Ratios Save Lives

[Oda Znidarsic]

Minimumnurse-to-patient ratios allow nurses to do what they're educated to do: provide the care patients need and deserve. California introduced nurse-to-patient ratios in 2004. A large study ten years later found that hospitals with ratios close to the state mandate reported significantly more favourable outcomes. The implementation of ratios allowed nurses to spend an additional three hours a day with each patient.

When nurses have team members to back them up on shift, their relationships with colleagues, physicians, and non-nursing staff improve, making them better able to provide patients with the dedicated care they deserve. In California, the implementation of nurse-to-patient ratios decreased nurse occupational injuries and illnesses by 32%. If we see a similar reduction here in BC, WorkSafeBC data suggests we'd save over $195 million in injury and illness claims over the next decade.

A 2021 study in the peer-reviewed medical journal The Lancet showed that the implementation of mandatory minimum nurse-patient ratios is a net cost savings to the health-care system. In fact, the article noted that the savings resulting from fewer patient readmissions and shorter lengths of patient stay is more than twice the cost of the additional nurse staffing.

Having more nurses can increase patient safety and improve quality of care, yet hospitals often differ in the number of nurses they have per patient. A recent study, funded in part by NINR, examined variation in patient-to-nurse staffing in NY hospitals and its association with adverse outcomes (i.e., mortality and avoidable costs). Findings revealed that nurse staffing varied considerably across hospitals ranging from having 4.3 to 10.5 patients per nurse. Importantly, each additional patient per nurse increased the likelihood of death, length of hospital stays, and chances of being readmitted to the hospital within 30 days. The authors concluded that improving hospital nurse staffing would likely save thousands of lives per year, and that the associated cost would be offset by savings achieved by reducing hospital readmissions and length of hospital stays. This study provides important information for administrators and policymakers to consider when determining ways to improve healthcare.

Although the 7,000 New York City nurses who went on strike this week reached a deal with their health systems on Jan. 12, nurse staffing levels will continue to be a problem in New York City and in hospitals across the country.

A means to take the visionary California law nationwide is already on the table: The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021 (S. 1567). This bill was proposed in Congress to require hospitals to put in place safe nurse-to-patient ratios. By requiring safe staffing, this legislation would protect patients.

It would also save hospitals money. A 2021 study conducted among New York Medicare patients found that safe staffing ratios would save 4,370 lives in two years while also saving hospitals $658 million each year due to shorter lengths of stay due to better care. A similar study in Australia showed that cost savings would be more than twice the cost of hiring additional nurses.

To be sure, hiring more nurses could be a problem, given the national nursing shortage that has been in the news. Nurses are leaving the profession in record numbers, and more than half of those still working are thinking about quitting. In a 2021 study, almost two-thirds of nurses suffering burnout reported inadequate staffing as a reason they left their jobs. Research published in JAMA supports this, finding that each additional patient per nurse increased the odds of burnout by 23%.

The American Nurses Association recognizes the benefits of safe staffing on patient outcomes, hospital costs, and nurse retention. It supports federal legislation like the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act for unit-specific nurse-to-patient ratios. The American Hospital Association, however, opposes this legislation, claiming that mandated ratios will worsen the nursing shortage. Its solution is to bring more nurses into the profession.

The Arthur Ross Gallery presents the work of artist, scholar, and curator David Driskell and explores his relationships with other artists. Friends include: Romare Bearden, Elizabeth Catlett, Jacob Lawrence, Keith Morrison, James Porter, and Hale Woodruff.

A new study published in The Lancet shows that a policy establishing minimum nurse-to-patient staffing ratios in hospitals in Queensland, Australia saves lives, prevents readmissions, shortens hospital stays, and reduces costs.

The researchers collected extensive data before and after the legislation from about 17,000 nurses and analyzed of outcomes for more than 400,000 patients. They found that there was a clear need for a safe hospital nurse staffing standard, and the policy led to better nurse staffing in the intervention hospitals. They also found that the staffing improvements stimulated by the policy led to better outcomes for patients, and are consistent with a substantial body of evidence on the positive effects on patient outcomes when nurses have a reasonable number of patients in their care. There is similarly strong evidence that when staffing levels improve, nurses experience less burnout and job dissatisfaction, which are key drivers to costly turnover and result in nurses leaving their careers at the bedside.

