For the California Nurses Association, which successfully lobbied for RN staff-inpatient ratios, the study reinforced "what nurses are seeing throughout the U.S., that safe RN staffing and patient ratios save lives," said Melinda Markowitz, one of CNA's presidents.
However, she says, the study "didn't specify a number," and because of that, it didn't really go far enough."
"What we have found in many hospitals outside of California is that hospitals will use all sorts of pretexts. They'll say staffing is budget-driven and the budget won't allow it. But I believe that kind of thought process really does put the patient at unnecessary risk for death and more adverse events."
Markowitz adds that RN- to-patient ratios save lives and save them money, not just in avoided nurse burnout, which may result in the need for training new staff, but also in avoidance of negative outcomes, which may no longer be reimbursed by federal payers. Sen. Barbara Boxer, D-CA, has introduced a bill that would require even more stringent ratios than the California law requires, Markowitz says.
The American Hospital Association, and its subsidiary, the American Association of Nurse Executives, which in the past expressed objections to mandatory nurse-staff ratios, issued this statement:
The study "highlights what hospitals know: nurses are on the frontline of care and naturally affect the care patients in need receive.
"To ensure high quality care for patients it is critically important that staffing decisions be the responsibility of nursing leadership at the bedside.
"Many factors influence a hospital's staffing plan, including the experience and education of its nursing staff, the availability of other caregivers, patients' needs and the severity of their illnesses, and the availability of technology.
"Nurses are striving every day to provide the best care possible – that's not an easy job. All hospitals are concerned with maintaining safe, quality care and work hard every day to achieve this mission. The real challenge is how we make sure patients get the care they need and that nurses can provide care in an appropriate setting.
"We've seen hospitals create a range of innovative solutions from reorganizing care teams to limiting patient admissions. AHA and AONE will continue working within the nursing community to assess their impact and find ways to do even more."