Health

Low Nurse Staffing Spurs Unsafe Outcomes

Nurses are an integral part of patient care, and numerous studies have shown that better hospital nurse staffing correlates with better patient outcomes, such as fewer complications and deaths, fewer hospital admissions, and greater patient satisfaction. And yet nurses are forced to care for an unsafe number of patients.


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Osato Ukponmwan, MD, JD

I am in my third year as an internist and work at three hospitals. During my medical training, I have worked in several hospitals in New York and New Jersey and have seen nurses being asked to care for too many patients, limiting their ability to do their jobs effectively and assisting medical assistants with nursing duties. .

Even before the COVID pandemic, hospitals in New York faced a high workload for patients. It’s only gotten worse. In a recent survey of nurses in New York and Illinois, 70% of nurses would not recommend their hospital to someone in need of care. Half of the nurses gave their hospital unfavorable figures for patient safety and a third gave poor figures for infection prevention. Half of the nurses had a high burnout and a quarter plan to stop working within 1 year.

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In other states, California enacted the first comprehensive state legislation in 2004 limiting the number of patients hospital nurses can care for at the same time. It took 14 years for a similar ballot issue to legally enact nurse staffing in Massachusetts, but it failed, in part due to a lack of awareness of nurse staffing ratios.

Hospital problems have never been more prominent worldwide than during the COVID pandemic. Conditions primarily restricted to people working in hospitals and patients receiving care became widely known, along with discussions of overworked staff and burnout, as New Yorkers banged their pots and pans to salute “healthcare heroes.”

A 2020 New York Comptroller report found that Governor Andrew Cuomo numbered more than 4,000 pandemic-related deaths in nursing homes. Nursing homes were encouraged to transfer funds from the facility to investors and owners instead of investing in additional staff.

Last year, the New York state legislature passed a bill touted as a victory for unions. The New York Safe Staffing for Quality Care Act establishes minimum RN, LPN, and assistant staffing hours for nursing home residents and safe staffing standards for hospitals. The law requires nursing homes to spend at least 70% of their revenue on direct patient care, with at least 40% being spent on staff working with nursing home residents.

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Opponents of the nurse staff legislation will suggest that there is no direct offer of nurses to comply with the legislation, but that would be incorrect. California currently has fewer nurses per capita than New York and has had nursing staff laws for two decades. Currently, the state license mandate increases the burden on nurses to work in multiple states and supplement their income.

Passed in many, but not all, states, the Nurse Licensure Compact allows a nurse to practice in another state through a multistate nursing license. New York recently introduced a bill to pass the Nurse Licensure Compact, which will increase the supply of nurses who can work in New York.

While legislation addresses this issue, its implementation leaves behind. Ongoing discussions and laws must be passed to ensure that low nursing ratios are the norm throughout New York. Ensuring that nurse ratios are kept low gives nurses more time to interact with patients and perform their duties efficiently. Nurses may also feel less stressed. Medical residents can focus on their duties, rather than assisting the nursing staff. Finally, and most importantly, patient safety will improve.

Osato Ukponmwan, MD, JD, is a third-year internist at SUNY Downstate Health Sciences University in Brooklyn, New York. Before studying medicine, he practiced law and is currently a member of the New York State Bar Association.

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