Solution bomb is an expression a former colleague of mine used when he felt like a solution was presented without proper thought or respect to the implementation, sustainability, available resources, or to the individuals impacted by the “solution.”
I was reading an article last week about how healthcare organizations and the government were responding to the nursing crisis. I couldn’t help but think, “solution bombs!”
Here’s my response to the number one hot topic in nursing today: mandatory staffing ratios.
SOLUTION BOMB!
Do I agree with the concept that appropriate staffing results in safer care, better patient outcomes, and greater satisfaction for both patients and nurses? YES! 100%. Will government mandates on staffing achieve this? NO! Here’s why:
Many argue that correcting the ever-expanding nurse/patient ratio is the key to nurse retention and recruitment. Lessen the workload and they will come (and stay)! Right? I’m not so sure. California was the first state in the nation to mandate RN staffing ratios across all units and specialties. Other states have followed suit. New York, Oregon, Maine, and Massachusetts all have forms of legislation regulating patient ratios. Pennsylvania, Georgia, Maine, Illinois, and New Jersey have pending legislation. However, even with mandated staffing ratios, California is one of 10 states with the largest projected nursing shortage in 2035. I’m not picking on California, they were simply the first to recognize this as a threat to the industry, and have been working on a solution for over two decades.
So why solution bomb vs solution? Because the how has never been addressed.
How do we pay for it?
The cost of compliance with the nurse staffing ratios in California adds about $3 billion to California’s health care system. The value and impact on patient care and employee and patient satisfaction is worth every bit of $3 billion, and more, but if you don’t have the money, you don’t have the money. So, that $3 billion must be reallocated from somewhere else in the system. We meet the mandated staffing ratios, but at the expense of what? Work environment? Employee benefit costs? Professional development? Community access? Hospital infrastructure? Needed equipment? All of which have been indicated in survey after survey as the reasons why nurses are leaving the profession. Do we lose the safety factor if we shift the problem from nurse staffing to another area?
Where do we get the nurses?
Ratios are irrelevant without nurses. Without a steady stream of “new” nurses entering the workforce to replace those who left the profession and those retiring, and with a solid plan for retention from the industry, mandated staffing ratios are merely words on a page.
From 2020 to 2021, the supply of RNs decreased by more than 100,000—the largest drop observed over the past four decades. By 2032, it is projected that there will be just over 190,000 RN vacancies in the country, with only 170,000 projected new RNs entering the workforce.
Healthcare must address the factors driving nurses out of the profession: workplace violence, unsafe work environments, lack of respect, poor onboarding, lack of professional development and career advancement. In addition to those issues, we must address the obstacles facing education: the shortage of educators, pay, high cost of tuition, expansion of the scope of practice, and education reimbursement.
Overall, I support mandated staffing ratios, but we must solve the issues mentioned above, and so much more, before the value of the mandated ratios can be appreciated. I encourage nurses across the country to join your state nurses association and get involved. Help develop solid “solutions” that elevate our profession and avoid the dreaded “solution bombs.”
