2. Nurse Staffing Plan and Ratios Wanda Ewell, RN Robin Patch, RN

3. Introduction Safe nurse staffing refers to keeping patient needs in balance with adequate staffing. In addition to the obvious, saving lives, safe staffing has a positive impact on retaining nurses. Robin Patch

4. Purpose of the Policy Reduction of patient mortality Increases patient/family satisfaction Increases workplace satisfaction and retention of nurses Allows nurses more time with patients Wanda Ewell

5. Decisions, Decisions Implement into law, safe staff measures  Unit-specific staffing minimums  Additional staffing when patient acuity is high  Regulated use of unlicensed staff Robin Patch

6. And More Decisions  Competency, determination and orientation  Accommodations in areas with registered nurse shortages  Maintain accurate records of staffing to ensure compliance Robin Patch

7. Decision Makers Nurses Caregivers The constituents Robin Patch

8. Problems with the Issue Nurse burnout Less time to educate patient Financial burden to facilities Decision-making control Wanda Ewell

9. Who does it affect? Patients/Families Community Healthcare as a whole Robin Patch Why is it a problem? Higher mortality rate Inability of facilities to provide safe care

10. “ ” Since the California ratio law was signed, the state has increased its number of actively licensed RN’s by more than 110,000, tripling the average annual increase prior to enactment of the law Policy History Wanda Ewell

11. Efforts to Address the Problem Unit by unit nurse staffing model plans Hospital reporting of nurse staffing plans Robin Patch

12. Pros Lower patient mortality Increased patient/family satisfaction Increased nurse retention Safe environment Cons Ensuring coverage for breaks Financial burden Wanda Ewell

13. Stake Holders Hospitals Skilled Nursing Homes Rehabilitation Facilities Wanda Ewell Objections/Support?? Financial pressure Sufficient number of nurses

14. Summary The significance of this bill as studied by, Linda Aiken at the University of Pennsylvania School of Nursing, showed that approximately 20,000 patients die each year from inadequate staffing at hospitals. The Safe Nurse Staffing Act was not passed into law. Representatives Lois Capp, a Democrat from California, and Ginny Brown-Waite, a Republican from Florida, introduced a second attempt. Congress did not pass the bill as written. The legislation was revised and resubmitted to the 2010-2011 session of Congress where it is still circulating through committees. Wanda Ewell

15. California was the first state to implement minimum nurse-to-patient ratios in acute care hospitals. Fourteen (14) other states have enacted some type of regulation related to nurse staffing levels. Seventeen (17) states has introduced legislation mandating minimum ratios. Wanda Ewell

16. References Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of American Medical Association. American Nurses Association. (2013, May 8). Registered nurse safe staffing bill introduced in congress. Nursing World. Retrieved from http://nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2013- PR/Registered-Nurse-Safe-Staffing-Bill-Introduced-in-Congress.pdf American Organization of Nurse Executives. (2004). State-mandated nurse staffing levels alleviate workloads, leading to lower patient mortality and higher nurse satisfaction. American Organization of Nurse Executives. Retrieved from https://innovations.ahrq.gov/profiles/state-mandated-nurse-staffing-levels-alleviate-workloads-leading-to-lower- patient-mortality-and-higher-nurse-satisfaction Kasprak, J. (2004). California RN staffing ratio law. Retrieved from http://www.cga.ct.gov/2004/rpt/2004-R-0212.htm