Being The Change: Safer Nurse to Patient Ratio’s Gina L. Gilmore, RNGina L. Gilmore, RN James Madison UniversityJames Madison University

Inadequate Nurse to Patient Ratio’s Have Been Linked to: Increased Medication Error’s 6 Increase Patient Complications 6 Increase Mortality 1 Decrease Patient Satisfaction 5 Decrease Nurse Satisfaction 7 Increase Nurse Burnout 1 Reduced Nurse Retention 1

H. R. 1821, The Registered Nurse Safe Staffing ACT of 2013 April 30, 2013 during the 113 th 1 st session of Congress in the House of Representatives a bill known as the Registered Nurse Safe Staffing Act was introduced. 10 findings by Congress were reported. Establishment includes amendment of the Social Security Act (42 U.S.C. 1395cc, written into part of the Patient Protection and the Affordable Care Act (Public Law ). Guidelines for implementation of nurse staffing plan, requirements, reporting, responsibilities, and penalties outlined. H.R th Congress: Registered Nurse Safe Staffing Act of (2013). In Retrieved from

H. R. 1821, The Registered Nurse Safe Staffing ACT: 10 Findings by Congress 1) Higher staffing levels of experienced registered nurses directly relates to less negative patient outcomes. 7 2) Sub-optimal staffing is linked to increased incidences of in hospital patient mortalities. 1 3) Health care worker fatigue is a major safety hazard. 6 4) A reduction in adverse events was found when an optimum skill mix of registered nurses was present. 7 5) Value based payment programs use key measures like Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) showed improved patient satisfaction scores as appropriate nursing levels were reached. 5

H. R. 1821, The Registered Nurse Safe Staffing ACT: 10 Findings by Congress continued: 6) Appropriate staffing of nurses costs significantly less than the adverse events experienced by patients that nurses are vital in preventing. 5 7) Cost benefit analysis shows higher nurse staffing generates payor savings. 5 8) Improved nurse staffing leads to a decrease in incidence of catheter aquired urinary tract infections. 1 9) There is a negative impact on healthful work environments when nurses are unable to perform because of poor work conditions caused by understaffing. 7 10) The Federal Government has a compelling interest in the promotion of safety for patients which are directly affected by safe staffing levels of registered nurses. H.R th Congress: Registered Nurse Safe Staffing Act of (2013). In Retrieved from

What Can You Do? Become Educated About The Facts Join a Professional Nursing Organization Use Your Voice To Create Agency Write To Your Congressman Learn About Workforce Advocacy Tell Others About The Registered Nurse Safe Staffing Act (H.R. 1821) Safe Staffing Impacts Patient Safety Quality of Care Medical Errors Incidence of Infection Hospital Readmission Quality Improvement FallsPatient Days Nurse FatiguePneumonia Patient Satisfaction Scores Decreased Burnout Pressure Ulcer Prevention Fewer Complications Improved Retention Mortality Reduction In Cost American Nurses Association (ANA), 2013

The Code of Ethics for Nurses Nurses are responsible articulating nursing values Maintaining the integrity of the profession and its practice Shaping Social Policy Nurses can work individually or collectively through political action to bring about social change, reshaping health care policy and legislation to affect accessibility, quality, and cost of health care. Appropriate Nurse Staffing Improved Patient Outcomes Increased Nurse Satisfaction Decreased Costs Improved Patient Satisfaction American Nurses Association.(2001).Code of ethics for nurses with interpretive statements. (2001). Washington, D.C.

American Nurses Association (ANA) Tools Research Staffing Bill Introduced to Congress Staffing Bill Introduced to Congress ANA’s Principles for Nurse Staffing ANA’s Principles for Nurse Staffing Take Action for Safe Staffing Workforce Advocacy Tools

My Tell The World Project For my tell the world project I wrote to Representative Eric Cantor to urge him to cosponsor the Registered Nurse Safe Staffing Act (H.R. 1821). I shared with him some of the links that have been discovered between patient outcomes and staffing ratios. I told him of the key concerns that nurses face day to day at the bedside. I spoke of the impending nursing shortage, nurse retention, and nurse satisfaction. I shared how the increasing workloads and rising acuities of patients are affected when nurses have more than 8 patients. I also shared that research shows that there are lower mortalities, shorter hospital stays, reduced costs and complications when ratios are lower. I urged him to support us as a profession to help create safe work environments for patient care.

Conclusion Healthcare is ever in motion, we as nurses are at the front line and must be actively involved and ever vigilant in the changes that take place around us. Nurse driven research has yielded what we now know, that patient safety is directly related to the quality of care that nurses are able to provide. In order for quality care to be provided, and patient and nurse satisfaction, nurse: patient ratios are critical to outcomes.

References 1. Aiken, L. H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. The Journal of the American Medical Association. 288(16): doi: /jama American Nurses Association.(2001).Code of ethics for nurses with interpretive statements. (2001). Washington, D.C. 3. American Nurses Association. (2013). The American Nurses Association World of Nursing. Retrieved from H.R th Congress: Registered Nurse Safe Staffing Act of (2013). In Retrieved from 5. Rothberg, M. B., Abraham, I., Lindenauer, P. K., & Rose, D. N. (2005). Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Medical care, 43, 785–791. doi: /01.mlr fa 6. Shekelle, P. G. (2013). Nurse-patient ratios as a patient safety strategy: a systematic review. Annals of internal medicine, 158, 404–9. doi: / Wallace, B., (2013). Nurse staffing and patient safety: What's your perspective? Nursing Management. 44(6): doi: /01.NUMA