Registered Nurse, or Mandated Nurse?

My mother is a nurse. My husband is a in medicine. My sister-in-law is a nurse. My pre-college best friend is a nurse, and my post-college best friends are medical students. I don’t know organic chemistry from organic corn chips, but I can tell you the difference between prn and dc. As a spectator, I find medicine fascinating. As a spectator with little aptitude for science, I find the business and communications side of medicine even more intriguing.

This NYT piece by Theresa Brown caught my eye in light of recent conversations with my newly licensed sister and my 25-year veteran mother. My sister is having trouble finding work because hospitals scraping for cash aren’t willing to hire new graduates. My mother recently left a job serving clients she loved for fear that she would lose her mind permanently.

According to Brown, hospitals aren’t meeting safe staffing levels because hiring more nurses is expensive. A new University of Pennsylvania study shows that adopting California’s mandated staffing ratios could reduce patient deaths in states without mandates.

My mother works for a state facility providing long-term care to the intellectually disabled. She has not received 3 of her last 5 cost-of-living wage adjustments because of state cuts. She can retire in October, but could not make it in her current job. In the last 6 months, 5 of the 7 nurses on her unit left to find work elsewhere. They are overworked to exhaustion and still cannot provide care for patients completely dependent on a nurse’s attention to their needs. Most of Mom’s clients cannot tell her when they have an ear infection – she has to guess when they begin behaving differently. She was lucky enough to find another state facility needing nurses in the area – the local prison – so that she does not lose her retirement. Burnout? Poor staffing practices? As the Minnesotans say, you betcha.

Results from recent studies are suggesting state-mandated ratios for patient care, and hospitals resist. As Brown notes:

The real issue, of course, is cost. There’s no denying that hiring more nurses is more expensive in the short term. But having too few nurses leads to burnout, not only because it’s too much work, but because good nurses quit from the stress of knowing they can’t keep their patients safe. Mandated ratios could ultimately save money, because they would reduce both staff turnover and the number of patients who become critically ill due to insufficient care.

In my small circle, a new nurse cannot find work because hospitals don’t want to pay to train new graduates. An experienced nurse leaves the job she’s had for 25 years (a specialized area of nursing at which she’s an expert) because she feared making a mistake in her overwhelmed and exhausted state. My sister suffers a lack of income, my mother suffers a demotion, cut in pay and the guilt of knowing that she’s had to abandon clients that love her. Meanwhile, what do their potential and former patients suffer?

Are staffing ratio mandates an effective way to reduce burnout, increase hiring of new nurses, and increase standards of patient care? A new study says yes, venerable institutions like Mayo Clinic say no. Mayo has a complex system that matches staffing to patients’ needs and allows providers to call in for additional help. And then there’s health care reform and the Long Recession to consider. Maybe fascinating and intriguing weren’t the right words to describe medicine… I should at least add confusing to the mix.


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