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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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  • April 20, 2021
  • 16
  • 2020/2021
  • Summary

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  • politics
  • and global health
  • ch c159docx running head mandated nurse patient ratios c 159 proposition of mandated nurse patient ratios in north carolina western governors university c159 policy

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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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