Can Malpractice Be Prevented by Mandating Nurse Staffing Levels?

As noted many times on this blog, nurses are the patient safety mainstays of good hospital care. So should hospitals be required to maintain a minimum nurse-to-patient ratio? California has done so, and nurse Theresa Brown wrote an op-ed recently in the New York Times discussing a proposed federal mandate (which seems to be going nowhere).

Now several nurses have interesting responses to the mandate issue in the Times’ letters column, including this one:

As a staff registered nurse on a busy medical telemetry floor in a Midwestern hospital, I can certainly sympathize with Ms. Brown’s assertion that mandatory nurse-patient staffing ratios can improve patient care and save lives. But I disagree with legislative action to accomplish this end.

Patient acuity and staffing, as Ms. Brown well knows, are complex and individual issues that require thought and attention rather than bureaucracy. Nurses are not warm bodies with a nursing license. Nursing excellence and better patient outcomes can be achieved only with a well-educated, properly trained nursing staff dedicated to our profession.

Mandating staffing ratios will further destroy the idea that nurses can speak for themselves. Our voices are already a dim whisper in a discordant health care debate. The fragmentation of our care, increased patient complexity and the existing nursing shortage compound our difficulties in providing safe care, but one arbitrary staffing law will not fix this.

As an R.N., I’ve safely cared for seven surgical patients at night, and have had days when three acutely ill patients seemed too many. Our professional judgment as nurses is sophisticated enough to determine our staffing needs, and a well-run hospital will support quality care at every level, especially nurse-patient ratios. Let us not as nurses turn over yet another decision to someone else, especially legislators.

Jennifer Abraham Normal, Ill.

Many other nurses favor mandatory minimums and look for other ways to assert nurses’ autonomy.

One solution might be to require full disclosure of average nurse-to-patient ratios in hospitals. That would let patients readily see which local hospitals try to cut dangerous corners with their staffing.

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