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Nursing
Nurse-Patient Ratios
The problem with the union proposal is that the evidence that shows increased levels of nurses lower the incidence of preventable death and injury among patients is that the evidence is difficult to come by, and many people oppose government mandated staffing levels. There is great conflict in the arguments, as a group of writers note. They say, "We propose that many of the debates that appear to be intractable disputes over the evidence arise from conflicts in the other spheres that influence decisions, such as the values, preferences, and circumstances of individuals and the communities they represent" (Atkins, et al., 2005, p. 102). Thus, extensive research should be conducted to back up the evidence that so many groups cite, but research into the other elements the authors mention, such as preferences and values, should be undertaken too, so that the solution addresses all of these issues, and not just the evidence issue.
If the ultimate goal of the proposal is to increase the validity of health care and patient survival, then research needs to look into what increased staffing levels mean to patient care, quality, and survival. They also need to research how much increasing the staffing levels will increase costs, and where funding will come from to cover those costs.
There is another aspect of the argument that must be addressed, as well. There is a nursing shortage, and even if staffing levels are increased, there may not be enough nurses to bring the staff up to the mandated levels, and then health care facilities would be in non-compliance. The union proposal to adopt mandated staffing levels should also address implementing new training and recruiting techniques to help health care entities meet the staffing challenges that a mandate would bring. Without the nurses and other trained professionals to work in these areas, staffing mandates do not do much good, and if the union wants to be successful, they must recognize that.
References
Atkins, Siegel & Slutsky. (2005). Making policy when the evidence is in dispute. Health Affairs, 24(1), 102-113.
Feilding & Briss. (2006). Promoting evidenced-based public health policy: can we have better evidenced and more action? Health Affairs, 25(4), 969-978.
Wharam & Daniels (2007). Toward evidenced-based policy making and standardized assessment of health policy reform. JAMA 298(6): 676-690.
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