Penn Nursing students are bold and unafraid, ready to embrace any challenge that comes their way. Whether you are exploring a career in nursing or interested in advancing your nursing career, a Penn Nursing education will help you meet your goals and become an innovative leader, prepared to change the face of health and wellness.

Penn Nursing is the #1-ranked nursing school in the world. Its highly-ranked programs help develop highly-skilled leaders in health care who are prepared to work alongside communities to tackle issues of health equity and social justice to improve health and wellness for everyone.

A new study published in The Lancet today showed that a policy establishing minimum nurse-to-patient staffing ratios in hospitals in Queensland, Australia saved lives, prevented readmissions, shortened hospital stays, and reduced costs.

The study was carried out by the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in partnership with the Queensland University of Technology. Funding and support for the study was from Queensland Health, the National Institute of Nursing Research/NIH, and the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Medication-Assisted Treatment for Opioid Use Disorder; Mancher M, Leshner AI, editors. Medications for Opioid Use Disorder Save Lives. Washington (DC): National Academies Press (US); 2019 Mar 30.

As with any other disease, medications should not be withheld from people with OUD without sufficient medical justification. Withholding them on ideological or other non-evidence-based grounds is denying people needed medical care. However, some addiction treatment facilities that ban medications are still being supported by funding streams that are tied to the criminal justice system or housing authorities, creating strong incentives to steer patients toward non-medication-based treatment approaches.

Addiction is a chronic disease that involves compulsive or uncontrolled use of one or more substances in the face of negative consequences. As with other chronic medical conditions, a confluence of genetic, environmental, and social factors shape a person's vulnerability to addiction and ease of recovery from it. These factors determine a person's propensity to start using drugs and to keep using them, as well as a person's susceptibility to the particular types of neurobiological changes in the brain that characterize the progression to addiction. Building on decades of research, the scientific community has coalesced around the brain disease model of addiction. In people with OUD and other substance use disorders (SUDs), prolonged and repeated drug use over time causes lasting effects on brain structure and function. Prescription and illicit opioids produce powerful and sustained effects on the brain's opioid system; repeated use can disrupt the regulation of the system and result in tolerance, physical dependence, and addiction. The evidence shows that these brain changes can be treated effectively with medications that help people refrain from using drugs, thus sharply reducing their risks of overdose and death. By alleviating opioid cravings and withdrawal symptoms, the medications can also provide opportunities to address the behavioral and social components of addiction, which are critically important both to the disorder's development and its treatment.

This scientific understanding of OUD is at odds with the prevailing public perception of the disorder, which is colored by the misconception of addiction as simply a moral failing. That popular view has proliferated through generations of social stigmatization directed at people who use drugs; this misinformed stigma has also spread to the medications used to treat OUD. In fact, people with OUD have a chronic disease that, like many others, warrants long-term medical management beyond episodic acute care incidents.

OUD is a treatable chronic brain disease resulting from the changes in neural structure and function that are caused over time by repeated opioid use. The behavioral and social contexts are critically important to both its development and treatment. Stopping opioid misuse is extremely difficult. Medications are intended to normalize brain structure and function.

OUD is caused by changes in brain circuitry that can be treated with medication to restore healthy brain function, which leads to improvements in behaviors associated with addiction. The medications currently approved by FDA for treating OUD are evidence based, safe, and highly effective. Medication-based treatment for OUD focuses first on managing withdrawal symptoms and then on controlling or eliminating the patient's compulsive opioid use, most commonly with the agonist medications methadone or buprenorphine. Large systematic reviews and randomized controlled trials show that patients with OUD who receive these medications are less likely to die from overdose or other causes related to their addiction. Patients who receive medication have higher treatment retention rates, better long-term treatment outcomes, and improved social functioning; they are also less likely to inject drugs or transmit infectious diseases. For patients who have gone through withdrawal from opioids for a sufficient time, extended-release naltrexone may be used for maintenance treatment. Available evidence clearly supports the use of medications and the need to expand access to medications to reduce or eliminate compulsive opioid use, to reduce the risk of premature death, and to improve the quality of life of people with OUD and their families.

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