Nurse to Patient Ratios and Quality Health Care in Ohio

Nick DiCello
Attorney
(866) 735-1102 Ext 672
Posted by Nick DiCelloJuly 30, 2008 10:43 AM

In 2004, California passed a law setting minimum nurse to patient ratios for hospitals. The law was passed in response to studies and data suggesting that the more patients a nurse has to care for, the more likely one of his or her patients will receive substandard care and attention, and suffer injury, complications, or even die. California's law establishes minimum nurse to patient ratios, in part based upon the level of care required in any given hospital unit. For example, nurses working in critical care units will be assigned to less patients than a nurse working in a unit with patients who have less serious and/or complicated medical conditions and/or who require less monitoring or care. While the ratios fluctuate depending on the type of unit staffed, the maximum nurse to patient ratio allowed in California is one nurse for every four patients. This is a significant improvement over nurse to patient ratios in several Ohio hospitals.

The debate over nurse to patient ratios is a controversial one. Most hospitals claim lower nurse to patient ratios are unnecessary and that laws that define minimum ratios will drive up the already high cost of health care for everyone. Proponents of mandated nurse to patient ratios disagree and suggest that better nursing care will reduce cost by reducing injuries and complications. Furthermore, and more importatnlty, proponents of mandated nurse to patient ratios argue that patient safety necessitates legislation establishing nurse to patient ratios in the hospital setting.

Nurses in Ohio are proposing legislation, in part in response to what they claim to be inadequate legislation already in place. The proposal is nearly ready and is called the Ohio Patient Safety Protection Act of 2008. Proponents of the legislation are hoping Ohio legislators will introduce the Act later this year.

The Cleveland Plain Dealer's Diane Suchetka recently published an article addressing nurse to patient ratios in Ohio and describing efforts to pass the Ohio Patient Protection Safety Act of 2008. See her story. Diane chronicles some of the several e-mails and stories she received about the "horrors" expereinced in Ohio hospitals due to inadequate nursing staff and attention. What is interesting about Diane's article is that she heard from several nurses, many of whom strongly agree that nurse to patient ratios, sometimes as high as one nurse to every 10 or 12 patients, are dangerously high in too many hospitals in Ohio. Some nurses have even left the profession because they are fed up with an inadequate system.

Inadequate nursing staffing patterns place all of us at risk. Furthermore, it places unreasonable burdens on our nursing professionals. Nurses are an integral part of our hospital and health care systems. Indeed, nurses are the caregiver's direct contact with the patient. Hospitals should be staffed with an adequate number of nurses and nurses should not be overloaded with patients. Adequate staffing cannot be viewed as a business decision. Instead it must be viewed, as succinctly stated by the proponents of the proposed new legislation, as a patient safety issue.

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Scott Hodson
Posted by Scott Hodson
July 31, 2008 10:19 AM

Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. To achieve breakthrough improvements in quality, patient safety, and resource utilization hospitals and health systems must develop a "world class" quality management foundation that includes:

Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.

Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables "real time" information.

Process: including concurrent intervention, the ability to identify key quality performance "gaps," and performance improvement tools and methodologies to effectively eliminate quality issues.

Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay "survey ready every day."

Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.

My firm has assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality.

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