Mandatory Nurse-Patient Ratios

The issue of mandatory nurse-patient ratios remains widely controversial among many vested stakeholders, including nurses, patients, physicians, unions, nursing organizations/lobbyists, re – searchers, employers (in particular, hospitals), and federal and state governments . Support for mandatory nurse-patient ratios is drawn from the belief that regulated registered nurse (RN) staffing will increase positive patient outcomes, decrease nursing shortages, and increase nurse recruitment and job satisfaction. According to Blakeman Hodge and col- leagues, better RN staffing results in higher quality patient care (e.g. decreased hospitalization). What are the implications of mandatory nurse-patient ratios? What are the alternatives?


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Background In the early 1990s, health care financing and hospital restructuring led to a decrease in licensed caregivers and an increase in unlicensed caregivers (service aides). At the same time, managed care requirements led to increased patient acuity and decreased hospital lengths of stay. Mandatory nurse-patient ratios became law in California in 1999 with the passage of California Assembly Bill 394, which mandated minimum, specific, and numerical nurse-patient ratios in hospitals. Passage of this legisla- tion led to changes in nurse staffing levels; RN workloads increased and RN job satisfaction decreased. Retaining and recruiting RNs became more difficult for hospitals. Additionally, the state of California was reported to have one of the lowest nurse populations in the nation.

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