The National Nursing Shortage: Is Mandatory Nurse-to-Patient Staffing Ratio Legislation the Solution?

The National Nursing Shortage: Is Mandatory Nurse-to-Patient Staffing Ratio Legislation the Solution?

Jason S. Greis   By Jason Greis and Lara Duda

The authors state: “Many states face shortages of registered nurses ("RNs" or "nurses") and other health care professionals. Such shortages will only be exacerbated as some seventy-eight million Baby Boomers retire and begin placing additional demands on the nation's health care resources. In April 2006, the Health Resources and Services Administration ("HRSA") projected that the nation's nursing shortage may exceed more than one million nurses by 2020. Additionally, HRSA's projections indicate that all states will experience shortages of nurses by 2015. The nursing shortage is presently most severe in emergency, critical and intensive care units as well as in the operating rooms of rural hospitals. Hospitals nationwide, however, have felt the impact of nurse shortages in almost all inpatient clinical settings.  Compounding the problem, nursing schools across the country are struggling to expand enrollment levels both to meet the rising demand for nurses and to replace the growing number of nurse retirees.”

 

The authors also write: “The nursing shortage in the United States is not a new phenomenon and has often been attributed to a number of socioeconomic, financial and other factors. These conditions have produced a bottleneck in nursing recruitment as well as an exodus of nurses from direct patient care settings. Commentators have cited the following reasons for the shortage: (1) insufficient educational faculty, facilities and equipment and a resulting shortage of nursing students;  (2) poor working conditions resulting from increasing caseloads of acutely ill patients, insufficient staffing, mandatory overtime, undesirable work schedules, physical strain and increasing administrative and regulatory burdens; (3) a general lack of appreciation for care provided; (4) competing employment opportunities for nurses in alternative care settings, such as physician practices, consulting services, temporary or contract nursing, and health care facilities management; (5) low levels of wages and benefits; (6) high attrition rates by new graduates and dissatisfaction with nursing as a profession; and (7) an aging nursing workforce approaching retirement.”

 

The authors add:  “The nursing shortage has broad implications for the future ability of the U.S. health care system to provide quality patient care. Meanwhile, the U.S. health care system has received a number of recent notorious distinctions. For example, in 2000, the World Health Organization ranked the U.S. health care system thirty-seventh in overall performance.  Similarly, others have criticized the U.S. health care system for having significant disparities between high-income and low-income adults in the quality and quantity of care provided.  Many commentators anticipate further declines in patient care quality as the U.S. health care system strains to treat an increasing number of acutely ill Baby Boomers. A number of recent studies have found a statistically significant correlation between nurse staffing levels and the provision of quality patient care. In March 2007, for example, a comprehensive report prepared for the Agency for Healthcare Research and Quality found that insufficient nurse staffing levels posed a potential threat to quality of patient care, while increased staffing was conversely associated with reductions in hospital-related mortality rates and length of patient stays.  In response, states have taken remedial steps to ensure sufficient nurse staffing levels.”

 

This article provides an overview of various short- and long-term strategies hospitals have implemented to address nursing recruitment and retention challenges caused by the nursing shortage. The article then discusses the benefits and drawbacks of one of the most contested legislative solutions offered to address the nursing shortage: mandatory unit-specific nurse-to-patient staffing ratios ("Nurse Staffing Ratios").

 

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Jason S. Greis is an associate in the Chicago office of McGuireWoods LLP's Health Care Department. He focuses his practice on providing solutions for complex business and legal issues pertinent to long-term acute care hospitals and other post-acute care organizations. He also regularly structures corporate transactions for healthcare and life sciences companies, while addressing various regulatory compliance issues commonly associated with such transactions.

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