Alternatives to Nurse Mandatory Staffing

Public concern over the safety of patient care has been the primary catalyst of proposals to legislate mandatory nurse-to-patient ratios. On October 23, 2002, the Journal of the American Medical Association published a study revealing that each additional patient assigned per nurse related to a seven percent increase in the likelihood of patient mortality. However, research of this staffing paradigm has so far failed to quantify a universally applicable ideal ratio. Healthcare providers can explore alternative steps to address patient safety as it relates to nurse staffing.

Self-Regulation

• Inappropriately heavy nursing assignments may increase patient mortality.

  One alternative to instituting mandatory nurse-to-patient staffing ratios is for each health care institution to decide nurse staffing according to its own policy. Using this method affords health care providers the greatest latitude and fewest restrictions for making decisions. However, the absence of accountability to an evidence-based standard for staffing exposes both nurses and patients to greater risk. This approach to staffing may present conflicts of interest as well. For example, manipulating nurse-to-patient ratios can translate to cost-savings for providers, even as doing so detracts from nurse and from patient safety.

Nurse Staffing Plans

• Nurses best understand the variables which determine optimal staffing at any given time.

  Many factors influence nurse staffing, including nurse experience and education, the availability of support staff and the complex, dynamic needs of each patient. Using a Staffing Plan approach, knowledgeable nurse decision-makers match staff nurses criteria with patient criteria at each shift, on every unit. According to the "American Nurses Association", this approach ensures that providers implement safe, unit-specific staffing plans with input from nurses. This alternative method would include public reporting of staffing data, financial penalties for noncompliance and protection for whistle-blowers--employees who report unsafe staffing practices.

Nursing Intensity Billing

• Nurses are trusted experts as well as patient advocates.

  In the Nursing Intensity Billing model described by John Welton, PhD, RN, nursing care is "unbundled," or separated from inclusive room and board charges. A 2007 article appearing in "The Online Journal of Issues in Nursing" addresses problems relating to mandatory ratios and describes how, in contrast, patients can be billed for the actual hours of nursing care they receive. According to Welton, this alternative to mandatory nurse-to-patient ratios creates a revenue source from nursing care and provides incentive for healthcare institutions to improve nurse staffing.

Public Disclosure

• Healthcare institutions can disclose staffing information to patients.

  Public disclosure of nurse and nurse-support staffing is another alternative to mandatory nurse-to-patient ratios. The State of New Jersey currently mandates displaying staff numbers and ratios for each shift. In theory, public disclosure of this data pressures healthcare institutions to adhere to safe staffing practices.