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From the staff development bookshelf: Outside controls on the practice of nursing

Staff Development Weekly: Insight on Evidence-Based Practice in Education, January 20, 2012

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The U.S. Government has standards in the Federal Registry that require all hospitals that participate in Medicare to have adequate licensed staff and other personnel to meet the needs of patients in their care. This language is less than specific, leaving much of the decision-making to the individual organizations. Another gap is in the enforcing of these regulations, often leaving states to ensure “safe staffing” is in place. Three general approaches to ensure sufficient nurse staffing have been utilized at the state level.

1. The first is to require hospitals to have a nurse-driven staffing committee create staffing plans that reflect the needs of the patient population and match the skills and experience of the staff
2. The second approach is for legislators to mandate specific nurse-to-patient ratios in legislation or regulation
3. A third approach is that of requiring facilities to disclose staffing levels to the public and /or a regulatory body

California’s mandated ratio laws in 1999, after 12 years of debates and a variety of proposals, became a landmark change in the course of nursing. While there are indications that both support positive outcomes for patients and the nursing staff, the topic is still very controversial. Fifteen other states, plus the District of Columbia, have enacted legislation and or adopted regulations which impact nurse staffing: CA, CT, IL, ME, MN, NV, NJ, NY, NC, OH, OR, RI, TX, VT, and WA. Five other states have some sort of public reporting. Others have considered or proposed various approaches to controlling nurse staffing based on the auspices of safety.

Ratios are not limited to governmental mandates. California’s approach is very prescriptive, individualized by clinical specialty such as ICU or medical/surgical units. The California plan is also fixed and must be in place at all times, including provision for breaks and meals. Ratios are a common strategy for staffing plans, particularly in specialty areas of nursing such as the ICU or labor and delivery. Patient units often have a very diverse mix of patients, based on the services provided in the organization and the demographics of the population. This is especially true when you start looking at some of the units which cover a broader spectrum of patients such as the medical/surgical or progressive care units. Critical points to consider if you use a ratio structure include the following:

• Direct care nurses have input into the plan
• Individual needs of patients are integrated into the plan
• Competency of the staff is a consideration, including experience and training
• Consideration for the technology devices which are a part of the care
• Inclusion of support services for provision of care

This approach to staffing is much more flexible to the needs of patients and offers the opportunity for changes in technology, as well as change in the condition of the patient which often occurs on a moment’s notice.
 
Source: Book excerpt adapted from The Nurse Leader’s Guide to Business Skills: Strategies for Optimizing Financial Performance by Pamela Hunt, BS, MSN, RN and Deborah Laughon, RN, BSN, MS, DBA, CCRN.

Readers of Staff Development Weekly receive a 10% discount on this book! Just enter source code EB102930A at checkout. Click here to visit www.hcmarketplace.com.
 

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