Why Quota for Nurses Isn’t Cure-All

WSJ Article ($) | Free Version of Article

Thanks to Dan Markovitz for pointing this article out to me a few days ago:

At IHI's patient-safety conference today in Orlando, Fla., Ms. Rutherford is presenting an alternative to ratios: a redesign of medical-surgical units so nurses, who may spend only a third of their time on direct patient-care activities, can reduce time spent on paperwork, charting, finding supplies and resolving operational problems.

Amen to that. The Institute for Healthcare Improvement (influenced by Steven Spear and others) is doing a great job with lean concepts.

There's so much waste in nurse's work and in a nurse's day. It's not their fault, it's the way the system is designed (or not designed), lack of lean thinking, etc. I've seen this waste in many hospitals and many different patient settings. It's clearly systemic and needs fixing.

I disagree with the push for arbitrary patient:RN ratios because you can't generalize the number of nurses needed any more than you could mandate by law how many employees GM and Toyota need. Different hospitals with different layouts, different patient populations, different nurse skill/training levels, etc. will all require different staffing levels. Laws to mandate these ratios might have many unintended consequences. For example, hospitals might close rooms when they don't have enough nurses, meaning fewer patients can get care. Is it worse to have overstretched nurses or closed rooms?

I worked recently with a major city hospital that didn't have a law mandating it, but they were shutting down rooms because they had their own internal mandates for patient:nurse ratios. This was already a hospital that was having trouble meeting demand, as rooms were full, the ER was backed up, and they were having to turn away ambulances (something that should be a criminal act, if anything). They have to fix their processes and not just turn away patients.

Some hospitals are starting to get it, the idea of reducing waste rather than giving up and closing up rooms/units. Some hospitals will be like GM and Ford, making excuses and placing blame. Others will fix their problems and will reduce waste.

Here are some letters to the editor from today's WSJ on the topic.