Issues into the mandatory nurse staffing ratio policy
Reports of deteriorating working conditions and the quality of patient care are believed to have led to the creation and establishment of the mandatory nurse staffing ratio by the federal and states governments. Since it was established, there have been various debates on the issue, for example, the debate about identifying what constitutes a safe, minimum or effective staffing level in nursing continues to be contentious. Moreover, there is a wide belief among the nursing experts that the staffing levels and issues should be best left to local management, taking into account the local workload and available resources (Buchan, 2005).
The use of mandatory ratios removes staffing decisions from the power of local management; however, instead of deciding the number of staff to deploy in a particular ward on a particular day, the management has to make sure that the deployed staffing level complies with a minimum ratio established by a government department or agency (Buchan, 2005). Buerhaus (n.d) brings out a very health argument by stating that there exists relationship between the labor and capital purchased by a hospital, and therefore hospitals need to be given the freedom to willingly adjust to these. For instance, Buerhaus (n.d) observes that hospitals are involved in purchasing and providing patient care services in relation to each hospital’s capacity and capability to acquire the necessary resources. Therefore, enacting a system without any thorough investigations into the issues affecting patient care service provision implies ignoring the inevitable.
The system generally creates imbalances depending on where it is implemented. However, an overall view of the mandatory ratios shows that there is tendency of an “increased overall in costs of care with no much guarantee for improvement in quality or positive outcomes of hospitalization” (Welton, 2007). To make the necessary changes and improvements in the policy, research in certain areas is needed. These areas may include: the current nurse/patient ratios and the organizational/specialty variations in these ratios; what can be the viable alternatives to ratios in relation to regions; what should be the eligibility criteria for exemptions from the compliance; and lastly, the groups that the policy can effectively address among the RNs and qualified nurses (Buchan, 2005).
Nurse practitioners and policy development
For many years, nurse practitioners have been executing a larger role in the federal health care especially in the regions that have experienced few doctors. Of recognition, the NPs have been credited for their exemplary services in working with the elderly due to their adequate health preparation they get from the nursing programs. Currently, most nurses are regulated by the states which set laws that highlight the roles that nurses must undertake as well as qualification required for physicians. According to the studies, NPs are equally excellent in providing services when compared to the physicians, give satisfactory evidence and provide high quality primary care in the areas of competence, and therefore, their role in health care need to be expanded.
The physicians have doubted this position of NPs being independent, claiming it will compromise provision of the medical care (Voice of America, 2010). According to Weiland (2008), “the legal authority for NPs to practice independently is recognized, but the problem is the ability to put that authority into practice is undermined by the historical failure of the political, professional and social entities to recognize NPs as providers capable of providing primary care independently.” Therefore, what Weiland expresses is the failure of the key institutions to ‘cooperate’ into realizing the autonomy of the NPs. Weiland continues to state that the Nurse practitioners can never be seen as members of a profession by either themselves or others without the actual reason of independence and autonomy. The author sums up her views by observing the need for policy in the profession by stating that, “although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is impossible. And, without professional autonomy, NPs will continue to have only employee’s voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations” (Weiland, 2008).
Contemporary issue in nursing today
As the debate goes on about the need for NPs autonomy, the real pressing issue currently believed to affect the majority of NPs is the working conditions in their places of work. Many nurses are finding it difficult to do their jobs; they feel unsafe and also are not respected as professionals. Additionally, in some states and cities nurses are forced to mandatory overtime, workplace violence, latex allergies and needlestick injuries. Therefore, a lot of effort needs to be put in fighting and looking into ways of protecting the nurses from these vices and harmful exposures. The nurses need conducive and safe environments just like the physicians to carry out their roles. Effective bill of rights for the nurses needs to be put in place and all relevant authorities need to ensure it is functional. Through these, the autonomy of the NPs will be accompanied with dignity and respect.
References
Buchan, J. (2005). A certain ratio? The policy implication of minimum staffing ratios in nursing. Journal of health services research and policy, Vol. 10, No. 4. Edinburgh. Web.
Voice of America. (2010). Nurse practitioners expand role in US health care. Web.
Weiland, S.A. (2008). Reflections on independence in nurse practitioner practice. Journal of the American Academy of Nurse Practitioners, Vol. 20, No.7. Web.
Welton, J.M. (2007). Mandatory hospital nurse to patient staffing ratios: Time to take a different approach. The online journal of issues in nursing, Vol. 12, No.3. Web.