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Bedside Nursing Care by the Numbers

Overwhelmed by the nurse-to-patient ratio?

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I think we all can appreciate the argument. Nurses feel overwhelmed when the nurse-to-patient ratio is extended beyond our means. Not only beyond our means, but also when it borders on compromising patient safety.

That has always been the source of our angst and distress. Having one nurse care for additional patients in a single assignment becomes cumbersome and borders on unsafe. We nurses have always felt that when the ratio increases sooner or late something can or will be missed.

There is of course many details that are involved with nurse-to-patient ratio assignments. The most important of them all is the ‘gold standard’ acuity level of the patient. How ill (sick) are they. We some how have transformed a patients’ illness into a classification system? You of course have your general medical floor patients (med-surg), then your telemetry (monitored) patients and then the critically ill (intensive care) patients. And with each of those classifications you are further delineate into how ‘severe’ each is. I won’t tie up this post with all the measures I’ve come across that evaluate and ‘classify’ how sick a patient is according to whomever has created the classification. It seems these classifications differ by state, by facility, by administration, etc, etc. It’s quite exhausting.

Here’s my beef.

How can we ‘classify’ a patients’ level of acuity? In my humble opinion some of the most stable and ‘healthy’ patient’s require the most amount of time and nursing care? I mean that what it boils down to – manned work hours right? I know there is some sort of ‘formula’ out there that crunches a bunch of numbers to evaluate and decide what the ‘appropriate’ nurse-to-patient ratio is. How the heck does that make any sense? Just because the patient isn’t critically ill does not mean you will be providing any ‘less’ nursing care.

In the end it’s the patient’s who suffer. We nurses have always put up the good fight in advocating for our patients. I think we can all agree we never have an ‘enough’ time. We always want more time to provide that optimum care for our patients- but when you are overwhelmed with call bells, phone calls, responsibilities, etc time just slips through your fingers.

My ‘rant’ was fueled by a recent study that researched the new state law in California. Does the new mandated minimal level of nurses on duty have an impact on patient outcomes? Study Suggests a Lighter Load for Nurses May Aid Patients – NYTimes.com

Researchers concluded that 225 hospital deaths in New Jersey, or 13.9 percent of all deaths in general surgery, and 200 deaths in Pennsylvania, or 10.6 percent, could have been averted with rules similar to California’s.

It sure is one heck of an argument? Don’t you think?

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