The pandemic put a spotlight on healthcare staffing challenges, especially in nursing. California is still the only state to mandate minimum nurse/patient ratios.
Are minimum nurse staffing ratios an effective way to ensure quality care and patient safety in hospitals?
Bonnie Castillo: Copious research has proven that safe staffing ratios protect patients from complications arising from missed care, medical errors, healthcare disparities, infections, and much more. Lower patient assignments mean more time to provide lifesaving care, observe subtle changes in a patient’s condition, to educate and emotionally support patients and families. This has become more critical during COVID.
John Welton: In my professional opinion, the answer is no. And the literature supports that view. They’re sort of a blunt instrument. When California instituted these mandatory staffing ratios, there was a lot of scrutiny as far as what happened after the first 10, 15 years. There were really minimal changes as far as the overall quality. The costs of hospital nursing care went up. Nurse satisfaction clearly went up.
Waivers were granted for California’s minimum ratios due to COVID-19. Do you believe those were necessary?
Castillo: Absolutely not. In many ways, the hospitals were responsible for creating conditions they could use to justify a waiver request. … There were hospitals that laid off nurses and then didn’t post open positions—in COVID units. Others canceled shifts or furloughed nurses. Some closed units. Others canceled travelers’ contracts or reduced travelers’ pay, saying they were no longer in a crisis.
Welton: The problem with the pandemic is that COVID patients present in respiratory distress, extreme distress sometimes, and then respiratory failure. That’s the primary issue. And because of the nature of the pandemic, hospitals couldn’t really plan for how many patients are going to present to the emergency room. … The acuity is really, really hard to account for.
What do you believe would be the single most effective policy approach to grow the nurse workforce?
Castillo: We must increase public infrastructure, funding and support for public nursing programs, especially associate degree nursing programs. Public ADN nursing students are more diverse, more likely to be from under-represented and under-served communities than students in private programs, and more likely to provide bedside care—all critical for serving a diverse patient population and healing racial inequities in healthcare.
Welton: I’m an outlier here. I don’t believe legislative solutions are the best way to handle this. I think we need to use technology and the data we have to allocate nursing costs and time directly to each individual patient like we do for ancillary charges in hospitals, and then bill for the nursing care. That aligns the actual care to each patient from a nursing perspective and sends a bill out. It also puts accountability on not only the hospital, but the nurses as well.
