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Summary CH C159.docx Running Head: MANDATED NURSE-PATIENT RATIOS C-159 Proposition of Mandated Nurse-Patient Ratios in North Carolina Western Governors University C159: Policy, Politics, And Global Health Trends Proposition of Mandated Nurse-Patient Ratios$7.49
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Summary CH C159.docx Running Head: MANDATED NURSE-PATIENT RATIOS C-159 Proposition of Mandated Nurse-Patient Ratios in North Carolina Western Governors University C159: Policy, Politics, And Global Health Trends Proposition of Mandated Nurse-Patient Ratios
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CH C Running Head: MANDATED NURSE-PATIENT RATIOS C-159 Proposition of Mandated Nurse-Patient Ratios in North Carolina Western Governors University C159: Policy, Politics, And Global Health Trends Proposition of Mandated Nurse-Patient Ratios in North Carolina When one thinks of a hospital, s...
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Running Head: MANDATED NURSE-PATIENT RATIOS
C-159
Proposition of Mandated Nurse-Patient Ratios in North Carolina
Western Governors University
C159: Policy, Politics, And Global Health Trends
Proposition of Mandated Nurse-Patient Ratios in North Carolina
When one thinks of a hospital, safety should be in the forefront. However, studies show
that patient outcomes worsen as nurse-patient ratios increase (Halm, 2019). Despite this
knowledge, California remains the only state to have law mandating nurse-patient ratios after it
was passed in 2004. Fourteen other states have passed a form of safe staffing laws; however, in
thirteen of those states, the law requires only a general plan to be in place for management
instead of regulation of ratio (King University Online, 2019). North Carolina is one of the
remaining thirty-five states to have no governing guidelines or mandates for nurse-patient ratio.
What follows is an analysis of nurse-patient ratio with a proposal to advocate for that change
through multiple approaches.
Policy Proposal
This is a proposal for a North Carolina policy to propose mandated minimum nurse-
patient ratios in all acute care, rehabilitation, residential treatment, and long-term care facilities.,
with emphasis on specifics depending on acuity of the unit and/or facility.
A1. Public Policy Issue
All states should have a policy in place that requires mandated minimum nurse-patient
ratios that each care facility must follow. These minimum ratios would, ideally, be based on
acuity of unit and/or facility, to best accommodate the safety of each patient. North Carolina has
laws mandating the maximum number of hours a licensed nurse can work per week, but there are
no laws currently in place that are set to regulate staffing ratios. The policy should also cover
,every possible situation, such as a disaster or unit overflow, and must not decrease staffing of
other positions to accommodate for the increased payroll load.
A1a. Issue Selection
This policy issue was selected secondary to the author’s experience in multiple facilities
throughout the state of North Carolina. The author has experienced immense patient overload
with being the unit nurse supervisor on duty, along with charge nurse and having to care for
seven patients simultaneously. Though this particular floor was identified as a
pulmonary/medical-surgical floor, the ICU step-down unit in the hospital had been eliminated
and this floor had been designated as its replacement without being equipped accordingly.
Unfortunately, that was not an uncommon scenario at that specific facility. When this occurs,
there is barely time for the minimum care needed to follow providers’ orders and keep the patient
alive, let alone develop a nursing relationship with the patient and provide holistic care. This
policy will not only increase patient safety and decrease mortality rate, but it will also allow
nursing staff to practice safely and within their scope of practice.
A1b. Issue Relevance
A direct correlation between patient safety and nurse-patient ratio has been found time and
time again; there is also a direct correlation between nurse workload, mortality rate, and nurse
burnout report. Halm’s (2019) evidence review found that better staffing environments were
associated with fewer patient falls, lower mortality rates, higher cardiac arrest survival at
discharge, higher quality of care and safety ratings, and less job dissatisfaction and burnout
amongst nursing staff. In another study, it was found through discrete event simulation that as
nurse-patient ratio increased, care quality decreased and nursing work load increased (Qureshi et
al., 2019).
When care is sought or necessitated, patients rightfully expect to have it delivered in a safe
manner. As the previously stated studies noted, increased nurse-patient ratios cause decreases in
patient safety, quality of care, and recovery rate upon discharge. It seems obvious that a law or
, public policy should already exist in each state to ensure appropriate and safe care is being
delivered with the overwhelming evidence present; however, this is not the case.
A1c. Financial Impact
With any policy that mandates staffing levels, a rise in costs related to increased amount of
staff is expected. More registered nurses will need to be hired to meet the mandated minimum
nurse-patient ratio, resulting in increased salary, recruiting, and training costs. However, per
results from the studies done on effect of nurse-patient ratio on nurse job satisfaction, a decrease
in ratio should have an increase on job satisfaction and retention. According to NSI Nursing
Solutions, Inc’s 2020 report on health care retention and registered nurse staffing, the average
cost of bedside registered nurse was $44,375 per nurse lost, resulting in the average hospital
losing $4.9m per year. The geographic area in which this writer is located, the South East, has the
highest percentage of total registered nurse turnover at 17.7%. The study estimates that for each
percentage decrease in turnover rate, the facility is expected to save $306,400 per year (NSI
Nursing Solutions, Inc., 2020).
Along with increase in job satisfaction, mandated nurse-patient ratios will result in an
increase in patient safety, thus resulting in higher reimbursement rates from the Center for
Medicare and Medicaid Services (CMS). Since adverse patient outcomes, such as fall rates,
missed care, readmission rates, and hospital-acquired infections, will decrease with an improved
nurse-patient ratio, there will be less penalties from CMS.
A2. Personal Values
As stated above, I have worked too many times in unsafe situations related to my patient
load in conjunction with my job responsibilities. I felt like each time I spoke to leadership about
my feelings regarding this, they were dismissed, even if I brought forth studies that showed
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