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Nurse staffing ratios take center stage

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Levels based on patient need being discussed

CORRECTION RAN FRIDAY (8/20/04)

The ratio of Mayo Clinic nurses to patients was incorrect on Pages 1A and 3A of some editions Thursday. There are 3.3 nurses to every patient.

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By Jeff Hansel

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jhansel@postbulletin.com

Now that California requires hospitals to follow mandatory nurse-to-patient staffing ratios, the idea is the talk of the nursing industry.

Much of the discussion, though, focuses on a different concept of staffing; deciding staffing levels based on patient need.

Jan Rabbers, spokeswoman for the Minnesota Nurses Association, said the association has not called for minimum ratios. Patient mix changes hourly in hospitals, she said, and MNA believes staffing should be based on patient need instead of mandatory -- and arbitrary -- numbers.

In 2001, floor nurses in Minnesota were codified as the best ones to decide when they need help. Supervisors called "charge nurses" were given specific authority to close a unit from new admissions, for up to two hours.

"It's not been tested that much because it usually has been worked out," Rabbers said. Instead of closing a unit, a hospital either delays elective procedures, calls in extra nurses or "floats" nurses from slow areas to busy ones, Rabbers said. Often a single hospital will have several intensive-care areas in places like pediatrics, adult care and trauma, she said. If patient census decreases in one, a nurse can float to another.

"Being able to assess the situation as it comes along, I think that gives you a little more freedom," Rabbers said. Rochester is doing well, she said.

"Mayo Clinic has staffed up. They have made the effort to add more nurses," she said. More nurses result in fewer bad decisions, Rabbers said. More nurses also means patients get better faster, with less chance of another hospital stay. Rabbers said there are "fewer bed sores, pneumonia, and all of those things that happen when a nurse isn't able to watch a patient -- and they are very costly incidents -- and you're going to have less errors and you're going to have less death."

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There is no national system to collect staffing data, Rabbers said, and that would be a first step toward better understanding of the issue.

California tried to fill the gap and is requiring hospitals to keep track of staff-patient numbers.

Chris Donnellan, associate director of government affairs for the American Nurses Association, said "our goal is to have an adequate number of nurses taking care of patients because we know, with less nurses, patient care is jeopardized."

Hospitals should post data on the Internet and in the building daily, he said. But some won't publish their rates.

"I think the consumer should be afforded as much information as possible to be able to make up their decisions," Donnellan said.

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