Opinion | Staffing Ratios Are The Wrong Fight For Nurses, This is Why
By Kathleen Bartholomew , MN, RN
Disclaimer:?The views and opinions expressed in this article are those of the writer and do not necessarily reflect the views or positions of?nurse.org
Are staffing ratio’s the solution? In my opinion, no. Staffing ratios continue to keep nurses in an oppressed position and are a perfect example of learned helplessness.??
Have you heard the story of the chained elephant? Well, it goes something like this - a baby elephant is chained for the first few years of its life.?It tries thousands of times to break out of the small circle it has been confined to, but eventually, the day comes when the elephant stops trying. Then the owner removes the chain. The elephant believes escape is impossible – and this belief keeps him imprisoned for the rest of his life.??This is what sociologists call "learned helplessness."
Nurse Oppression
Nurses have been extorted for decades.?They have little control or power over what they need to safely deliver quality care.?They think ratios are the answer because it is a longer chain that will give them more of what they need - but it’s still a chain as long as somebody else besides the nurse decides ratios.
The oppression nurses experience isn’t really about our profession. If we expand our perception, it becomes obvious that this power struggle is really about what our nation values.
In the current business model, the dominant value is profit - and caring is oppressed. Nurses are empathetic healers whose acts of heartfelt service are not reimbursed in the current business model.??
There is No Billing Code For Compassion?
Nor is there no billing code for the vigilant nurse who intervenes in time to prevent a bad outcome or the only nurse who can get a patient to take their meds. These exceptional moments when a nurse saves a life or connects profoundly with his or her patient are free… like pennies on a convenience store counter.??
Because the work we cherish has no monetary “value” in the current business system, our self-esteem decreases, in-group arguing prevails, and we start measuring ourselves using the language of the dominant group: turn-around time, length of stay, and hours of care per patient day. This is why staffing ratios are the wrong fight. It’s still about control – like Rosa Parks fighting for a seat on the 2 a.m. bus.?
Autonomy and Power are The Real Fights
We think we are exerting power, but we are not.?It is pseudo-power designed to give nurses only a little bit of what they need. By fighting for ratios, we are still playing into the values of the dominant group. I want to waive a red flag and yell?“Stop! There’s another way! Look!”??
If you are going to fight, fight for the real thing: your own autonomy and power.??
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The Charge Nurse’s Role
The only person in an organization who is qualified?to decide staffing levels is the charge nurse.?This person knows,
1) the real-time acuity level of every patient
2) the experience and skill level of oncoming staff
The charge nurse (with the support and endorsement of their manager) should get as many nurses as they request. Period.?Fight for that!
If you are smart enough to be a charge nurse, run a crash cart, save lives, manage complicated calculations and patients, etc., then you are smart enough to know how many nurses are needed for safe staffing for the next four hours (and yes, staffing must be assessed every 4 hours). Any other option dummies us down.
Staffing Ratios Are a Temporary Solution
Where is the advocacy for our own judgment, power, skill, and knowledge? That’s Nursing unchained.
Staffing ratios are a temporary, stop-gap solution. They will not create the respect and value our profession deserves.?It never dawns on nurses that there shouldn’t be a chain at all - that nurses themselves should have the power to set ratios on an hourly basis.?
By playing into ratios, we are still holding ourselves in an oppressed position because we are discounting our own ability to make this critical decision. And we all know that conditions change quickly.?What if my ratio is 1:4 - then one patient crashes and I can only safely take 3 patients???
Oops!?The ratio says 4 so sorry.
Only when we are given the resources that we request to do our job will our patients ever be safe.?
Only then, and not until then.
Kathleen Bartholomew, RN, MN?uses the power of story and her background in sociology to illuminate the healthcare culture in her presentations, books, and Op-Eds.??For over twenty years she has spoken to nurses, physicians, and leaders about how to nurture relationships that create a culture of safety. Her?TEDx talk?challenges our covert belief that some people are more important than others.?
Nurse-invented the ??'s 1st highly effective UNIversal & UNIsex Siphoning Urinary Catheter device, "UniSUC"....RN, PHN, B.Eng., Founder/CEO
1 年ADVOCACY: A nurse is providing care for a female patient who is obese. The nurse administers diuretics and places a Purewick to assist with urinary management. After two hours, only 100ml of urine is collected in the suction canister and the patient's clothing is soaked. Two nurses help turn, clean, and change the patient's gown, chuck, and Purewick. This cycle continues every 2-3 hours for the remaining 9-10 hours of the shift. Have you ever encountered a similar situation? If so, you understand how physically demanding this work can be. Many people experience this daily. How can you advocate for your patients if the hospital has limited resources to prevent this repetitive method of care? Patients are allowed to bring their own personal CPAPs and other non-invasive devices to the hospital. Why not allow them to bring their own UniSUC as well? Assist your patients by suggesting they visit www.alpepllc.com or search for "UniSUC" on Google to order UniSUC for their own use instead of using Purewicks, it could be beneficial. Best of all, it's FREE! If they include a message stating "I'm a patient at the hospital" ADVOCATE! Pass this message to your colleagues ??. #nomorebedsores Www.alpepllc.com
CRRN at Encompass Health/Mount Carmel Inpatient Physical Rehabilitation Unit
1 年As a bedside RN for over 30 years, staffing ratios would help but it is very difficult to precept another RN or a Tech or aide when the Preceptor has as many patients as others whom are not precepting. This leads to burnout especially when one cannot precept effectively. We allow one new hire to be precepted by too many different preceptors and none of these are communicating effectively with all parties to ensure success. Needless to say, new hires may not make it since when on their own, he/she do not have that safeguard of having a Preceptor on their assignment and others are just too busy at times to help. Charge RN’s can make a difference if they have the pulse of their acuity and workforce for that day but they get hammered with havingto take a partial or whole assignment at times. I have seen the push to place some nurses with little experience into a Charge Role or that RN is tired of being a floor RN and figure taking less patients may be better so will go into other roles. I love to do physical work but we need more ancillary help to turn, feed, and toilet patients so RN’s can effectively do their licensed tasks. Experience should count for something in helping this profession succeed but changes have come to slow
?Thought Leader, Expert, & Consultant on nurse staffing, scheduling, and finance providing a holistic approach to nursing workforce management that balances patient care, time off, and education. ?
1 年Great article, Kathleen Bartholomew. I take a look at the issue from a slightly different angle in my Nurse-to-Patient Ratios: An Incomplete Solution to Nurse Understaffing blog article. https://informaticsnurse.com/nurse-to-patient-ratios-an-incomplete-solution-to-nurse-understaffing/ When designing solutions to our nurse staffing challenges, we must be careful not to select half-measures for expediency. We need a deeper, more holistic understanding of the mathematics of care delivery within the context of optimal resource allocation. We must advocate for all resources required for safe and effective care. This includes staff at the bedside, additional staff to provide adequate time off for employees to reduce burnout, and the resources needed to provide coverage for education and orientation to maintain and improve workforce competency. Mandating nurse-to-patient ratios without ensuring we also have the resources for time off and education will likely result in facilities that are still understaffed and cutting corners on time off and education while still relying heavily on overtime and travel RNs to meet the ratios.