Mandated staffing ratios could improve care, bottom line at hospitals

Posted 22 December 2015 at 12:00 am


In your article, “County Legislature, Medina Memorial oppose mandated staffing levels at hospitals,” I must strongly object to Lynne Johnson’s quote which says, “One size does not fit all.” There should be some differentiation between units sure, but ultimately, when it comes to caring for sick patients in hospitals, one size does fit all.

When considering appropriate staffing levels for nurses, there are numerous things to take into account. A hospital’s budget should not be one of them. There is no arguing that Medina Hospital is a great and much needed resource in our community. Assuredly, I would like it to remain open. But what good is a resource if it’s not really a resource at all?

Overburdening your nurses with too many patients or simply more sick patients than one nurse can handle means you’ve effectively removed that skilled caregiver from the equation. At that point, wouldn’t you be better off staying home?

I have worked in small hospitals and large. Understaffing is an issue across the board and it undeniably leads to poorer patient outcomes, errors in judgement and high staff turnover. These are all very, very costly to healthcare systems.

Yet, something happens when you become an administrator. You start to see things in terms of immediate, daily dollars and cents, forgetting what it’s like to have every one of your call lights going off with no help in sight.

Stop for a minute and imagine the cost savings of having every nurse you’ve trained remain within your facility because they’re happy, your liability/litigation costs drastically reduced for lack of offenses and patient satisfaction surveys coming back favorably (which would directly increase your federal reimbursements). What a wonderful world it would be, no?

Well, that is the case in California where minimum staffing levels have been legally mandated and in place since 2004. The sky did not fall and healthcare did not crumble. In fact, in a 2010 study (see, it was noted that these lower patient-to-nurse ratios led to lower patient mortality and increased staff retention.

I have been on the lesser side of a 15:1 patient-to-nurse ratio in an emergency department in the last year, more than once. It’s happening everywhere, believe it or not. Sure, Medina doesn’t have those volumes but how about 6:1 and all of the sudden there’s a cardiac arrest? It’s scary for everyone involved: doctors, nurses, patients and patient family members.

Ask yourself, if we know that every additional patient a nurse assumes leads to a 7 percent greater likelihood of any of his/her patients experiencing adverse events, why do we keep pushing the envelope? The answer is, simply, money. And that’s a sad state of affairs.

I would encourage anyone who is interested in learning more to follow the Hub’s link to and read about nurse staffing ratios. I’d also encourage you to talk to any one of your friends or family who are bedside nurses not involved in policy making or facility-level decisions. Ask them how often they’re understaffed and what that means. Most importantly, write your state representatives and let them know that this matters to you.

Robert Shaw RN, BSN, CCRN, CEN