We've made promises along the way-persuading the powers that be-that all it would take is numbers. Whether that is true, we have some promises to keep.

Let's make sure that the improvement in ratios was not all about us but that it was, in fact, all along, about the patient.

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