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188 unit 3 | Professional Issues CikguOnline
Staffing Ratios only licensed practical nurses (LPNs) but also with
unlicensed assistive personnel (UAP).The legal reg-
Although some state nurses associations are calling
ulation of nursing practice is defined by each state
for mandated staffing ratios, the issue is not clear-
nursing practice act; however,the ANA believes that
cut. What has become clear is that there is no “one
“curricula for all RN programs should include con-
size fits all”solution. In 2004 a review was conduct-
tent on supervision, delegation, assignment, and
ed of peer-reviewed studies published between
legal aspects regarding nursing’s utilization of assis-
1980 and 2003 of the effects of nurse staffing on
tive personnel” (nursingworld.org/readroom/
patient, nurse employee, and hospital outcomes.
position/uap/uaprned).
The literature offered no support for specific nurse-
Hospital workforce issues will continue to be
patient ratios. However, findings from 12 key stud-
influenced by economic changes, managed care and
ies stood out, citing specific effects of nurse staffing
insurance issues, media forces, and the nursing
on patient outcomes: incidences of failure to rescue,
shortage. Linda Aiken has been researching rela-
in-patient mortality, pnuemonia, urinary tract
tionships between positive patient, nurse, and
infections, and pressure ulcers. Effects of nurse
agency outcomes and RN staffing, educational
staffing levels on nurse employee outcomes includ-
preparation, and organizational culture (Aiken,
ed needlestick injuries, nursing burnout, and nurs-
2002, 2004). Nurses voice disillusionment with
ing documentation, whereas hospital length of stay,
nursing practice and decreased loyalty to organiza-
financial outcomes, and direct nursing care were
tions. Nursing leaders in the 21st century must
experienced by the hospital. Table 12-3 provides a
demonstrate a respect and value for their nursing
matrix for staffing decision making.
staff, communicate effectively with all levels of the
Above all, the ANA recommends moving
organization, maintain visibility, and establish par-
staffing away from an industrial model of measuring
ticipative decision making. As you move forward in
time and motion to a more professional model that
your career, be part of the solution, not the problem
examines factors needed to provide quality care.
(Ray, Turkel, & Marino, 2002).
Changes in staffing levels should be based on analy-
sis of nursing-sensitive indicators (nursingworld.org/
readroom/stffprnc). Reporting Questionable Practices
Using Unlicensed Assistive Personnel Most employers have policies that encourage the
reporting of behavior that may affect the workplace
Educational preparation and clinical experiences in
environment. Behaviors to report may include
practice for nurses differs for basic registered nurse
(ANA, 1994):
(RN) education. The nursing shortage will contin-
ue to force health-care facilities to explore creative 1. Endangering a patient’s health or safety
ways of providing safe and effective patient care. 2. Abusing authority
This will most likely include RNs working with not 3. Violating laws, rules, regulations, or standards
of professional ethics
4. Grossly wasting funds
table 12-3
The Code for Nurses (ANA, 2001) is very specific
Matrix for Decision Making: Staffing about nurses’ responsibility to report questionable
Patients Characteristics and number of patients behavior that may affect the welfare of a patient:
requiring care When a nurse is aware of inappropriate or ques-
Intensity of Unit Intensity of individuals within and across tionable practice in the provision of health care,con-
and Care the unit; variability of care; admissions, cern should be expressed to the person carrying out
discharges, transfers, volume
the questionable practice and attention called to the
Context Architecture of unit; technology available
possible detrimental effect on the patient’s welfare.
Expertise Staff consistency, continuity, and
cohesion; staff preparation and When factors in the health-care delivery system
experience threaten the welfare of the patient, similar action
Other Quality improvement activities; nursing should be directed to the responsible administrative
control of practice person. If indicated, the practice should then be
Adapted from nursingworld.org/readroom/stffprnc reported to the appropriate authority within the