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.

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.

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 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.

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.

Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field.

The objective of this article is to implement mandatory staffing ratios on a national level. This requires the passage of state and federal legislation to change hospital staffing from suggested guidelines that hospitals should follow, to a health mandate that health care providers are legally obligated to implement. The change outlined in the article is needed because the lack of regulated staffing ratios has led to nurse burnout, nurse turnover, and created unsafe environments for pateints. The article implies that states and the federal government should implement regulations similar to California's AB394 legislation. Unlike many changes in health care, due to the regulatory aspect of the change, a political campaign using nurse advocacy groups, such as the American Nurses Association, will be needed to disseminate information. The long term effects of the change will be incorporated into quantitative data regarding patient morbidity and mortality, survey data on nurse satisfaction and nurse turnover, and patient satisfaction.