The term “nurse staffing ratio” has been in the news recently. The ratio refers to having a nurse care for a fixed number of patients at a time. However, fixed nurse-patient ratios do not necessarily lead to better care for patients, nor do they solve the ongoing nurse shortages. In fact, fixed nurse-patient ratios have the potential to restrict access to care.
If fixed nurse-patient ratios were the answer, California, which implemented mandatory nurse-patient ratios in 2004, would have all the nurses it needs, and would have the best quality of care in the nation. However, California, which pays the highest registered nurse (RN) salaries in the nation, is currently short 22,000 to 36,000 RNs, according to various estimates. Their RN-to-population ratio is no better than in Hawaii, and Hawaii has an overall better quality of care.
Forbes Advisor looked at disease prevalence and mortality rate, substance abuse score, and lifestyle habits and health outlook score, and found that Hawaii has the healthiest population in the nation for 2023. On this same ranking, California comes in at 13th.
Another source for overall health by state is America’s Health Ranking — which showed that for 2023, Hawaii ranked the sixth-healthiest state in the nation, based on health outcomes, social and economic factors, physical environment and clinical care. On this ranking California comes in at 28th.
Our Hawaii emergency rooms are already very full and are at times overflowing. Our hospital inpatient beds are full also. We are taking care of 400 more patients a day than we were prior to the COVID-19 pandemic.
If we have fixed nurse-patient ratios, we may need to restrict access to care. If hospitals do not have sufficient staff to meet the ratios, they could be forced to close beds and units and turn away patients, until they can find more staff, or discharge enough patients to meet the ratios.
Fixed nurse-patient ratios do not produce more nurses. We are working hard in partnership with our educational institutions to increase the number of nurses and other health-care professionals to meet the increased post-pandemic demand, but this is not a quick or easy process. We have multiple programs and initiatives in our public high schools, in our community colleges and our universities, to train more health-care workers, including RNs.
Entry-level programs for certified nurse assistants, medical assistants and phlebotomists, for example, consist of a number of months of training, and there are multiple cohorts being trained in public and private academic settings across the state.
One recent success is the University of Hawaii Maui College licensed practical nurse (LPN) one-year program that graduated 31 students in December, and there are 38 students enrolled in that program for 2024.
The UH-Manoa and the UH community colleges also have a variety of health-related programs, and we are working to increase the number of nursing faculty at UH so we can train more of our own students who are pursuing a health-care career, including nursing.
We know that if we provide more educational opportunities and support for our own young people and residents, the chances of them staying in Hawaii and establishing a career here is increased.
Our hospitals and other health-care institutions value their nurses and other health-care professionals. Our hospitals are committed to patient safety and high-quality care, and they are committed to ensuring they have the staff they need to take care of their patients.
We are all committed to training more nurses and other health-care professionals, and doing all we can to ensure that all our staff are paid fairly for the work they do. Fixed nurse-patient ratios, however, are not the answer to better patient care, or to our nurse workforce shortages.
Hilton Raethel is president/CEO of the Healthcare Association of Hawaii.
