Although the 7,000 New York City nurses who went on strike this week reached a deal with their health systems on Jan. 12, nurse staffing levels will continue to be a problem in New York City and in hospitals across the country.
The New York nurses are just the latest group to speak out about hospitals that have long minimized nursing staff, prioritizing profits over safety. It’s a strategy that many nurses like me find all too familiar.
In the hospital unit where I last worked, a sign hanging above the nurses’ station proclaimed “Safety is our first priority!” with a group of bright-eyed, smiling hospital workers surrounding the slogan. As a nurse working in one of the hospital’s units, I was neither bright-eyed nor smiling one morning after administrators had denied my latest request to call in more nurses for the next shift. They were content to assign more patients to the nurses who were scheduled to work than the hospital’s policy allowed. “Safety is our first priority!” was a farce, cementing my decision to leave my job.
Having too few nurses working in a unit — meaning each nurse must oversee more patients — is dangerous in many ways. The odds of a patient dying in the hospital increases by 13% for each additional patient added to the average nurse’s workload, and that’s just the most severe outcome. I’ve seen this statistic in action: The chronically understaffed unit where I worked had the highest rate of central line-associated bloodstream infections in the hospital. Patients with these infections stayed longer, required more intensive medical care, and experienced worse outcomes. Nationally, these infections kill thousands of people each year.
Increased nurse staffing promotes higher quality care and shorter hospital stays. If safety and good outcomes are the priority, safe staffing ratios are the solution.
California is the only state in the country with a law establishing standards for nurse-to-patient ratios. The law, implemented in 2004, set limits on the number of patients assigned to one nurse, depending on the type of unit. Since then, California nurses have cared for up to two fewer patients per shift on average, compared to nurses in states without mandated ratios. Nurses who work in settings that match California’s ratios report less burnout, lower job dissatisfaction, and higher quality care.
A means to take the visionary California law nationwide is already on the table: The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 (S. 1567). This bill was proposed in Congress to require hospitals to put in place safe nurse-to-patient ratios. By requiring safe staffing, this legislation would protect patients.
It would also save hospitals money. A 2021 study conducted among New York Medicare patients found that safe staffing ratios would save 4,370 lives in two years while also saving hospitals $658 million each year due to shorter lengths of stay due to better care. A similar study in Australia showed that cost savings would be more than twice the cost of hiring additional nurses.
To be sure, hiring more nurses could be a problem, given the national nursing shortage that has been in the news. Nurses are leaving the profession in record numbers, and more than half of those still working are thinking about quitting. In a 2021 study, almost two-thirds of nurses suffering burnout reported inadequate staffing as a reason they left their jobs. Research published in JAMA supports this, finding that each additional patient per nurse increased the odds of burnout by 23%.
Following this logic, appropriate staffing can reduce burnout and retain nurses.
The American Nurses Association recognizes the benefits of safe staffing on patient outcomes, hospital costs, and nurse retention. It supports federal legislation like the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act for unit-specific nurse-to-patient ratios. The American Hospital Association, however, opposes this legislation, claiming that mandated ratios will worsen the nursing shortage. Its solution is to bring more nurses into the profession.
Pouring water into a leaky bucket isn’t the best way to fill the bucket. What’s needed first is to stop the leak by mandating safe staffing ratios to retain the nurses who are already working.
For nearly two years, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act has languished in committee as lives are being lost — 4,370 preventable deaths in two years in New York alone. Even bitterly divided lawmakers should be able to see the benefit in saving lives, money, and nurses.
Brigid Tonry is a pediatric and women’s health nurse in Virginia and a Master of Public Health student at the Johns Hopkins Bloomberg School of Public Health.
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