1. Allison May NURSE STAFFING

2.  Nurses Perspective:  Higher patient loads can lead to increased job stress (Cimiotti et al, 2012)  Higher patient loads lead to increased errors (Cimiotti et al, 2012)  Nurses may become dissatisfied with their work environment  Nurses don’t feel like they are supported (Sapatkin, 2012)  Less time to spend with patients THE ISSUE

3.  Patient’s Perspective  Less satisfied with the care that they receive  Less access to the nurse  Feeling of being less involved in their care (Kutney-Lee et al., 2010) THE ISSUE

4. POSSIBLE SOLUTIONS Fourteen States have laws or regulations that address nurse staffing Of those fourteen there are seven that require nurses to have a committee that is responsible for plans and policies related to staffing (ANA, 2015) http://www.nursingworld.org/MainMenuCategories /Policy-Advocacy/State/Legislative-Agenda- Reports/State-StaffingPlansRatios

5.  California  Laws put in place that regulate nurse to patient ratio that must be maintained at all times  This has resulted in lower mortality in patients with acute myocardial infarctions (Aiken et al, 2010)  Has provided nurses with a better work environment  Nurses felt they were given a work load that was reasonable  Missed fewer changes in patient care  Helps deal with some issues of nurse burnout  Fosters an environment of teamwork and collaboration (Aiken et al., 2010) POSSIBLE SOLUTIONS (CONT.)

6. CALIFORNIA STAFFING RATIOS Table 1: California RN to Patient Staffing Ratios Type of CareRN to Patients Intensive/Critical Care1:2 Neo-natal Intensive Care1:2 Operating Room1:1 Post-anesthesia Recovery1:2 Labor and Delivery1:2 Antepartum1:4 Postpartum couplets1:4 Postpartum women only1:6 Pediatrics1:4 Emergency Room1:4 ICU Patients in the ER1:2 Trauma Patients in the ER1:1 Step Down, Initial1:4 Step Down, 20081:3 Telemetry, Initial1:5 Telemetry, 20081:4 Medical/Surgical, Initial1:6 Medical/Surgical, 20081:5 Other Specialty Care, Initial1:5 Other Specialty Care, 20081:4 Psychiatric1:6 https://www.cga.ct.gov/2004/rpt/2004-R- 0212.htm

7.  Patient’s Perspective  They get more time with the nurse  The time they spend with the nurse is of a higher quality  They feel like they can be more involved in care (Aiken et al., 2010) POSSIBLE SOLUTIONS (CONT.)

8.  Myth: Mandating staffing ratios has caused hospitals to close or cut back services  Fact: There wasn’t a single hospital in California that closed  Myth: Implementing these changes cost hospitals to much money  Fact: They have reduced staffing turnover which saves the hospital money  Myth: Hospitals would have to lay off other types of caregivers to meet the mandated ration  Fact: The number of staff members that aren’t nurses rose  (Green, n.d.) MYTHS

9.  Access to Care  When the patient load is smaller patients have more access to the nurses and to care (Sapatkin, 2012)  Patient engagement in care  Having more access to care also increases the patient's engagement  They feel that they can ask more questions (Kutney-Lee et al., 2010)  Clinical information systems and quality of care  California shows that positives come out of this for both the patient and the nurse  They have more time to devout to giving the best care possible (Sapatkin, 2012) PATIENT CENTERED CARE

10.  Care Coordination/Interdisciplinary Care  Nurses have more time to help each other and have more time to work with different disciplines (Sapatkin, 2012)  Patient Feedback  Studies done in California have shown that patients are more satisfied with the care that they receive (Aiken et al., 2010) PATIENT CENTERED CARE (CONT.)

11.  Kentucky isn't among the states making progress  We need to be  Staffing ratios are better for patients and for nurses  Patients need to be at the center of their care  It needs to be a priority to provide a safe environment  In the long run this will save the hospital money WRAP UP