Discuss methods to evaluate the effectiveness of mandated nurse-patient ratios and variables to be assessed when evaluating project outcome
Evaluation Of Mandated Nurse-Patient Ratios
The legislation has improved levels of staffing and made reasonable workloads for nurse’s hospitals, leading to reduced patient deaths and increased standards of job satisfaction. Moderate the evidence consists of pre- and post-implementation comparisons of nurse staffing levels in California hospitals, along with post-implementation comparisons of key nursing-related metrics in California to several other large states without mandated ratios; metrics include patients per shift, 30-day mortality rates, levels of job satisfaction and burnout, and nurse skill mix (Tevington, 2011).
The effectiveness of the mandated nurse patient ratios can be evaluated by examining the extend of workloads to nurses. Since the implementation workload for nurses has reduced extensive reduction in workload .After implementation of the mandated ratios, nurses in California had, on average, 4.1 patients per shift, compared to 5.4 patients in both New Jersey and Pennsylvania, which do not have mandatory minimum ratios. This difference was reflected across various types of units, including medical-surgical (4.8 in California versus 6.8 in New Jersey and 6.5 in Pennsylvania), pediatric (3.6 versus 4.6/4.4), ICU (2.1 versus 2.5/2.3), telemetry (4.5 versus 5.9/5.7), oncology (4.6 versus 6.3/5.7), and psychiatric (5.7 versus 7.0/7.9), and labor/delivery (2.4 versus 2.6/2.8 (Vericourt, & Jennings, 2010).
Consequently, another approach that can be used in determining the level of patient outcomes in terms of deaths. A 2006 comparison of outcomes in California, Pennsylvania, and New Jersey hospitals found that 30-day mortality rates were 10 to 13 percent lower in California than in the other 2 states. California hospitals also had a significantly lower incidence of failure-to-rescue cases. In the aforementioned 2006 survey, a smaller percentage of California nurses reported that heavy workloads caused them to miss a change in a patient condition (33 versus 41/37 percent (Rothberg et al 2005). Effectiveness of the approach can also be viewed in terms of level of burnout, level of satisfaction and retention. The aforementioned 2006 survey found that California nurses reported less burnout (29 versus 34/36 percent) and less job dissatisfaction (20 versus 26/29 percent) than their counterparts in New Jersey and Pennsylvania. Two-thirds of California nurses agreed that they are more likely to remain in their jobs as a result of the legislation. Finally it may be viewed by observing the skill mix. The nursing skill mix in California hospitals did not fall after implementation of the mandate, as many critics had feared. In fact, it increased to a similar degree as in other states
Variable to be observed
Due to the reduced workload and good working condition the perception and attitude of workers that had initially deteriorated has now improved. They have improved attitude and morale towards their work. On the other hand, looking at the attitudes of patient it has really improved due to the better outcomes in hospital(Carayon & Gurses,2006). Finally, the rate of nursing staff turnover, the legislation has led to reduced level of burn out, increased the capacity of satisfaction and retention
Reference
Vericourt, F. & Jennings, O. B. (2010). Nurse-to-patient ratios in hospital staffing: A Queuing perspective. Management Science.
Tevington, P. (2011). Mandatory nurse-patient ratios. Medsurg Nursing, 20(5), 265-268.
Rothberg, M.B., Abraham, I., Lindenauer, P.K. & Rose, D. N. (2005). Improving nurse-to-patient ratios as a cost-effective safety intervention. Medical Care, 43(8), 785-791.
Carayon, P. & Gurses, A. P. (2006). Nursing workload and patient safety – A human factors engineering perspective. Patients Safety and Quality: An Evidence-Based Handbook for Nurses. Applied Ergonomics, 37(4), 525-535
