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The Registered Nurse Safe Staffing Act of 2015 (H.R. 2083/ S. 1132) was created to provide patient protection by creating safe nurse staffing levels at hospitals. Although nurses are humans and humans can make mistakes, having an improper balance in nurse to patient ratios can lead to patient mortality, issues with patient safety, nursing burnouts, and job dissatisfaction among nurses. All of these aspects can contribute to improper and unsafe hospitalization care and hospital environment. This is important to healthcare because nurses are the caregivers of the hospital. Bedside care is direct patient care and the hands on healing that improves health. Being able to provide safe and proper bedside care is important to the healthcare consumer because it provides the highest level of healing and leaves patients with lower anxiety levels which also can help with physical, emotional, and psychological healing. It also provides better patient outcomes and reduces the frequency of hospitalizations, which is the ultimate goal.
Senator Jeff Merkley and Representatives Lois Capps and David Joyce introduced the Registered Nurse Safe Staffing Act to establish register nurse staffing plans that uses a committee that is made up of direct care nurses. The purpose is to ensure patient safety, reduce readmissions and improve nurse retention. The American Nurses Association endorsed this act. It uses a balanced approach to determine the staffing levels. Without appropriate staffing levels, patients are at increased risk for infection, longer and more frequent hospital stays, medication errors, falls, injuries, and possibly death. It also affects the nursing staff and leads to nursing burnouts, which is the physical, mental, and emotional exhaustion because of stress and over engagement related to disengagement of the job (Sachs & Jones, 2015).
Ultimately, adequate nurse patient ratios can be the difference between a patient living or dying, which makes this an important halt care issue. This act considers the level of clinical experience, education preparation, and professional certification a registered nurse has. It also considers the complexity, amount, and stability of patients. It also includes that registered nurses are not to work in units they are not trained or oriented to, procedures fort investigating and receiving complaints, protects reporting any illegal or dishonest activities, and provides public reporting of staffing information. This act is to essentially protect both patients and nurses to provide the most excellent care (Sachs & Jones, 2015).This act keeps patients safe by reducing the amount of adverse patient events, medical errors, and preventable hospital-acquired injuries and illnesses. It cuts costs because it decreases the amount of unnecessary hospital stays, the amount of adverse patient events, and hospital readmissions (American Nurses Association, 2015).
The evidence of the importance of nurse to patient staffing ratios is in the research. In the article “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction,” a cross-sectional analyses of linked date was obtained from 168 nonfederal adult general hospitals in Pennsylvania. The results of the study showed that there were higher levels of emotional exhaustion and greater amounts of job dissatisfaction in nurses who worked in hospitals with high patient-to-nurse ratios, which leads to unsafe environments and the increase of errors. There is also an increase in complications and mortality related to those complications. I hospitals with high patient-to-nurse ratios, the surgical patients experienced higher risks of mortality after 30 days due to infection, complications, and errors (Aiken et al., 2002).
In “Nurse Staffing and Patient Outcomes: A Longitudinal Study on Trend and Seasonality,” the study showed that having better ratios decreases the amount of patient falls and hospital acquired pressure ulcers. Patient falls can lead to longer hospitalizations and greater complications, and hospital acquired pressure ulcers can lead to infection, sepsis, and longer hospitalizations. Having more nurses increases the availability to be able to turn and reposition patients to prevent pressure ulcers, and it also increases the availability of nurses to be able to bring patients to the bathroom and answer call bells in a more efficient manner to prevent falls (He, Staggs, Bergquist-Beringer, & Dunton, 2016).
In “Nurse Staffing Is an Important Strategy to Prevent Medication Errors in Community Hospitals,” the study conducted showed that the most common medication errors were dose omissions, improper doses, and failure to follow protocols. Dose omissions were most likely due to work overload and the wrong doses were most likely due to knowledge deficients of health care providers. Their findings showed that the nursing staff is an important part to prevent medication errors. When the hospitals had a greater amount of registered nurses, there was a decrease in the amount of medication errors. When there was a decrease in the amount of registered nurses, there was an increase in the amount of medication errors. Medication errors lead to unnecessary hospital expenses and puts patients in danger of complications, required hospitalizations, permanent damage, interventions to prevent harm or death, monitoring, or death (Frith, Anderson, Tseng, & Fong, 2012).
In “Missed Nursing Care is Linked to Patient Satisfaction: A Cross-Sectional Study of US Hospitals,” the research showed that on average, nurses miss 2.7 of 12 of the required activities of care per shift. This mostly consisted of missing the opportunity to comfort and talk to patients and to update and develop care plans, but it also consisted of not being able to teach or consul patients and their families, provide oral hygiene, adequately document care or round on patients, provide proper skin care, administer medications on time, prepare patients and their families for discharge, provide adequate pain management, coordinate patient care, and preform treatments and procedures. All of these things are important to the healing process for patients. Although in this study it did not lead to death, it leaves open the possibility of bad outcomes and readmissions into the hospital. Understaffing nurses leaves tasks undone because of the inability to preform everything in on shift because of the higher amount of patients for each nurse (Lake, Germack, & Viscardi, 2016).
Although there are many benefits to this act, there are a few problems with regulating nurse-to-patient staffing ratios. The first problem is that there are many variables that affect patient outcomes and staffing. The complexity of the unit, the amount of care a patient needs based on their condition and complexity of their condition, the census of the unit, the experience of the staff, and whether other nurses like nurse educators and charge nurses are assigned patients all are affected by a nurse-to-patient ratio. Another issue is the inability to measure the work a nurse contributes. Things like admissions, patients leaving the unit, discharges, and patients transferring from other units affect the patient flow which can mean that nurses are caring or doing work for more patients each day than what is reflected in how many hours a nurse works per patient each day or in the ratio. Financial aspects also come into play. There could be a decrease in the amount of other staff positions, like patient care associates, which would burden nurses and create the opposite effect of the purpose of the ratio (Hertel, 2011).Even with the possibility of these negative aspects, having an adequate nurse to patient ratio allows nurses to give more detailed care because they have the time to. This care would help patients heal physically and emotionally and prevent complications.
The problems that this research identifies is that inadequate nurse to patient ratios create unsafe environments for both parties. My proposed solution for this issue is that all states and institutions adopt more strict and safer nurse to patient ratios and stick to these ratios no matter what. This also includes other members of the healthcare team, including patient care associates, case managers, social workers, nurses, and nurse managers. My solution is not something that is not already created, but something that needs to be further considered and maintained in a stricter manner because adverse patient events should never occur. This issue matters because the hospital should be a safe place for patients to heal and a safe place for nurses and the healthcare team to work in. Improper nurse-to-patient ratio affects patients and their care in negative ways, so adequate nursing-to-patient ratios are needed to ensure safety and quality of care.
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