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The literature says exactly what we have all been hearing, lower nurse to patient ratios result in lower negative outcomes while higher ratios leads to higher mortality, burnout and job dissatisfaction (Aiken, Clark, Sloane, Sochalski & Silber, 2002). Some studies state that the data is inconclusive on the basis of higher staffing ratios, but that there is a direct correlation between negative outcomes and hours of care provided by an RN (Needlemen, Buerhaus, Mattke, Stuart & Zelevinsky, 2002). But, in my eyes, the most conclusive evidence is the state of California, the only state with mandated staffing ratios. In a study published in 2010, California was compared to two other states without mandated ratios. The results were clear. “Lower ratios are associated with significantly lower mortality. When nurses' workloads were in line with California‐mandated ratios in all three states, nurses' burnout and job dissatisfaction were lower, and nurses reported consistently better quality of care (Aiken, Clarke & Sloane, 2002)”

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Our education at SCOHS has impressed upon us many overreaching concepts. One thing that is specifically applicable to this is our job as nurses to advocate for our patient and ourselves. This will not change unless we, the nurses, are advocating like we should. Another is how to operate as a team. This is not an individual problem, so when faced with an unsafe situation it is the nurse’s responsibility to use her team to their maximum potential. Delegating where applicable and asking for help are key skills in successful nursing. All of these are necessary to be in a leadership role.

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1.    Participate in the March on DC.

2.     Contact local and federal representatives to garner support.

3.     Create committees within your own hospital to evaluate current staffing and introduce safer options.

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Nurses are participating to a certain degree. We are making noise with the March on DC. But when it comes to being on your unit and be faced with an unsafe situation there are a lot of things to consider, first being the patient. We cannot simply abandon our patients. We cannot refuse to take on an assignment if that means that the patient will not have any care at all. As previously stated, the nurse has to consider his/her personal responsibilities as well. It is not as simple as just refusing to accept and unsafe situation

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Nurse involvement is critical to the issue. We have a collective voice over 3 million strong. If we band together we will be heard! We are at the forefront of the issue, so if we don’t stand up for ourselves and our patients then who should?

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The nurses’ current role and participation regarding the issue is complicated. We want to do our best for our patients but we also need our jobs. We have families, homes, bills. We have responsibilities that require us to draw a paycheck. We cannot simply abandon those responsibilities because we are overworked. In the same breath, nurses are being placed in situations every day that they do not feel safe in but cannot say no! In this respect, we are actually worsening the problem.

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Aiken, L. H., S. P. Clarke, and D. M. Sloane. 2002. “Hospital Staffing, Organizational Support, and Quality of Care: Cross‐National Findings. International Journal of Quality in Health Care 14 (1): 5–13.

Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J., Silber J.H.. "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction". JAMA. 2002;288(16):1987–1993. doi:10.1001/jama.288.16.1987

Blitchok, A. (2018, January 6). Proposed Federal RN Ratios - What You Can Do About It. Retrieved from https://nurse.org/articles/federal-staffing-ratios/

Needlemen, J., Ph. D., Buerhaus, P., Ph. D., R.N., Mattke, S., M.D., M.P.H., Stuart, M., B.A., & Zelevinsky, K. (2002, May 30). Nurse-Staffing Levels and the Quality of Care in Hospitals | NEJM. Retrieved from http://www.nejm.org/doi/full/10.1056/nejmsa012247

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In conclusion, as nurses we have the obligation as well as the ability to in act change that will make our hospitals safer for patients and nurses. We have the ability to make our work environments more satisfying and fulfilling, but we have to take action to make it happen. Safe nurse staffing is better for our patients and ourselves so keep pressure on our government representatives and start pressuring your hospital network. Just because it hasn’t been mandated doesn’t mean that our hospital can’t lead the way.

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Inadequate staffing ratios create unsafe environments for patients and for nurses to

practice. According to the American Nurses Association

(ANA) such situations “are linked to higher rates of patient falls, infections, medication errors and even death.”

Additionally, the ANA states that unsafe staffing ratios is a contributing factor in the

nursing shortage by “creating an environment that drives nurses from the bedside”.

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The topic at hand is safety, more specifically the safety of not just our patients but also our nurses. Unsafe staffing ratios are more than just a tag line. What seems to be being largely attributed to budgetary considerations (Blitchok, 2018) is a real problem that is causing a ripple effect within the healthcare system. As newly minted nurses we need to be aware that this is a problem, know that we have an opportunity to create change, and take a stand to make change happen.