Nurse-To-Patient Ratios in Illinois the Facts for Essay

For many years the ongoing nursing shortage has required nurses to work longer hours and care for more patients, causing many of them to make fatal and near-fatal mistakes on the job that could have otherwise been avoided. Illinois has attempted to remedy this situation by enacting The Nurse Staffing by Patient Acuity Law on August 24, 2007 (“The Nurse Staffing by Patient Acuity Law,” 2012). Rather than setting hard numbers for specific nurse to patient ratios, the law instead requires hospitals to enact staffing plans recommended by a committee of their nurses that is comprised of at least 50% direct-care staff nurses. The plans created by these committees must be reevaluated semi-annually so that their effectiveness can be gauged.Nurse-To-Patient Ratios in Illinois the Facts for Essay.  The nurses on staff are responsible for continually monitoring the plans that have been put in place to ensure that patient needs are properly met, as opposed to standard ratio laws that mandate a certain number of nurses to patients regardless of the circumstances (“The Nurse Staffing by Patient Acuity Law,” 2012).

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History

Due to financial concerns, many hospitals resist adding extra nurses to fully staff their floors, so it became imperative that legislators step in to force such action. The first state to successfully implement nurse to patient ratio staffing was California, which mandated that minimum nurse to patient ratios be maintained at all times (“Nursing Staff Plans and Ratios,” 2011). This law was enacted in 2004 and since then many other states have followed suit with laws of their own, though California remains the only state to have enacted minimum nurse staffing requirements (Aiken et al., 2010, p.904).
While the need for some oversight of nursing coverage was generally recognized, many states felt that the California legislation was needlessly heavy-handed in eliminating the nurses and rest of the medical staff from the decision process. Illinois believed that there was a better way to implement such a plan and still maintain the sought-after effects of California’s bill. This was exemplified in the passage of the Patient Acuity Law, which allowed input from the medical profession, including the affected nurses, when attempting to create a plan for nursing coverage. This law has been in effect since its passage in 2007.

Effect of Legislation and Controversy Surrounding It

Studies have repeatedly found that nursing shortages often directly impact patient survival rates and infection rates, while nurse fatigue correlates to a higher incidence of self-reporting errors (Stone et al., 2007, p.571). In particular, when patient load is lower for nurses, there is a significant statistical gain associated with thirty day mortality and infection rates (Stone et al., 2007, p.575). Nurse-To-Patient Ratios in Illinois the Facts for Essay. Since the California nurse to patient ratio law has been implemented, studies have found that hospital nurses in that state cared for, on average, one less patient than nurses in other states, while medical and surgical nurses cared for two less patients than their counterparts in other states (Aiken et al., 2010, 904). These findings provide ample empirical……..

The Impact of Nurse to Patient Ratio on Healthcare Quality

The Impact of Nurse to Patient Ratio on Healthcare Quality

It would be hard to understate the importance of a high nurse to patient ratio (NPR) for patient and staff safety, as well as quality of care. While there are a number of different nursing factors that can influence these outcomes, including nursing education, experience, skills mix, contact time, frequency of interactions, and type of inpatient unit, the NPR has been the focus of considerable interest in part because it can be easily quantified (reviewed by Sidani, Manojlovich, and Covel, 2010). This review will examine the empirical evidence for the importance of NPR in determining patient and staff safety, as well as quality of care. Towards this goal, research articles obtained from the Library of Medicine will be reviewed in detail and compared to the findings of more recent research studies. This approach is intended to establish a historical foundation for this topic and then use it for elaborating on the different variables that influence the predictive value of the NPR.

Patient Safety

When the Institute of Medicine (2000) published their report on patient safety, To Err is Human, the American public woke up to the hidden reality that hospitals can be bad for patient health. The authors of this report estimated that between 44,000 and 98,000 people died each year as a result of medical errors. To put these numbers into perspective, this is more deaths than those caused by vehicle accidents, breast cancer, or AIDS. Nurse-To-Patient Ratios in Illinois the Facts for Essay.

In the aftermath of the Institute of Medicine report, Aiken and colleagues (2002) published a large study in the Journal of the American Medical Association revealing NPR to be a significant contributor to medical errors. Included in the study were 168 Pennsylvania general hospitals encompassing 232,342 patients and 10,184 nurses. The NPRs were broken down into less than or equal to 1:4 (11.9%), 1:5 (38.1%), 1:6 (24.4%), 1:7 (17.3%), and 1:8 or greater (8.3%). Based on the discharge abstracts for the patients included in the study, 23.2% experienced a major complication that emerged after being admitted to the hospital and another 2.0% died within a month. All patients were admitted for surgery: orthopedic (51.2%), gastrointenstinal (36.4%), and other (12.4%).  Nurse-To-Patient Ratios in Illinois the Facts for Essay.

