Ratios for Improved Safety – Health System Example

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"Ratios for Improved Safety" is a remarkable example of a paper on the health system. The organization in question and being represented is the Florida Nurses Association. The numbers of registered nurses being demanded by Florida hospitals are high and this has led to an increase in patients-nurse ratio and also the working hours have risen. This issue is becoming vital as far as the safety of the nurses and patients is concerned. The government may consider using the high nurse-patient ratio as an escape route and in the end contain the cost that would have been used to higher more nurses.

It is not only the U. S.A that is on a debate about this issue but the whole world is affected. Nurses in Florida Hospitals are tired of their bad working conditions that involve unsafe nurse-patient ratio. However, some of them have already planned for an industrial strike maybe that could help.   According to Shekelle (2013), various resolutions have been passed by over 22 municipalities so that the life-saving law could be passed by the legislative delegations. Additionally, more than 3,000 supporters within the community signed pledges in support of the legislation.

There is a high percentage of nursing shortage not only in Florida but America as a whole. The rate is estimated to have grown by 20% this year and it will increase further by 29% in the year 2020. Key Policy Events Previously, such bills had been introduced for debate for at least five times and in the end, all have died in the committee stage. “ Staffing Ratios in Health Care Facilities” is the title of the bill HB 1169 that was introduced for debate.   The bill requires that the registered nurses in various health care facilities be given minimum staffing level.

The bill also does not advocate for mandatory overtime therefore, it prohibits the registered nurses from having overtime services. In terms of nurse-patient ration, the bill specifically outlines the required ratio that should be in place. The use of monitors or video camera as a substitute for any level required by the health facilities is also prohibited. The bill has given direct care RNs the authority to assign various activities to other nurses.

Moreover, those facilities that try to violet the provisions act, the direct care RNs have been given the power to take action against such facilities. Nurses also have the right to bargain collectively since facilities have been prohibited from interfering with them. The agencies have also been authorized to impose fines on those who violate the rules. Lastly, the functions performed by registered nurses have been prohibited from being performed by that personnel who are not licensed. According to the majority of research hospitals, are not financially burdened by safe staffing ratios instead they are cost-effective.

Critics believe that hospitals always feel the weight of high operational cost with a mandatory nurse-patient ratio. The overall operational cost and the cost per discharge would increase with large numbers of temporary nurse staffing. However, safe staffing has some benefits which include; improvement in nurses’ performances, decrease in the rates of turnover, reduction in liability and staffing cost. According to the Journal of Health Care Finance, it was reported that the increase in nurse staffing led to the increase in operational costs for the hospitals involved but this did not reduce the profit for those particular hospitals. Second, implementing safe-staff ratio will reduce other additional cost involving supplemental nurses and other agencies since the rate of retaining nurses will rise with safe staffing. A study carried out in 2009 found that when hospital workforce across the U. S is increased by 133,000 registered nurses, medical savings in the region of around $6.1 billion would be produced in reduced patient care.

However, the additional value due to increased productivity is not included in circumstances when nurses aid patients to recover quickly.

In case patients recover quickly, an approximate amount of $231 million is saved per year. Social factors The patient care outcome has a great impact on nursing staff ratios of which all are influenced by the social factors.   One of the government influences was the Affordable Care Act. The legislation was signed by President Obama and its primary goal was to put back all American consumers in charge of their own healthcare. The act proposes for hospitals’ reimbursement be made based on value, not volume. Additionally, health care institutions have procedures whereby they can receive and investigate the patient’ s complaint. Economic factors It is more important to have safe and cost-effective staffing plans.

Health care costs include the nurses’ salaries, and when they increase the management will aggressively try to contain the expense. Therefore, the best cost-cutting measure is to reduce nursing expense. If the nursing staff is reduced, then there will be inadequacy in the provision of safe and quality care to patients. It is also of concern that increased hospital costs are due to a decrease in nurse-patient ratio.

  According to the study by the Institute of Medicine (2010), the health care saved approximately $35,000 per avoided death and $3,500 per life-year gained from an outcome of five fewer patients’ deaths per a 1,000 elective hospitalization. This gives a clear relationship between increased staffing and lower mortality. Political factors Mixed reports have evolved in regards to how effective and necessary is the nurse-patient ratios. The nurses and their unions are advocating for mandatory nurse staffing ratios. Contrary, the American Hospital Association (AHA) opposes the same. They claim that there is no evidence of the improvement of the quality care and therefore, passing the legislation which will affect the major stakeholders is quite dangerous. Ethical factors It is unethical to rely solely on nurse-patient ratio without considering factors like nurse education, skills, knowledge, experience and even patient acuity.

In Some cases, ethics can be compromised. However, this is critical in circumstances when the patients’ safety is jeopardized.       Policy intervention The skills and experience of the nurses are considered as the alternative policy to nurse-patient ratio. According to the research carried out, registered nurses (RNs) with a high level of experience greatly influence the patients than the RNs with skills (Tanner, 2010).

The other alternative is the development of customized staffing plans. These programs will consider any unique factors that might influence their operations. Additionally, staffing plans ensure that RNs provide appropriate care each day, shift and on each unit. The hospital staffing plans does not advocate for hospitals to set safe staff ratio but to evaluate how effective the plans are.   Major stakeholders                                      The debate over nurse-patient ratios includes many stakeholders that include; individual states, nurses, hospitals, patients and also third-party payers.

Any decision surrounding nurse-patient ratios have an impact on the stakeholders. Patients are on demand for better nursing services. On the other hand, nurses are also demanding job satisfaction, ability to look after their patients, and encouraging patient outcomes. Similarly, hospitals need to maintain the safety of their patients, reduce nurse turnover, and stay financially stable. States try to keep the people involved in healthy conditions by funding their health care facilities. About third party payers, they want a reduction in patient complication through an increase in the level of nursing care.

They also want a reduction in the time patients stays in hospitals. In conclusion, it is clear that every stakeholder is affected by the nursing profession. Therefore, nurses should be the decision-makers and also leaders at providing appropriate nurse-patient ratios. All staffing decisions must be controlled by the nurse and this will lead to a positive patient outcome. Recommendations   Nurses play vital roles as far as the health care system is concerned. Therefore, I recommend for Florida to push for the passing of the bill because of the benefits it holds.

Safe-staffing ratios will result in improvement in nurse retention and patient care. Understaffing is something that will put the lives of the patients and even nurses into danger and, many nurses may consider quitting the profession.   Nursing implications The experience and knowledge that nurses have had a greater influence on the quality of care that patients may receive. Nurses work in systems which include the staffing levels, the organization of support staff and needs of the patients which influence the quality of care they provide.

Under different environment and staffing conditions, nurses may opt to provide care of different quality. Conclusion Critical issues that are widely recognized can change policies. Similarly, solutions for such problems are either available or developed. About safe staffing, it is possible to make amendments in the legislature. Several studies have revealed the urgency to address this problem and this might build pressure so that the issue is kept on the policy agenda. When the policy is used appropriately, solutions to nurse-patient ratio can be identified. After the implementation of the policy, then patients will be safe and also nurses will be able to work in accordance with their ethical and legal practice.



Institute of Medicine. (2010). the future of nursing, leading change, advancing health. Institute of Medicine of the National Academies. Washington DC: National Academy of Sciences.

Shekelle, P. G. (2013). Nurse–patient ratios as a patient safety strategy: A systematic review. Annals of internal medicine, 158(5_Part_2), 404-409.

Tanner, C. A. (2010). Transforming prelicensure nursing education: Preparing the new nurse to meet emerging health care needs. Nursing education perspectives, 31(6), 347-353.

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