There are bills in the Texas House & Senate now to establish mandatory nurse staffing committees to help set policy on nurse to patient ratios in hospitals. It's well established in the literature that smaller ratios equal better patient outcomes. Less patients per nurse means more time spent with the patients. The current bills were introduced by Senator Jane Nelson and Representative Donna Howard. Howard is often cited as former nurse, but 1) I doubt she's let her license lapse and 2) even if you're not providing direct patient care, once you've put in a few years you're always a nurse.
The bills are supported both by the Texas Nurses Association (I'm a member) and the Texas Hospital Association in a good example of positive collaboration between organizations that are sometimes at odds. Essentially the bills require at least 50% of the nurse staffing committee members to be bedside nurses chosen by their peers, use patient-sensitive measures to evaluate their staffing, and it also extends whistle-blower protections to government-run hospitals and clinics (this doesn't already exist?! I need to look into that one further).
At the same time, there are competing bills supported by the National Nurses Organizing Committee—really an arm of the California Nurses Association that's aggressively pro-union and organizes in other states—that mandate specific, low nurse-patient ratios. While this sounds good, in reality the inflexibility of the ratio is a major stumbling block. Our ratios in ICUs are one nurse to two patients or 1:1, or even two nurses to one patient if acuity requires it. On the non-ICU patient floors, the nurse to patient ratio varies widely from hospital to hospital. Around 1:5 is decent, getting around to 1:8 is unacceptable in my opinion. Setting a specific ratio is nice, but ignores the reality. What if two of your patients need a lot of care? In that case a mandatory 1:5 doesn't really cover it. If your patients are doing well, 1:5 could be a light assignment.
As well, those mandatory ratios mean that staff nurses can't just give a quick report to a co-worker who will watch her patients during lunch. The hospital would have to hire extra nurses to cover meal breaks. Just really unnecessary. I'm for letting staff nurses make the best staffing plan at their hospital. Sure, step up investigation of hospitals with poor patient outcomes, but don't lay out a one-size-fits-all requirement as a panacea.
I didn't think the National Nurses Organizing Committee (and I am a fan of nurse unions, just not the way NNOC is going about it) had a chance of garnering much support for their bills, but I just read that Rep. Senfronia Thompson and Sen. Mario Gallegos filed them. Thompson did so after her granddaughter waited four hours at a hospital ER with a high fever. I'm going to have to call her office, because this bill has nothing to do with wait times in ERs. Patients seen in an ER are not in-patients until they're admitted upstairs and therefore nurse-patient ratios don't apply. The long wait times in ERs has more to do with many people not having coverage or access to a primary care physician and therefore the ER serving as their doctor or clinic.
OK, more on this later as I tease out the intricacies.