RN STAFFING LAWS: ‘Inadequate’ Cure for CA Hospitals’ Woes
Legislation enforcing minimum nurse-staffing ratios -- signed into law this fall in California and under review in nearly 12 other states -- will not be nearly as effective as "deeper reforms" such as improved patient access to quality report cards and insurance plans that offer greater choice among providers, opines an editorial in today's USA Today. Despite the political support for fixed staffing ratios, the "extent of the problem isn't altogether clear," the editorial argues. The paper points to a study published this year in Health Affairs showing that the ratio of hospital nurses to patient beds has actually risen and that the overall number of registered nurses in the workforce has grown from 1.37 million in 1983 to 2.03 million in 1998. In addition, the editorial notes, a 1996 Institute of Medicine report was unable to link nurse staffing levels conclusively to patient outcomes, finding that any link that does exist is "more likely due to overall hospital management." The paper says that "slapping fixed-nurse ratios on hospitals carries risks of its own," as inflexible staffing levels "could as easily hamper adequate care as boost it," should regulators calculate ratios inaccurately. The paper opines that granting patients access to quality report cards and allowing employees increased choice among providers will force hospitals to heed patients' demands and "boost quality, using however many nurses are needed to do so."
In a corresponding op-ed piece, Rose Ann DeMoro, executive director of the California Nurses Association (CNA), responds that California's new staffing law is a "tacit recognition" that market solutions have failed to fix the "health care crisis." DeMoro contrasts the billions of health care dollars "diverted to hospital profits, mergers and executive compensation" with nurse layoffs and increased use of unlicensed personnel. DeMoro backs the CNA's support of mandatory staffing ratios by citing research showing nursing workloads have increased nearly 9% and the average severity-of-illness levels in California has risen 6% in recent years, while the number of full-time RNs has dropped by more than 7%. A regulatory solution to falling nurse staffing levels means "more skilled caregivers, better quality of care and reduced long-term health care costs" (10/18).