Emergency call: we need more nurses per patient
Mandated nurse/patient ratios have a critical role in the provision of safe levels of care in our hospitals.
Mandated ratios means simply that there is a specified number of nurses for a specified number of patients. These ratios are established at levels set by regulation that guarantee safe care and safe nursing practice. This means there are different ratios depending on the needs of the patients in the ward/unit.
For instance, in an emergency unit in Australia, the ratio is one nurse to three patients in addition to a nurse in charge and a nurse for triage, while in an acute medical/surgical ward the ratio is 1:4, in addition to a nurse in charge am/pm.
It is unethical, unprofessional and dangerous to continue to accept nurse/patient ratios that do not allow nurses to provide safe care.
All research data reflects this key principle that nurses must control their own workloads. The recommendations from a 1996 USA congressional study by the Institute of Medicine are still relevant:
* Specify minimum standards for nurse staffing levels.
* Specify staffing levels that increase as the number of patients increase.
* Provide for the effect of admissions, discharges and day-only patients.
* Involve clinical nursing staff in determining and evaluating staffing levels.
* Provide for unpredicted variations in patient volume and acuity.
* Empower nursing staff to regulate work-flow and set criteria for bed closures to new admissions and transfers as nursing workloads increase.
In Ireland, there are locally set ratios, determined by budgetary constraints and employment ceilings rather than professional nursing judgement.
The need for these ratios to be given proper status was recognised in 1998 by the Commission on Nursing, which identified the need for a system to regulate nurses’ workload in the mutual interests of patient and nurse safety.
The failure to implement such a system has led to an exodus of nurses from our hospital system.
Currently it is not unusual in a medical/surgical acute ward for a nurse to have responsibility for 13 patients during an afternoon shift and for up to 30 patients at night.
In the state of Victoria in Australia, working groups of experienced clinical nurses were set up to provide advice and direction in developing appropriate ratios.
This recognised the wealth of knowledge and experience in the nurses who work at the bedside.
There is overwhelming international evidence that patient outcomes are better when nurses have control over their workloads, with fewer complications, fewer adverse outcomes and fewer deaths. The cost argument is often levelled against mandated ratios, but it has been shown that where mandated ratios are implemented, patients get better quicker, have shorter stays in hospital and are less likely to be readmitted.
Add this to the enhanced retention of experienced nurses and the cost argument is turned on its head.
Mandated ratios are a key component in tackling the current nursing shortage as they address the key issues of excessive workloads leading to burn-out, reduced job satisfaction and damage to nurses’ health.
The Irish Nurses Organisation is therefore pursuing mandated ratios as a priority and considers them to be a key element in the improvements we are all striving to achieve in our health service.
At a personal level I am continually alarmed at the unsustainable workload being carried by dedicated nursing professionals in our hospitals throughout the country.
I urge Prof Brendan Drumm to examine the research, which overwhelmingly supports the implementation of mandated nurse/patient ratios.
Madeline Spiers
President
Irish Nurses Organisation
The Whitworth Building
North Brunswick St
Dublin 7
