The Federal Regulation 42 Code of Federal Regulations (42CFR 482.23) was established to ensure that hospitals and long term institutions of health care who are certified to participate in Medicare maintain appropriate numbers of nursing staff to include licensed registered nurses, LPN’s, LVN’s and other ancillary staff to administer safe, effective and skilled nursing care to patients. This Federal standard sounds good, however, it serves as an impediment to nurses and other members of the health care team.
The language in 42 CFT 482.23 at first glance, appears to offer a little something for everyone. In theory, the regulation should satisfy nurses and others who are in the direct line of patient care, and it should also benefit the CEO’s, CFO’s and Administrators of medical facilities, however, the language in 42 CFT 482.23 is so vague, nursing teams and patients are consistently getting the short end of the stick in terms of how care is delivered and when it is received. In theory, 42 CFT 482.23 should mandate what the appropriate numbers should be in terms of nurse-to-patient ratios but it doesn’t.
The reason there is so much confusion in regard to what appropriate staffing numbers should be is that the regulation as it is written leaves it to each state to determine their own ratios. In the United States, there are some states with 5/15 nurse-patient ratios and then there are others with a mandate of 3/15. This is dangerous and poses extreme risks in terms of patient safety on dumping ground floors like Medical-Surgical units, and specialty floors like Labor and Delivery.