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Mandatory Nurse/Patient Staffing Ratios

By October 18, 2018Commentary

There are a lot of groups in health care who like to hide their economic interests behind supposed concern for patient welfare.  Nurse organizations and unions are not immune from that tendency.  They have for several years pushed for higher ratios of nurses to patients in hospitals, claiming that it would result in better quality.  As usual, research shows that the facts may be different.  A study published in the journal Critical Care shows that Massachusetts’ implementation of an intensive care unit ratio had no impact on outcomes.   (Crit. Care Study)   Massachusetts required ICUs to have a 2 patient to 1 nurse staffing ratio or even a 1 to 1 ratio, depending on patient acuity, by March 31, 2016, so the researchers obviously compared outcomes before and after that date.  The authors looked at mortality, complications and presence of do-not-resucitate orders.  Comparing Massachusetts hospitals before and after the mandate and with hospitals outside Massachusetts not subject to the mandate, there was absolutely no difference in mortality or complications.  So maybe the hospitals were doing fine before the mandate, or maybe they already knew what an appropriate staffing ratio was for an ICU.  And in fact, number of nurses changed in a very minor degree after the mandate, suggesting it was completely unnecessary or hospitals figured out how to game the acuity scores to justify existing staffing.  In any event, the mandate clearly made no difference, which is consistent with research on similar mandates in other states like California.

The results of this study are just the latest example of misguided regulatory fervor, impacted by pressure groups with their specific, usually financial, interests.  Government sucks, and it sucks (just like other big organizations do) because it almost inevitably is the result of people (and lets remember there is no such thing as an organization that does anything, it is the people in the organization) thinking they know best and should be able to tell others what to do.  People almost never have all the relevant information and they almost never come to the right logical conclusions and they are way too confident in their own abilities.  Couple that with the coercive nature of government power and you have the perfect recipe for stupid policies that rarely make things better and often make them much worse.  So lets commit to having fewer regulations about health care delivery, which would lower costs and probably improve care.

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