Viewpoint: Why state-mandated nurse ratios could harm patient safety

New York state's proposal to implement mandated nurse-to-patient staffing ratios aims to protect patients from harm, but these rigid rules may take the state backward on patient safety progress, Bea Grause, RN, and president of the Healthcare Association of New York State, argues in the Times Union.

The Safe Staffing for Quality Care Act aims to mandate nurse-to-patient ratios in New York healthcare facilities, according to the New York State Nurses Association. A bipartisan coalition is supporting it in the New York State Assembly and Senate.

The bill aims to protect patients through several measures, such as establishing nurse-to-patient ratios by hospital unit where no nurse is responsible for more patients than the specific ratio and requiring hospitals to create a staffing plan that adjusts staffing according to patient acuity and changing care needs.

Four insights from the op-ed:

1. The state's current approach of developing trained teams poised to deliver evidence-based care has been widely embraced across hospitals statewide and nationwide, Ms. Grause noted. "This approach works and supports a culture that helps high-risk industries like hospitals reliably achieve safe outcomes," she wrote. "As a former emergency room nurse, I understand that nurses are important team members, but so are nurses' aides, technicians, respiratory therapists, and of course, physicians." Altering this approach in favor of a one-size-fits-all set of mandated nurse-to-patient staffing ratios could wind up harming patients, Ms. Grause wrote.

2. Ms. Grause said hospitals in New York are nonprofit entities that have limited resources. "If hospitals must hire to fulfill this nurse-only state mandate, then it likely means fewer resources to employ other critical team members," she wrote. "Should government really decide how many nurses should be on duty in a hospital? Would care improve with more nurses and fewer physicians and other members of the care team? The answer emphatically is no."

3. "New York's hospitals and health systems are continuously innovating to deliver the highest quality care and improve patient outcomes, using broadly accepted, evidence-based approaches," Ms. Grause wrote. "Rigid ratios are neither broadly accepted [nor] evidence-based."

4. Ms. Grause argues that trained hospital caregivers should be the people who determine patient needs — not government officials. "Government-mandated nurse ratios will undermine the years of progress we have made on patient safety."

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