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High patient-to-nurse ratios put everyone at risk

An op-ed in The New York Times a couple of weeks ago has garnered hundreds of interesting comments from readers. (See the article here and click on the comments link for a small sample.) The subject is nurses, particularly the trend among hospitals to increase nurses' patient loads. Most everyone agrees that nurses are essential, that nurses play a critical role in patient outcomes. Hardly anyone agrees on why it is that hospitals continue to understaff emergency rooms, care units and clinics.

Is it greed? Are corporate profits put ahead of patient care? Are nurses undervalued by the health care system? Is nursing education missing the mark somehow? Are nurses not paid enough or not treated well? Are there other pressures that cause burnout?

There may be no single answer. Plenty of studies support the importance of balanced patient loads, though. Nurses interviewed by the article's author said they consider the maximum nurse-to-patient ratio to be 4-to-1 (2-to-1 in intensive care units). They were assigned, however, between seven and nine patients at once. One reported that she was assigned to care for 20 patients, a number somehow not at all mitigated by the fact that none had life-threatening conditions.

The data shows that the situation is not limited to New York; it's the same across the country. (With one notable exception: California law actually dictates minimum nurse-to-patient ratios that are lower than the recommended ratios.) A busy hospital in Philadelphia is just as likely to have either staffing issues or staffing policies that the nurses feel put patients at risk. And the risks are serious: infections, complications, readmission and even death.

The article and reader comments touch on the repercussions of high ratios for the nurses themselves. Of course nurses burn out. Anyone who speaks up risks retaliation, even being fired or blackballed in the community.

Barely mentioned is the risk to the nurses' licenses. Nurses run terrible risks when their workload forces them to cut corners. Burnout can compromise anyone's ability to do a job well. An investigation of a bad patient outcome may focus on that patient's care alone, ignoring the fact that this was one of nine patients the nurse was responsible for. The nurse who makes a mistake will pay the price, and that price may just be license suspension or revocation.

But what is the answer?

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