Nurses strive to provide top-notch medical care to billions of people around the world, day-in and day-out, and there's no doubt that being taxed physically, mentally, and emotionally takes its toll.
One of the biggest challenges is that there simplyaren't enough nurses to meet demand. This shortage is expected to continue as Baby Boomers advance in age further burden the healthcare system. Significantly more registered nurses are needed, as staffing issues for RNs can directly affect patient outcomes.
A new study published in BMJ Open has found that RNs who have 6 or fewer patients to care for during their shift have patient mortality rates that are significantly lower than their colleagues who have 10 or more.
There are no federal guidelines in the U.S. for patient ratios for nurses in acute care, and many states let each institution make their own decisions.
"There is currently significant debate about establishing mandatory minimum nurse staffing levels in England and elsewhere. However, the evidence base to draw on in order to identify specific safe staffing ratios is slim, despite the large volume of research," the authors wrote in the paper. "Recommended or mandated staffing levels for RNs in general medical and surgical units range from no more than four patients per RN to 10 patients per RN at night."
While overburdened nurses are typically given support staff such as Certified Nurse Aides to help carry out duties, the study found that they really didn't make a difference when it came to patient survival. The biggest factor was the education level of those caring for the patients.
CNAs and Techs do undergo a short training period and are able to take vitals, check blood sugar, and provide basic care to patients, but dispensing medication and more advanced care is outside of their scope of practice. If the patient needs something really important, they must defer to the nurses.
It's not clear if the problem lies with the competency of those in supporting roles, whether needs just aren't getting communicated quickly enough, if the high number of patients leads to medication errors by the nurses, or if other factors are involved.
The conversation about working standards for nurses and patient outcomes isn't new; safety issues related to staffing have been discussed for quite some time. Fatigue from long shifts or working overnight can impair a nurse's judgment, leading to errors. Though they often perform their duties with superhuman-like abilities, they do in fact have their own needs that need to be met.
The researchers admit this study isn't enough to inform widespread guidelines for nurse-to-patient ratios, but those in charge of staffing should consider the dangers of giving a nurse too many patients in exchange for help from CNAs and other support staff.
"When determining the safety of nurse staffing on hospital wards, the level of RN staffing is crucial and there is no evidence to suggest that higher levels of [support] staffing have a role in reducing mortality rates," the authors continued. "Current policies geared toward substituting [support staff] for registered nurses should be reviewed in the light of this evidence."
Want to help ensure that nurses have working standards that are safe for everyone? Support nurses' unions that fight for better contracts for RNs and contact political representatives to create widespread safe standards.
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