• July 31st, 2015

What About Mandated Staffing Ratios for Nurses

Paper, Order, or Assignment Requirements

What About Mandated Staffing Ratios for Nurses

You are the Chief Nursing Officer in a large medical center located in a city with four other medical centers. Recently the nurses in all of these hospitals carried out a one day “work stoppage,” but a full strike was averted in last minute negotiations. According to the nurse, a major issue that contributed to the work stoppage was a desire that the hospitals agree to a minimum RN to patient staffing ratio modeled after legislation passed in the State of California. To educate the CNO’s at the other hospitals on this issue, you prepare a memo:
Part 1

(3 pts.) a. You summarize what you think are the strongest arguments that advocates of legislated minimum ratios can muster in support of their position, including any evidence they might present.

(3 pts.) b. You describe what you feel would be the strongest case that can be made in opposition to legislated minimum staffing ratios. What is the evidence you can use to support your arguments?

(3 pts.) c. To diffuse the controversy, you propose a specific alternative to legislated staffing ratios that could appeal to both nurses and the hospitals. Fortunately, several such alternatives have been proposed in the literature. Which specific alternative do you suggest and why?

Part 2

(3 pts.) a. How are nurse staffing issues addressed in medical centers in Saudi Arabia? Provide an example if possible.

(3 pts.) b. Would the issues regarding imposition of mandated nurse staffing ratios in Saudi Arabia be different, or similar, to those you discussed above for hospitals in the U.S.? Explain.

The CNO expects a thorough analysis complete with citations and supporting evidence, and wants you to limit your memo to no more than four double-spaced pages in size 10 font or larger. References are not included in the four page limit.


Public Policy Towards Nurses

  • *  Schultz, D. “Nurses fighting state by state for minimum staffing laws.” Kaiser Health News, April 23, 2013. 
  • *  Fairman, J.A., Rowe, J.W., Hassmiller, S., Shalala, D.E. “Broadening the scope of nursing practice.” New England Journal of Medicine 364:193-196, 2011. http://www.nejm.org/doi/pdf/10.1056/NEJMp1012121
  1. Shekelle, P.G. “Nurse—patient ratios as a patient safety strategy: A systematic review.” Annals of Internal Medicine 158(5-Part 2):404-409, 2013. http://annals.org/issue.aspx?journalid=90&issueID=926462&direction=P
  2. Shenoy, R. “Nurses set aside goal on hospital staffing.” MPR News, March 16, 2013. 
  3. Kasperowicz, P. “Dem proposes federal regulation of nurse-to-patient ratios in hospitals.” The Hill, April 17, 2013. 
  4. “Nurse ratios are for hospitals, not legislators, to decide.” TwinCities.com Pioneer Press, February 16, 2013. http://www.twincities.com/opinion/ci_22600798/editorial-nurse-ratios-are-hospitals-not-legislators-decide
  5. “Minnesota responds sensibly on nurse staffing ratios.” Star Tribune, March 28, 2013. http://www.startribune.com/opinion/editorials/200523861.html

Further Readings

  1. HealthDay News. “Good news for those worried about U.S. nursing shortage.” USNews, December 5, 2011. 
  2. Wood, D., “Retirees and new graduate nurses: The wild cards impacting the nursing shortage.” NurseZone.com, February 18, 2011. http://www.nursezone.com/nursing-news-events/more-features/Retirees-and-New-Graduate-Nurses-The-Wild-Cards- Impacting-the-Nursing-Shortage_36300.aspx
  3. Krischke, M.M. “Decreased interruptions lead to more time at the bedside.” NurseZone.com, March 18, 2011. 
  4. Weber, T. and Omstein, C. “Nurses cited elsewhere kept licenses; many punished in other states will now face disciplinary action in California.” Los Angeles Times, June 28, 2010. p. A.1. http://articles.latimes.com/2010/jun/28/local/la-me-adv-nurses- 20100628
  5. Bovbjerg, R.R., Ormond, B.A., and Pindus, N. The Nursing Workforce Challenge. Public Policy for a Dynamic and Complex Market. Washington, DC: Urban Institute, August 2009. http://www.urban.org/uploadedpdf/411933_professionalnurse.pdf
  6. Buerhaus, P.I., Auerbach, D.I., and Staiger, D.O. “The recent surge in nurse employment: causes and implications.” Health Affairs – Web Exclusive 28(4):w-657-w668 (published online June 12, 2009). http://content.healthaffairs.org/content/28/4/w657.full.pdf+html
  7. Linden, C. and Suran, M. “Nurses, once in high demand, face job shortages.” Kaiser Health News, August 28, 2009. 
  8. Smith, A. “Nursing crisis looms as baby boomers age.” CNNMoney.com, December 23, 2009. 
  9. Georgia Health News. “Nurses without jobs: A sign of the times.” March 11, 2013. 
  10. Horstmann, S. “When nurses bond with their patients.” The New York Times, September 13, 2013, http://well.blogs.nytimes.com/2013/09/13/when-nurses-bond-with-their-patients/?_r=0
  11. Punke, H. “3 biggest causes of nurse turnover.” Becker’s Hospital Review, July 12, 2013. 
  12. Cheung, K. “One-fourth of nurses seek new jobs after dissatisfaction.” FierceHealthcare.com, June 29, 2011. 
  13. Cheung, K.M. “Hospital labor study reveals hidden costs of nurses.” FierceHealthcare.com, June 9, 2011. 


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