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Imagine you are a patient in a hospital. You need help. You call for your nurse, but they cannot come right away because they are helping one of the many other patients in their assignment. Your nurse wants to be there to help you, but unfortunately, their overwhelming patient assignment does not allow them to provide the care they know you deserve. So you wait, and become even more anxious in the already anxiety-inducing situation of being in a hospital. Nurses are given patient assignments that are accompanied with unrealistic expectations. These high patient-to-nurse ratios are associated with higher risks of injury to patients and nurses.

Pennsylvania House Bill 2092 will help solve this problem. The bill, if passed to law, will require hospitals to form a committee consisting of bedside nurses and hospital administrators. The goal is for committee members to come to a consensus about nurse staffing standards that takes into account the complex factors that go into safe patient-to-nurse ratios. The value in creating this committee lies in the requirement for nurses to have input on nurse staffing ratios while being protected from retaliation by employers. 

The contents of the bill aligns with the American Nurses’ Association’s view on safe nurse staffing. What’s more, there are seven other states that have already passed similar laws that mandate nurses to have input on safe staffing. In the following article I discuss the pros and cons of Pennsylvania House Bill 2092. 

The link between lower patient-to-nurse ratios and better patient outcomes has been repeatedly confirmed in the literature over the past 10 years. Lower patient-to-nurse ratios have been shown to decrease the risk of patient death in the hospital by 14 percent. Smaller assignments for nurses are also linked to decreased risk of medication errors and rates of infection. The overwhelming body of evidence dispels any reasonable doubt about the relationship between patient-to-nurse ratios and patient outcomes.

Higher patient-to-nurse ratios lead to nurses experiencing job dissatisfaction, burnout, and desire to leave their jobs. A nursing shortage is anticipated due to the aging of the population and a retiring nursing workforce. By 2022, experts predict there will be 1.13 million vacant nursing jobs. We cannot afford to have nurses leaving their profession.

Those against nurses having input on patient-to-nurse ratios claim it will be a financial burden on the hospital. Of course hiring more staff will cost money. Yet, if nothing is done, nurses will become burned out and leave the nursing profession. This will lead to hospitals having to hire and train more nurses to replace those that leave. When those nurses experience burnout and leave the profession, the cycle will begin again. Nurses that are satisfied in their jobs tend to stay in their positions longer, which is a saved cost to the hospital. Yes, upfront costs of hiring more staff may be unappealing, but in the long run it will prevent nurses from leaving shortly after they start. 

Another financial benefit to the hospital of lower patient-to-nurse ratios is the prevention of medication errors, infections, and patient deaths. If nothing is done, preventable errors will remain a huge burden on hospital budgets. It goes without saying that there is no amount of money that could excuse a preventable patient death. 

Hospital public relations departments advertise they are in the business of helping people. If hospital administrators claim they cannot keep the hospital profitable if they have to staff nurses safely, perhaps they should not be in this business. Hospital administrators need to be aware of the large body of data that supports safe staffing of nurses. If they are aware and choose to ignore the data, they are neglecting their customers and their employees.

I hope you never end up in a hospital bed. But, if that day were to come, I invite you to consider the care you would expect. Do you feel safe as a patient knowing the number of patients in your nurse’s assignment is decided without any input from the nurse? Does it make sense to leave things the way they are when a strong body of evidence says we need a change? 

Pennsylvania 2017-2018 Regular Session House Bill 2092 is sitting in the house. Without your help this bill may never become a law. Call House Representative Judy Ward, the primary sponsor of this bill, at (814) 695-2398 or (814) 742-7204. Tell her you support this bill and you want to help nurses help you. 

MELISSA ATTANASIO is a graduate student in the School of Nursing.

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