At first glance, state-mandated nursing ratios might sound like a godsend: Administrators would have no choice but to increase nursing staff to safe levels. However, many emergency department (ED) managers argue that these controversial laws are ineffectual and even dangerous. California was the first state to pass legislation requiring minimum nurse-to-patient ratios in hospitals. Florida, Iowa, Kentucky, Missouri, New Jersey, and Rhode Island are considering similar laws.
However, most ED managers hardly consider this good news. Charlene Fullam, director of patient care for the ED at Southside Hospital in Bay Shore, NY, points to the California ratios. "How anyone can deem them a victory is beyond me, because they do not take into account the variable needs of patients," she says. Other states easily can follow suit, warns Fullam. "California is known to be the trendsetter," she notes. "That’s a fearful issue for ED managers." Enforcement of that state’s staffing ratios has been postponed to July 2003. "The delays are related to issues of recruitment and finance," Fullam says. "It’s great to set ratios, but how will they get the nurses and the monies for those ratios?"
Working with raw numbers can lead only to inefficiency, by overstaffing and understaffing, Fullam argues. "Your goal should be to meet patient needs, satisfy nurses, and leave your hospital financially viable," she says. For an ED, variability of patients is a key factor in nursing satisfaction and patient care, she emphasizes. "If the ratio is 4:1, would you rather care for four broken wrists or four traumatic arrests?" she asks.
If EDs were proactive in implementing acuity-based staffing, Fullam says that ineffective ratio mandates could be avoided. (For more information on this topic, see "Don’t rely on staffing ratios alone: Here are cutting-edge strategies to use," ED Management, November 2002, p. 121.) "Otherwise, legislation will force ineffective solutions to something managers should be doing all along," she says.
For more information on legislation mandating nurse/patient staffing ratios, contact:
• Charlene Fullam, Director, Patient Care, Emergency Department, Southside Hospital, 103 E. Main St., Bay Shore, NY 11706. Telephone: (631) 968-6230. Fax: (631) 968-7389. E-mail: firstname.lastname@example.org.