Is there another way to solve the nursing shortage?

[Note: This article originally erroneously stated that the nurses associations supported mandatory ratio legislation in all states where it is under consideration; the wording has been clarified.]

Six states and the District of Columbia are considering legislation that would establish mandatory minimum hospital-nurse staffing ratios to deal with patient volume "peaks," but there may be an easier way of addressing the problem, according to a column in the Wall Street Journal.

Hospitals have long opposed staffing mandates, which are under consideration in, Iowa, Massachusetts, New York, Texas, Minnesota and New Jersey claiming they cannot afford increased staffing levels, Eugene Litvak, president of the Institute for Healthcare Optimization, writes in the Journal.

The time of day when patient volumes peak is when the increased staffing would be most needed, but since the average hospital cannot afford sufficient staff to cover peak times, "legislated nurse-staffing ratios would either drain hospital finances or lead to ambulance diversions when hospitals aren't legally able to 'digest' excessive patient demand," according to the article.

Although patient peaks and volumes have long been the status quo for hospitals, they can no longer afford to maintain it--or its fallout. Johns Hopkins Hospital found that in 2009, during high-admission periods, the rate of intensive care unit readmission was as high as 500 percent, Litvak writes.

However, Litvak says, there is a solution. Volume peaks are driven not by emergency admissions, but by scheduled admissions. "Without the peaks in demand that hospitals themselves bring about with their scheduling practices, the hospitals could afford a much better nurse-staffing ratios without controversial legislative measures," he writes.

The major obstacle to implementing this solution is that hospitals will have to reduce the level of autonomy given to surgeons for it to work effectively. This coordination strategy has proven effective in the past, Litvak writes, citing the Cincinnati Children's Hospital, which, in 2009, worked with the Institute for Healthcare Optimization to reform patient flow and saved $100 million.

"The only thing standing in the way of [admission streamlining's] implementation at all of the nation's 5,800 or so hospitals is a health-care culture too accustomed to excessive waste and a lack of inspired leadership," Litvak concludes.

A May study found a direct correlation between nursing staff ratios and the number of pediatric readmissions, FierceHealthcare previously reported.

To learn more:
- read Litvak's column (login required)

 

 

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