Hi Jeanette Slimpson,Please see this link if this could of any help to you.

http://www.nursingtimes.net/download?ac=1258604,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653880/

Thanks and Best wishes,

Joby George

Hello Jeanette

This 2005 slide presentation might be of interest:

https://www.iienet2.org/uploadedfiles/SHS/Events/Details/Webcasts/ProsandConsofRatios080405.pdf

This is a conference paper:

Hershbein, B. (2005). Nurse-to-patient ratios: research and reality. In New England Public Policy Center Conference Report. Federal Reserve Bank of Boston.

https://www.bostonfed.org/economic/neppc/conreports/2005/conreport051.pdf

Patterson, J. (2011). The effects of nurse to patient ratios. Nurs Times, 107(2), 22-5.

http://www.nursingtimes.net/Journals/2013/01/18/o/j/c/180111The-effects-of-nurse--to-patient-ratios-.pdf

Douglas, K. (2010). Ratios-If it were only that easy. Nursing Economics, 28(2), 119.

https://www.nursingeconomics.net/necfiles/staffingUnleashed/su_MA10.pdf

Reiter, K. L., Harless, D. W., Pink, G. H., & Mark, B. A. (2012). Minimum nurse staffing legislation and the financial performance of California hospitals. Health services research, 47(3pt1), 1030-1050.

https://www.researchgate.net/profile/David_Harless/publication/51860951_Minimum_Nurse_Staffing_Legislation_and_the_Financial_Performance_of_California_Hospitals/links/0deec5294c2d9a92f4000000.pdf

Hertel, R. (2012). Regulating patient staffing: a complex issue. Academy of Medical-Surgical Nursing, 21(1), 3-7.

https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSM-Hertel-Jan12.pdf

Mitchell, P. (2009). Nurse staffing—A summary of current research, opinion and policy. A report of the Ruckelshaus Center Nurse Staffing Steering Committee. Pullman, WA: The William D. Ruchelshaus Center. Retrieved July, 10, 2012.

http://ruckelshauscenter.wsu.edu/wp-content/uploads/2013/06/NurseStaffingfinal.pdf

Shindul-Rothschild, J. (and other letters) Mandatory nurse/patient ratios. Nursing2003, Volume 33, Number 10 46-48.

http://journals.lww.com/nursing/Abstract/2003/10000/Mandatory_nurse_patient_ratios__A_good_idea_or.45.aspx

I have the full text of this if you are unable to access it.

Best wishes with the debate!

Mary

Article Minimum Nurse Staffing Legislation and the Financial Perform...

The above responses include great references.  As you probably know hospital safety has come under great scrutiny.  In the research on patient falls, staffing has shown to be a factor in the number of patients to whom adverse events can occur.  Here are two references;

Dunton, N., Gajewski, B, Taunton, R.L., & Moore, J. (2004). Nurse staffing and patient falls on acute care hospital units. Nursing Outlook, 52, 53–9.

Hitcho, E, Krauss, M., Birge, S., Dunagan, W., Fischer, I., Johnson, S. et al. (2004).  Characteristics and circumstances of falls in a hospital setting. JGIM: Journal of General Internal Medicine, 19 (7), 732-739.

Also staffing with at least a mixed of experienced RNs is significant.  Hill, K. S. (2010). Improving Quality and Patient Safety by Retaining Nursing Expertise. Online J Issues Nurs. 2010;15(3). 

The safety of patients improves when experienced nurses are present in the clinical area. 

This is all most significant because of patient safety but it is also financially significant for hospitals.  Medicare and most private insurers do not reimburse hospitals for conditions created in hospitals, such as fall injuries.  Hospitals are required to provide that care without reimbursement.  There is an increased expense with adequate staffing.  However, hospitals need to calculate how much the increased staffing costs are offset by the reduction in Hospital Acquired Conditions (HACS) that are not reimbursed. 

The American Nurses Association is offering a Webinar in this regard, tomorrow between 1 and 2pm. The link is here: https://learn.ana-nursingknowledge.org/products/Exploring-Innovative-Staffing-Solutions-Free

The 2015 Avalere White Paper on Staffing can be downloaded from this link:

https://nursecredentialing.wufoo.com/forms/download-the-2015-avalere-white-paper-on-staffing/

I can access the White Paper if the link does not work for you.

Jeanette

It may be too late to inform your debate but in case it helps i'd like to offer the following. The truth is that there is very little evidence for the benefits of mandatory ratios, the best single source is: Donaldson, N. and S. Shapiro, Impact of California mandated acute care hospital nurse staffing ratios: A literature synthesis. Policy, Politics, & Nursing Practice, 2010. 11(3): p. 184-201.

Basically, for California, there is evidence that staffing improved and little evidence of the feared harms BUT direct evidence of benefit it scant. Some more recent studies looking at mortality largely bear this out - see the attached paper (submitted for publication) for a summary. There is stronger (just) or at least clearer evidence from Australia where the NHPPD method is quite similar.

Evidence showing associations between patient safety outcomes and nurse staffing levels (also summarised in the attached paper) does not directly tell you that there will be a benefit from mandatory ratios for lots of reasons. Not least because the effect of the mandate will depend on where you are starting from in terms of staffing levels AND mandatory ratios cannot (theoretically) be better than staffing against a system that perfectly identifies staffing requirements based on individual patient need. However, I know of no such system and staffing mandates have been introduced because of a perception that staffing often falls below safe thresholds...

It's extremely complicated and I suspect that the ultimate answer of what it 'right' or 'best' cannot be directly answered by research. 

Peter

what about Shekelle, P. (2013). Nurse-patient ratios as a patient safety strategy a systematic review. Annals of Internal Medicine, 158(5), 404.  Retrieved from http://annals.org/article.aspx?articleid=1656445