Will Ratios save nursing?
I recently read the latest LAMP journal produced by the NSW nursing union and honestly, it got me a little perplexed and I have spent a few days trying to unravel it all.
Having worked at a senior level in the healthcare system, I frequently attended meetings with senior execs and change management consultants, who would frequently highlight how ratios wouldn’t fix the challenges we face. I was equally as confused in these meetings, as that’s what EVERYONE wanted. Why would it resolve the issues?
As I was reading the Unions journal, I couldn’t help but notice that every page was referring to the need for Ratios.
Honestly, I really struggle to see how ratios alone will resolve the issues we face on a global scale.
Hear me out:
Do I think ratios are a good idea? yes – there’s so much evidence to suggest they improve patient safety and staff workloads.
Will they solve ALL of our problems? Er… no.
However, if you look around this is ALL we are focused on. That’s all that was posted in LAMP.
Nursing is complex. Yet we are being led to believe that one solution – ratios, will solve ALL of our problems.
My concerns with ratios include:
- Ratios will not address the staffing issues we currently face. We will need more staff per shift – where do they come from?
- Due to the above concern, non clinical nurses will be pulled from their roles to fill gaps clinically, meaning less education, less operational functionality and less management/leadership support.
- Ratios are not being globally implemented, meaning that in some states and territories that in critical care/acute care they are not implemented. What happens is that these Acute care/critical care nurses are then taken to fill staffing gaps on non critical wards, purely to meet a KPI.
- Relatives will still complain with an increase ratio – they are only human.
- Ratios do not account for the acuity of your patient load. You could have 4 acutely unwell patients and even a 1:4 would not be manageable.
- Ratios will not improve our work fulfillment. That comes from our thoughts about our work.
- Ratios will not reduce burnout – burnout is a symptom of a misaligned career and mismanaged mind.
- Ratios will not reduce bullying, again that is a human issue, that can only be rectified through education/support/strong aligned leadership and staffs ability to be emotionally intelligent and aware – all of these things will be compromised when CNE’s are taken from their duties and made to work on the floor.
Ratios are great for patients, but I think we have to be mindful that a one size fits all solution is often heavily flawed and a band aid solution for a much bigger issue.
What I would like to see:
- Ratios implemented with acknowledgement of the reality and impact, providing people a balanced view of the realities!
- Coach training integrated into all leadership/education roles to help leaders thrive and manage their mind/teams better!
- Education/Leadership roles protected from being pulled onto the floor to fill staffing gaps, having broader organisational impact.
- Stronger digital health systems and tools for senior leaders to lead effectively.
- An education system that focuses and teaches sustainable self-care tools and skills.
- Government level campaigns in schools – showing nursing and midwifery as an appealing career.
- Stomping out of the bullying that exists and stronger performance management processes.
What are your thoughts on all of this?
I would love to hear!
