Mandating nurse staffing ratios

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A hospital’s patients will be better off when there are more experienced nurses to tend to them—all health experts agree with that. In 2004, California began implementing a law requiring all of its hospitals to limit the numbers of patients that its nurses could treat at any given time.

A survey of nurses by the American Nurses Association found 54% saying that they did not have sufficient time to spend on each patient, despite 43% of the respondents working longer hours during the prior year.

Currently, 15 states (CA, CT, IL, ME, MN, NV, NY, NJ, NC, OH, OR, RI, TX, VT, and WA) plus the District of Columbia have enacted legislation or adopted regulations to address nurse staffing.

Of these states, seven (CT, IL, NV, OH, OR, TX, and WA) require hospitals to have staffing committees to address staffing plans and policies; one state (CA) requires the minimum nurse-patient ratio to be maintained at all time; and five states (IL, NJ, NY, RI, and VT) require public disclosure or reporting.

The limits would vary depending on the hospital setting.

For instance, the ratio in an operating room can’t exceed one nurse for every one patient, while a psychiatric ward can have up to six patients for every nurse, and pediatric and emergency-room units can have up to four patients per nurse.

States with Staffing Laws 14 states currently addressed nurse staffing in hospitals in law / regulations: CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT, and WA.

A nursing intensity adjustment to hospital payment, such as that described above, has already been endorsed by national nursing organizations. The safety and quality of patient care is directly related to the size and experience of the nursing workforce.

Efforts to implement this model nationwide within the next few years have already been initiated. Inpatient working conditions have deteriorated in some facilities because hospitals have not kept up with the rising demand for nurses. Adjustment of inpatient care reimbursement for nursing intensity.

A recent ANA survey of nearly 220,000 RNs reported that 54% of nurses do not have sufficient time with patients, 43% have been working extra hours because of short staffing, and 20% found that inadequate staffing affected admissions, transfers, and discharges.

Legislation to aid in staffing plans and ratios has been discussed on both the state and federal levels.

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