Legislation :: Staffing Ratios

Position Statement on
Mandated Nurse Staffing Ratios

NCONL POSITION

The North Carolina Organization of Nurse Leaders (NCONL) believes that every person deserves access to health care and that its members have the responsibility to ensure safe practice conditions for all nurses. NCONL opposes legislated mandated nurse staffing ratios. Mandated staffing ratios will only serve to increase the stress on an already overburdened healthcare system and potentially create a greater public safety risk.

OVERVIEW

Mandated nursing ratios are determined by one staffing variable, a simple count of the patient population, and fail to factor in the more important variables, including patients' needs and complexity of patients' condition, the environment in which the care is delivered, the education and experience of the nurses, and the availability of adequate support services within the acute care setting. Establishing mandatory staffing ratios is not the answer. Working together with policy makers in seeking solutions to ensure an adequate supply of nurses and other healthcare workers is a better approach to address the factors that contribute to the healthcare crisis in North Carolina and across the country. The U.S. Bureau of Labor Statistics projects by 2010, the nation will have a deficit of more than one million nurses.


RATIONALE

Because hospitals provide 24-hour health care and workload is unpredictable, nurse leaders must have the flexibility to manage changing patient care needs, while ensuring that competent staff delivers quality nursing care.

• An ongoing assessment of patients' needs, rather than an arbitrary number, formula or ratio must determine staffing. Staffing decisions require the judgment, critical thinking and flexibility of nurse administrators, nurse managers and professional nursing staff who best understand the patients and their health care needs.
  
  
• Great variability of patient mix exists from hospital-to-hospital. This mix depends on each hospital's setting. The number of nurses required to meet the needs of a specific patient population cannot be based on a formula and must be determined by a variety of factors including the specific needs of each patient within an acute care setting.
  
  
• This increasingly dynamic patient care environment requires flexibility to provide staffing based on patient need, not by fixed numbers of ratios. Shortened lengths-of-stay and observation patients add to the complexity of ensuring appropriate staffing levels to meet patient need, since the number and acuity of patients can change from shift-to-shift, and hour-to-hour. NCONL supports evaluation of staffing on an ongoing basis and making adjustments according to patients needs and level of acuity.
  
  
• Nurses with varied education and experience bring different skills to each patient's bedside. Nurse-to-patient ratios do not consider the impact these differences have in determining the level of care versus the number of nurses that are needed to provide that care.
  
  
• Outcomes must be addressed by each acute care facility according to criteria of regulatory agencies.

REFERENCES

Duff, Susanna (2002) Too Little, Too Late or Enough? Modern Healthcare August 5, 2002, 6-7; 10.

MONE Position Statement. May 7, 2002

Maintaining Patient-focused Care in an Environment of Nursing Staff Shortages and Financial Constraints. AACN Nov. 2000.

Blegen MA, Goode GJ, Reed L. Nurse Staffing and Patient Outcomes. Nursing Research 1998; 47(1):43-50.