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Advocacy Letter

June 15, 2014

Congressman Edward Scott Rigell

4772 Euclid Rd., Suite E
Virginia Beach, VA 23462

Dear Congressman Rigell:

There is a new bill that is being proposed, HR 1907 before the
113 Congress in favor of mandating nurse to patient ratios within the
hospital settings. It was very exciting and encouraging to read over
this bill, as I am a Registered Nurse and I feel a lot of the items listed
within your bill are pertinent to nursing retention and patient safety. It
was quite disturbing to discover though, that this proposal is predicted
to have a 0% chance of passing. Bill number H.R. 1907 should be
passed in order to ensure patients receive the quality of care they are
entitled to by keeping the nurse to patient ratio in a manageable range
in combination with the acuity of the patients, thus improving patient
satisfaction and outcomes along with increased job satisfaction for the
nurse which will decrease nursing burnout and turn over as nurses are
able to provide safe, skilled and timely care.

In January of 2004, California was the first state to put in place a

safety plan for the patients and nurses in mandating the nurse to
patient ratio remain at a 1:4 ratio in the general care settings. This was
done in an effort to decrease occurrences of errors by staff, decrease
injuries to patients, up to and including death. A lower nurse to patient
ratio was thought to also increase patient and staff satisfaction. After
eight years of instituting this policy into practice the results are
inconclusive that a 1:4 nurse to patient ratio is working and ongoing
research is needed, as many of the surveys did not show a decrease in
error or an increase in patient satisfaction. Serratt (2013) states at the
end of her article, Nursing leaders must critically evaluate and
support future research to assess the benefits and risks of this type of
staffing policy ( Serratt, 2013, p. 585).
Although Californias research was not overtly conclusive that
the answer to a lot of nursing issues would be solved in lowering the

nurse to patient ratio, this motion can not be dismissed either. In

mandating the maximum number of patients a nurse can have during
their shift, shields a nurse from being forced to take on more patients
than is safe and practical. This would enable the Registered Nurse
(RN) to increase the amount of time spent with each patient at the
bedside tending to the ill. It is this time at the bedside, that drives up
patient satisfaction scores and increases patient outcomes as the RN is
able to listen to and engage the patient in his or her own care. During
this valuable time allotted with their patients, they are able to identify
changes in the patient condition and intervene as medically necessary
in a timely manner, potentially improving their patients prognosis.
There is a lot of research and articles to support this movement within
nursing journals. For instance, in the Journal of Clinical Nursing, Hinno
and her colleagues addresses this situation stating, inadequate
staffing and unrealistic workloads place an unnecessary burden on
nursing staff, reduce the quality of care that nurses are able to provide
and lead to fatigue, unachievable expectations and uncompleted
tasks (Hinno, S., Partanen, P., & Vehvilinen-Julkunen, K, 2012, p.
1585). This statement addresses both the effects of how low nurse to
patient ratios have on both the provider and the recipient. When staff
is forced to take on more patients, this takes it toll on a nurses spirit
and wellbeing and over time chips away at their desire to return to this
setting. This is the perfect setup for burnout as staff is unable to keep
up with the daily demands of work. Patterson notes in her publication
that, patients in a 1:8 assignment, had a 31% increase in mortality
(Patterson, 2010). These statistics are frightful.
In conclusion, I must plead that you persuade your colleagues to
at least research this bill and make an informed decision on passing
this bill. Capping off a maximum number of patients a nurse can safely
care for on a general care unit is a start in the right direction to
improving patient outcomes, not to mention safety to both staff and
patients. By passing this bill they will ensure that their constituents will
receive the best care a nurse can administer due to the appropriate
nurse to patient ratio enforced through the passing of this bill- HR

Pamela A. Johnston RN, CPHON

4329 Shrew Trail

Virginia Beach, VA 23456


Hinno, S., Partanen, P., & Vehvilinen-Julkunen, K. (2012). Nursing

activities, nurse staffing and adverse patient outcomes as
perceived by hospital nurses. Journal Of Clinical Nursing,
21(11/12), 1584-1593. doi:10.1111/j.1365-2702.2011.03956.x

Patterson, J. (2011). The effects of nurse to patient ratios. Nursing

Times, 107(2), 22-25.

Serratt, T. (2013). California's Nurse-to-Patient Ratios, Part 3. Journal Of

Nursing Administration,
43(11), 581-585. doi:10.1097/01.NNA.0000434505.69428.eb

Honor Code Statement

I have neither given nor received unauthorized aid on this examination (or other material
turned in for credit) nor do have reason to believe that anyone else has.
Signature: Pamela Johnston