The main factors investigated in the study by Aiken and colleagues (2002) were the relationship between NPR and nurse burnout and patient adverse events. Their data reveal that for every patient increase in the NPR, nurses were 23% and 15% more likely to report feeling burned out and dissatisfied with their job experience, respectively. Every increase in NPR by one patient also increased the risk that a patient would die by 7%. To put this last estimate in perspective, increasing the NPR from 4:1 to 8:1 would result in 18.2 and 5.0 excess deaths per 1000 patients with and without complications, respectively. While there are some limitations to this study, including a hospital selection bias and the inclusion of only a few confounding factors, the large representative sample the authors were able to obtain created a high degree of confidence in their findings.

In support of Aiken and colleague’s (2002) findings, a number of studies have investigated the same issue during the years since the Pennsylvania hospital study was published. However, none have conducted a controlled study of an intentional change in staffing levels. To get around these limitations, researchers have taken advantage of below target staffing levels to see if this tended to increase adverse outcomes for patients within the same hospital. By taking this approach, such variables as differences in organizational attitudes, the quality of nursing staff, and other variables would be minimized or eliminated.

This approach was taken by Needleman and colleagues (2011) at a major medical center when they examined almost 200,000 records for adult patient admissions to see whether there was an association between units operating with below target staffing levels and increased patient mortality. They also controlled for a number of other confounding factors, such as day vs. night shift and type of unit, and purposely selected a well-respected, high quality tertiary care hospital with a low NPR. Nurse-To-Patient Ratios in Illinois the Facts for Essay. Taking this approach allowed them to ascertain whether subtle changes in nurse staffing levels had a negative impact on patient safety. They also controlled for the impact that patient turnover would have on nursing load and patient mortality.

/> Staffing levels were generally found to be near target levels for most units, but 16% were more than 8 hours below target, including over 19% of ICUs (Needleman et al., 2011). Differences between daytime and nighttime staffing were limited to step-down and general care units, with higher staffing levels in the daytime. After adjusting for selected confounding factors, the authors found that the risk of death increased significantly [Hazard Ratio (HR) = 1.02, 95% CI, 1.01-1.03, p < 0.001] if staffing levels dropped more than 8 hours below target levels or a shift experienced high patient turnover (HR = 1.04, 95% CI, 1.03-1.10, p < 0.001). Both results are consistent with the theory that any factors that increase nursing workloads will tend to have a negative impact on patient safety, including NPR.

The study by Needleman and colleagues (2011) revealed how patient safety can be degraded when the NPR does not meet target goals in a high-quality hospital, but it also revealed that more subtle changes in nurse workload can still have a significant negative impact on patient mortality rates. Nurse-To-Patient Ratios in Illinois the Facts for Essay. What this implies is that NPR functions as a healthcare quality indicator because it has a dramatic impact on nurse workload.

One of these aspects is the ratio of nursing training and expertise, such that an increased percentage of well-trained and experienced nurses would tend to decrease negative patient outcomes. This implies that more nursing assistants will not make up for a lack of RNs and LPNs. A longitudinal and cross-sectional study in Australia examined the effect of an equivalent RN:LPN:NA ratio in randomly selected medical, surgical, ICU, and emergency units in 19 hospitals (Duffield et al., 2011). The percent RNs ranged from a low of 45% to a high of 100%. The nursing workload and demand was calculated, such that a score of 100 indicated a balance. Among all units, about 25% had scores of 100 or less, which implies that nursing workload was above recommended levels for 75% of all units, with the highest score reaching 250. NPRs varied from 1:6 to 1:10, but the RN to patient ratio averaged around 1:8.

The longitudinal arm of the study revealed that over the 5-year study period, units that experienced a higher percentage of RNs (including clinical nursing specialists) had lower rates of patient adverse events (Duffield et al., 2011).  Nurse-To-Patient Ratios in Illinois the Facts for Essay.The three patient outcomes significantly associated with a low RN to patient ratio was bedsores, pneumonia, and sepsis (p ? 0.01). Other factors that significantly influenced patient outcomes in a negative manner were patient turnover rates, temporary vs. permanent nursing staff, threats of physical violence, and patient acuity. All these factors tend to reduce the effective nurse staffing level for a unit because they increase the workload on nursing staff. These findings reveal that the importance of NPR to patient safety depends on more than simply having a nurse attending to a patient’s needs, but also the skills level of the nurse.

