A perennially hot topic in nursing is staffing ratios: for how many patients does a nurse care at one time? It is well-proven that keeping these low saves lives. California alone in the nation legislated nurse staffing ratios with Assembly Bill AB394 in 1999.

Of course, several factors must be considered: the acuity of the patients’ conditions and the type of nursing unit. For example, the level of care required in an ICU is higher than in a med/surg unit, so the staffing ratio for ICUs is 2:1 whereas for med/surg it’s 5:1. And, of course, when there is a pandemic everything is impacted.

Classic Struggle

Alas, as highlighted in National Nurse, the quarterly publication of National Nurses United, the Covid pandemic is driving us in the other direction. It is the classic struggle between payroll costs and quality of care.

“The California Department of Public Health (CDPH) handed hospitals a gift: permission to violate the State’s RN-to-patient safe staffing law. Under ‘expedited waivers’, hospitals can, upon mere submission of the form, increase the workload in intensive care units to 1:3, in step-down to 1:4, in ERs and telemetry to 1:6, and in medical-surgical to 1:7.”

With the pandemic, both patient admissions and acuities have risen. Nonetheless, some hospitals have actually laid off some nursing staff. As a result we are, NNU says, “…overworked and exhausted.” Is the culprit the pandemic or the opportunism of hospital management?

There are two sides to every story but I can say for certain that even in normal times, as a med-surg nurse I was at the limit of what I could do to deliver top-quality care for five patients. Today, with the added burdens of sicker patients and PPE, seven would stretch me beyond the breaking point. Something’s got to give… Let it not be our patients’ health and lives.

Who’s to blame? No one; we just serve different constituencies. Nurses serve patients; hospital management serves patients, too, but also shareholders.

Good News

Recent news is good: on Feb. 1, the California department of Public Health (CDPH) reversed itself on waivers of safe staffing ratios. That is, it no longer permits hospitals to increase nurse staffing ratios. We can resume delivering top-quality care — that’s why we are nurses!

Go nurses!

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