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Staffing ratios in the Sunshine State?

April 3, 2005 -- Today the MSNBC site posted a substantial piece from the South Florida Business Journal about bills now pending in the Florida legislature that would set specific nurse-patient ratios and ban mandatory overtime. The piece, by Brian Bandell, is a somewhat management-focused look at efforts to impose such ratios, with opponents arguing the measures are costly and impractical in the midst of a critical shortage, and supporters arguing that they will improve care without raising costs in the long run. The piece touches on many of the major issues and even mentions the recent federal staffing bills, though it fails to explore fully certain aspects of the nursing crisis, notably the role of hospital short-staffing as a primary cause of the shortage. Similar bills were reportedly filed in past years in Florida, but this year they are likely to be heard.

The piece presents many of the standard themes relevant to such measures and the shortage. It quotes a Nurse Alliance of Florida union member arguing that the ratios would improve outcomes, citing a University of Pennsylvania study, and that they would do so without decreasing profit, since the increased operational costs would be offset by decreases in lengths of stay, readmissions, post-op complications, and malpractice suits. The piece also briefly describes the efforts of nurses to highlight their "tough work assignments." The piece devotes significantly more space to the views of two hospital nurse managers, who argue that strict ratios are unnecessary and impractical, given the nursing shortage. Some officials cite the example of California, where some hospitals have claimed that the state's new mandatory ratios were a factor in their closures. One Florida nurse manager argues that her hospital can get by with a one to eight ratio because of its nurse practitioners and "patient care attendants;" the piece fails to challenge this assertion, which is not consistent with research as to what happens when there are fewer bedside nurses. The piece notes that both of the nurse managers cited do support the bills' inclusion of measures to bar mandatory overtime. The Florida Hospital Association reportedly opposes the ratios, as does the Florida Nurses Association, which argues that the bills "override nurses' judgment over how to treat patients." The piece does not explain how a mandatory minimum of nursing staff is a threat to nurses' judgment in treating patients; it's difficult to imagine a nurse seriously arguing that too many bedside nurses is a threat to clinical nursing practice, as opposed to budgetary practice.

A key point the piece fails to make explicitly is that many believe the leading immediate cause of the shortage is short-staffing, which has driven huge numbers of existing nurses from the bedside. Thus, many believe imposing ratios would not ultimately result in higher vacancy rates, but would instead bring large numbers of existing nurses back to the bedside, as has reportedly occurred in California.

As to the California situation, the piece clearly gives more attention to the concerns of the hospital industry there that the staffing ratios have threatened facilities, and that they cannot be met in view of the shortage. But towards the end it does point out that some hospital systems, notably Kaiser Permanente, have actually embraced the ratios, even closing the piece with a quote from a Kaiser spokeswoman as to the system's successful efforts to meet the ratios through aggressive recruiting, high salaries, and small patient loads. The piece could have benefited from some input from California nurses who support the ratios, such as members of the California Nurses Association.

One positive element of the piece is its brief mention of some of the bills recently introduced in the U.S. Congress to improve nurse staffing and end mandatory overtime. The piece only mentions the bills without specific staffing ratios, and not the one introduced last month in the House that does include specific ratios. Most of the mainstream press has completely ignored these bills, which represent important efforts to address one of the nation's most ominous public health problems.

See the MSNBC article by Brian Bandell from April 3, 2005.


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