A similar study was conducted by Patrician and colleagues (2011a) in 13 U.S.military hospitals. They discovered that the percentage of RNs made a difference on patient safety when measured in terms of falls, falls with injury, and medical errors, but in a more nuanced way. The analysis was broken down into three types of medical units: medical-surgical, step-down, andcritical care. Nurse-To-Patient Ratios in Illinois the Facts for Essay. Each 10% increase in RN percentage reduced falls in medical-surgical and critical care units by 30% and 36%, respectively. The training and experience of the RN also mattered, since each 10% decrease in the presence of a civilian RN increased the chance of a fall by 33-48% and medical errors by up to 67%. The other RNs on staff were military, contractor, and reservist. The reason civilian nurses provided a significant advantage to patient safety was because their average experience level was 14 years, compared to 5 years for military nurses. A higher NPR reduced both falls and falls with injury. In addition, most falls occurred during night shifts. Reduced medical errors were associated with more RNs and civilian RNs per shift, higher NPR, and night shift.

Patrician and colleagues (2011a) admit that there are several weaknesses to their study, including a reliance on the more controversial incident reports. Such reports are viewed by many researchers as an invalid measure because incidents tend to be underreported for fear of reprisal and litigation. The other weaknesses mentioned were not adjusting for differences in the risk of falling and medical errors for patients, but the authors argue that dividing up the data by unit type tended to provide an equivalent…

Patient Advocation, Nursing, Rn, Nursing Shortage

Nurse-to-Patient Proportions in Illinois

The Facts

For many years the ongoing nursing shortage offers required rns to work longer hours and look after more individuals, causing quite a few to make fatal and near-fatal mistakes on the job that could have otherwise been avoided. The state of illinois has attempted to remedy this situation by enacting The Nurse Staffing simply by Patient Awareness Law in August 24, 2007 (“The Nurse Staffing needs by Sufferer Acuity Legislation, ” 2012). Rather than environment hard quantities for specific nurse to patient proportions, the law instead requires hospitals to enact staffing strategies recommended with a committee of their nurses that is certainly comprised of at least 50 percent direct-care personnel nurses. The plans created by these kinds of committees has to be reevaluated semi-annually so that all their effectiveness could be gauged. The nurses in staff are responsible for continuously monitoring the plans that have been put in place to ensure patient demands are correctly met, as opposed to standard ratio laws that mandate a certain number of rns to individuals regardless of the instances (“The Doctor Staffing simply by Patient Acuity Law, ” 2012).

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Background

Due to financial concerns, various hospitals withstand adding extra nurses to completely staff their floors, so that it became imperative that lawmakers step in to force these kinds of action.Nurse-To-Patient Ratios in Illinois the Facts for Essay.  The first state to effectively implement doctor to patient ratio staffing requirementws was Washington dc, which decided that minimum nurse to patient proportions be preserved at all times (“Nursing Staff Strategies and Proportions, ” 2011). This rules was passed in 2004 and since then many other declares have used suit with laws that belongs to them, though California remains the sole state to acquire enacted minimal nurse staffing requirements (Aiken et ‘s., 2010, l. 904).

Even though the need for a few oversight of nursing protection was acknowledged, many says felt the fact that California legislation was unnecessarily heavy-handed in eliminating the nurses and rest of the medical staff from the decision procedure. Illinois thought that there is a better way to implement this kind of a plan but still maintain the desired effects of California’s bill. This is exemplified in the passage in the Patient Perception Law, which will allowed insight from the medical profession, including the affected healthcare professionals, when looking to create a plan for nursing insurance coverage. This rules has been in impact since its verse in 3 years ago.

Effect of Guidelines and Controversy Surrounding This

Studies include repeatedly discovered that nursing jobs shortages typically directly effects patient your survival rates and infection costs, while nurse fatigue correlates to a higher occurrence of self-reporting errors (Stone et ing., 2007, s. 571). Especially, when patient load is lower for rns, there is a significant statistical gain associated with 25 day fatality and infection rates (Stone et al., 2007, l. 575). Considering that the California health professional to sufferer ratio legislation has been implemented, studies have got found that hospital rns in that point out cared for, usually, one significantly less patient than nurses in other states, whilst medical and surgical nurses cared for two less patients than their counterparts in other states (Aiken ainsi que al., 2010, 904). These types of findings present ample scientific. Nurse-To-Patient Ratios in Illinois the Facts for Essay.