Should Hospitals Set Workloads for Nurses?

Some states are taking this power out of the hands of nurses and administrators and creating laws to follow. Discover one nurse's thoughts about Illinois HB 2604.

In a recent Chicago Sun-Times Letter to the Editor, nurse Mary Nnene Okeiyi responds to the need for safe workloads in Illinois hospitals and current legislation that lawmakers are reviewing.

Illinois House Bill 2604

Illinois House Bill 2604 provides the maximum number of patients that can be given to a registered nurse in specific situations. Under the bill, hospitals will be able to assign the nurse with fewer patients during their shifts, but never more. The legislation also limits the ability of facilities to pull nurses to units they haven’t previously received training to ensure the nurse has the essentials needed to provide care to this specific type of patient.

Administrator’s Point of View, Should Hospitals Set Workloads for Nurses?

Mary wrote her letter following a letter from A.J. Wilhelmi, President and CEO of the Illinois Health and Hospital Association. In Wilhelmi’s letter, he states that “While supporters of ratios say it (mandatory nurse staffing ratios) will help patients, it will do the opposite.” He contends that the state of Illinois doesn’t have enough nurses as it is, quoting a 21,000 nurse shortage with another one-third of RNs planning to retire within five years. He went on to say that the ratio legislation will only deepen the shortage of nurses in the state and create safety issues for patients.

Wilhelmi’s solution? Leave staffing in the hands of hospital administration, not lawmakers.

One Nurse’s Point of View

Let’s go back to Okeiyi’s letter for just a moment to gather an understanding of her perspective. Should Hospitals Set Workloads for Nurses? She says that she went into nursing for a career that “inspires, educates, and advocates for others.” She went on to say that unfortunately, she is often expected to assume the care of an unsafe number of patients. Mary contends that the ‘big business’ mentality of hospitals is more about money than safe patient care and that administrators are often more worried about their bottom line. She closed her letter with a simple, yet powerful statement, ”What we cannot trust hospitals to do on their own, we ask politicians to do by passing HB 2604.”

Breaking Down the Issue

Illinois won’t be the first or the last state to consider and possibly pass nurse staffing ratios. Let’s take a look at a few nursing staff ratio laws in states across the nation.

There are currently fourteen states with official staffing regulations. Another seven states require hospitals to have staffing committees for nurse-driven ratios and staffing policies. California is the only state that provides a minimum nurse to patient ratio. Massachusetts passed a law specific only to the staffing ratios in the ICU. Minnesota requires that a CNO or designee develop a staffing plan for ratios, and the state of New Mexico has given powers to specific stakeholder groups to recommend staffing standards.

Staffing issues have long been a source of contention between nurses and administration. This is why many have turned to lawmakers to take the role of mediator to create policies that must be followed. While a federal regulation (42CFR 482.23(b) has been in effect for some time, without a law backing it up, there isn’t a way to hold hospitals and other facilities to the rule. The dangers of not having enough nurses, like medication errors, patient mortality, and hospital readmissions, should be enough to make any administrator consider their staffing ratios. However, it seems that it just isn’t enough.

Who Should Decide?

So we come down to one simple question - who is in the best position to decide how many patients any one nurse should be assigned to care for during their shift? As nurses, we know the dangers of having too many patients, but can we be objective and offer this information for the good of all involved? Or, should this be up to administrators or even lawmakers?

Tell us how you feel about Mary’s letter and who you think should be in charge of making nurse staffing ratio policies.