Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs. Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. They show how hospital cost cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients-leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation. With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors' history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in the United States and the world.

The business of nursing is to provide care for those who are ill or injured and require enhanced levels of care that require great attention and detail to the patients in their charge. To be able to provide high quality and safe patient care nurses need a work environment that fosters the ability to do so. The effect that a nurses' workload can have on the patient outcomes and the nurses own outcomes are significant. Numerous studies show a significant association with nurse to patient staff ratios and patient outcomes including mortality rates. 'Surgical patients had higher risk adjusted mortality and nurses had higher burnout than those nurses with less of a work load' (Purcell, Kutash, and Cobb 2011, pages 715). There is no consistency from state to state within the United States regarding the methods used to create nursing assignments within the hospital settings, more specifically within Medical/Surgical units. California is the only state with a legally mandated nurse to patient ratio, and this mandate has been related to significantly lower adverse patient outcomes (Aiken and others 2010), including a 25'26% decrease in mortality rates (Twigg, Duffield, Rapley, and Finn 2010). Utilizing the current research that shows the positive effects that the California staffing mandate has had on patient and nurse outcomes in addition to the vast amounts of research the display a strong relationship between nurse to patient ratios and patient and nurse outcomes, a suggestion to create legislation to mandate a nurse to patient ratio on Medical/Surgical units and even hospital wide is suggested for the national level and more specifically within the state of Oregon. Multiple articles were reviewed for the purposes of this paper and the findings of the research conducted that a mandated nurse to patient ratio would effectively improve patient and nurse outcomes in terms of decreased mortality rates and other adverse outcomes for patients and decreased burn out and improved job satisfaction for nurses. It is further suggested that the legislation for a staffing mandate follow the mandate outlined in the California staffing model.

The purpose of this proposal is to examine the association between patient to nurse staffing ratios and patient outcomes, in hospitalized patients, in the acute care environment. After identifying the patient care issue related to the absence of mandatory nursing staffing ratios, fifteen evidence-based articles were reviewed to determine a solution. The use of mandatory nurse staffing ratios, based on unit specific acuity, was determined to be an evidence-based solution, and an implementation plan was created. The implementation plan integrated the use of mandatory patient to nurse staffing ratios throughout a 339 bed acute care facility over a six month trial period. An evaluation plan was formed to review results of the implementation plan, as well as to provide information to disseminate to key stakeholders, and the greater nursing community. The findings provide evidence that mandated patient to nurse staffing ratios, in comparison with no mandated patient to nurse staffing ratios, result in fewer incidences of inpatient mortality, pressure ulcers, failure to rescue, patient falls, pneumonia, urinary tract infections, and blood stream infections in hospitalized patients, in the acute care setting.

Building on the revolutionary Institute of Medicine reports To Err is Human and Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working conditions and demands. Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system. During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk. This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.

The objective of this proposal is the mandatory implementation of nurse-to-patient staffing ratios nationally. Implementation of mandatory staffing at a national level requires state and federal legislation to be passed. This legislation would mandate a change in staffing from the current suggested safe guidelines to a government mandate requiring hospitals to adhere to safe staffing ratios. Currently the state of California is the only state with legislatively mandated staffing ratios. According to research, past and present inadequate nurse-to-patient ratios have resulted in adverse patient outcomes, nurse job dissatisfaction, burnout and turnover, all of which impact health care facilities financially as well as carry costly physiological and psychosocial implications for patients and families affected by adverse outcomes. This proposal supports the state and federal implementation of mandatory staffing ratio models similar to that of California's legislation AB394. Due to the magnitude and regulatory aspect of this change, partnering with national and state nursing organizations such as the American Nurses Association and the Nevada Nurses Association will be crucial in getting legislation passed, disseminating evidence and evaluation of the implemented change. Through the use of quantitative and qualitative research the need for change has already been established. Going forward as future legislation is passed, the continued use of these types of studies will be used to gather and assess data regarding the successes, barriers and failures of implementing mandatory staffing ratios to ensure the continued safety and satisfaction of patients and nursing staff.

Nurses hold a vital part in today's integrated health care system. Mandatory safe staffing ratio is critical to ensure safety of patients and staff. Adequate nurse staffing is a key to provide quality safe patient care and increase nurses' recruitment and retention rates, while inadequate staffing can endangers patients and drives nurses from their profession. Staffing problems will only intensify as baby boomers age and the demand for health care services grows, making safestaffing ratios an ever-pressing concern. According to evidence provided by multiple research studies implementing mandatory nurse patient ratio can improve nurse recruitment and retention rates in acute care settings. Mandatory nurse ratio can reduce the rate of burnout, improve quality patient care, improve job satisfaction for nurses, and create more positive working environment for nurses by nurses. An adequate nurse-patient ratio is an ongoing challenge and demand in nursing anywhere in the world. Mandating nurse-patient ratio will improve safe and quality of patient care, reduce nurses burnout rate thus increased nurse recruitment and retention rates, and increased job satisfaction. Increased nurses' retention rate in the facility means reduced cost-per-hire on nurses spent by the organization. Increased nurses in the hospitals can reduce patient care cost in United States. Reducing ratio from 1:7 to 1:4 reduces rates of nurses' burnout and increased job satisfaction. Organizational change theory was used to implement the mandatory ratio changes in the facility. A quantitative survey was done in August 2014 in an acute care setting by using questionnaires to evaluate nurse job satisfaction, dissatisfaction, intent to leave, and quality of care provided. Results showed mandatory ratio has positive outcomes in every aspect in nursing. Dissemination was done to stakeholders and the greater nursing community by face-to- face meeting and providing evidence from the study results.

Hospitals and nursing homes are responding to changes in the health care system by modifying staffing levels and the mix of nursing personnel. But do these changes endanger the quality of patient care? Do nursing staff suffer increased rates of injury, illness, or stress because of changing workplace demands? These questions are addressed in Nursing Staff in Hospitals and Nursing Homes, a thorough and authoritative look at today's health care system that also takes a long-term view of staffing needs for nursing as the nation moves into the next century. The committee draws fundamental conclusions about the evolving role of nurses in hospitals and nursing homes and presents recommendations about staffing decisions, nursing training, measurement of quality, reimbursement, and other areas. The volume also discusses work-related injuries, violence toward and abuse of nursing staffs, and stress among nursing personnelâ€"and examines whether these problems are related to staffing levels. Included is a readable overview of the underlying trends in health care that have given rise to urgent questions about nurse staffing: population changes, budget pressures, and the introduction of new technologies. Nursing Staff in Hospitals and Nursing Homes provides a straightforward examination of complex and sensitive issues surround the role and value of nursing on our health care system.