code blog: tales of a nurse

Now, I don't claim to have all of the info regarding these nurse-to-patient staffing ratios. All I know is that as of January 1, 2004, staffing ratios in California went into effect. The whole idea was inspired by the Aiken Study, which was published in JAMA in October of 2002.

A summary of the findings are as follows:

• The study found that for each additional patient over four in a nurse’s workload, the risk of death increases by 7% for surgical patients.
• Patients in hospitals with the highest patient-to-nurse ratio (eight patients per nurse) have a 31% greater risk of dying than those in hospitals with four patients per nurse.
• On a national scale, staffing differences of this magnitude may result in as many as 20,000 unnecessary deaths each year.

What are staffing ratios? It's different for each area of the hospital. ICU's are to have only one-two patients per nurse. Medical/Surgical floors are supposed to have only 6 patients per nurse. (I've worked on med/surg floors and have had nine patients.) The staffing ratios were supposed to be put into effect over the course of several years. This means that as of yesterday, January 1, 2005, med/surg nurses were supposed to be assigned only 5 patients apiece.

Governator Arnold had different ideas about this, however. When nurses caught wind of this, they sought to express their displeasure. Here's an excerpt: After nurses crashed his little party, protesting his hold on implementation of the staffing laws, Governor Schwarzenegger stated, "Pay no attention to those voices over there," he said. "They are the special interests. Special interests don't like me in Sacramento because I kick their butt."

NURSES ARE SPECIAL INTEREST GROUPS???? Is Arnold saying that he kicks nurse butt in Sacramento?

That is absurd. What's even more absurd are these misleading commercials where they pretend to put real-life nurses (Ok, I don't really know if they're real nurses or not) on camera supporting our Governator's decision to continue ratios as is. A lot of nurses think these commercials are ridiculous. Here are "nurses" THANKING the Governator for keeping their workload as is, instead of reducing it. What most people don't realize is that the ratios "as is" ARE an improvement over what was going on a couple of years ago.

However, imposing ratios also creates a need for more nurses. Where have all the nurses gone? Maybe they got tired of taking care of a gaggle of patients (hereby defined as more than 6). Maybe they got burned out and left the profession. Maybe they've been telling other prospective nurses that bedside nursing is too difficult. Avoid going into nursing! It's a low-respect, average-paying, high-stress job! So what happens? No one goes to nursing school, so there are no nurses to fill these positions.

So the poor, poor hospitals have no nurses. Did anyone out there realize that this law was signed back in 1999? 5 years before the ratios were even implemented? Does anyone else think that 5 years was enough time to go ahead and campaign for nursing? Get some people into the schools, so that by now they'd be all graduated and ready to go?

Guess not.

So what happens when there aren't enough nurses to comply with the law? Does anyone even follow it anyway? I know our ER has closed its' doors at times because we didn't have enough nurses to care for the patients, according to the law. But is that any way to run a hospital? By turning away business?

I guess I agree, in part, with holding on to the ratios that we have now. Now that the law has been in place for a year, hospitals are beginning to realize that safe staffing costs money. It requires the woo-age of nurses. Imagine that! Wooing nurses! The alternative to holding the ratios as is would be to scrap them altogether, which would be a huge step backwards.

I think now that we have at least established ratios that are reasonable, we can wait for the hospitals to catch up. For now. To do otherwise would be shooting ourselves in the foot - if hospitals close because of not being able to make ratios, no one wins.