Nurse to patient ratios: The key to Quality! Really?
A recent article in the Washington Post titled “D.C. Council chairman to propose bill boosting nursing staffs at hospitals” brings up again the issue of nurse-to-patient ratios. D.C. Council Chairman Phil Mendelson is quoted as saying “I think this bill is today’s version of the eight-hour day — something that we will see business resist but, on the other hand, makes good sense and leads to quality care.”
Wouldn’t it be nice if nurse-to-patient ratios were the key to quality care? The proposed bill includes some ratios, such as intensive care unit patients should have one nurse to every two patients. That sounds good, but some patients require one-on-one nursing due to their complexity, so is the mandate that those patients can’t have one-on-one nursing? Might there be patients in the intensive care units for whom one to three is appropriate? In my experience that answer is absolutely yes!
As far back as when I was in medical school, and that’s a long time ago, when nurses (or physicians) were busy, there was always an outcry for more help. But when things were not as busy, you rarely heard “We have too much help.” The difference is that most folks of my generation went into healthcare to help people. So if more people needed help, we stayed late, came in early, vented our frustrations to each other (not to the media) and just did our jobs. Certainly some places have unsafe ratios and that needs to be addressed – but not with legislation.
Who is in the best position to determine how to care for patients: health care providers or legislators? Should we in healthcare not be the ones to fix this? I for one don’t want to be the person who can’t be admitted to the hospital when sick because I would cause the nurse to have one too many patients. Quality is multi-factorial, and I object when non-clinicians use the word quality as a hot button to stir up the public. I wholeheartedly agree that staffing should be safe, but as with many things in life, there is not a bright line here, but a gray zone. Thoughts?
About the Author: William F. Mills, M.D., MMM, CPE, FAAFP, CMSL, is currently the senior vice president of quality and professional affairs for the Upper Allegheny Health System located in western NY. Mills is a graduate of Hahnemann University School of Medicine and completed his family practice residency at the West Jersey Health System. He is certified by the American Board of Family Medicine, and a fellow in the American Academy of Family Physicians. Mills is currently a clinical assistant professor at the School of Medicine, State University of New York at Buffalo. He is also certified in addiction medicine through the American Society of Addiction Medicine, and currently serves as a medical review officer. Prior to transitioning to full-time administrative medicine, Mills spent more than 20 years as a practicing family physician, and more than 10 years as the medical director of a residential drug and alcohol treatment facility. He also holds a Master of Medical Management degree from the Marshall School of Business, University of Southern California and is a Certified Physician Executive from the Certifying Commission in Medical Management.
