In the United States, it has been a topic of debate, for multiple reasons, as to how much the minimum number of patients per dialysis nurse should be.
Primarily, it is based on the increasing number of patients as opposed to dialysis nurses, and this has caused an overload of workload.
Some studies mention the value and importance of establishing minimum staffing levels in dialysis clinics. For many years they have not been enforced, and it has affected nurses’ lives in different ways.
Based on this, this article details the importance of having a minimum number of patients, how not setting a minimum affects nurses’ lives, and much more.
What is the minimum number of dialysis patients per nurse?
Countries such as Brazil, Argentina, France and the Autonomous Communities of Catalonia and Madrid agree that the minimum should be four patients per nurse. Clearly, this may vary according to the dependency and the activity required by the patient.
On the other hand, some studies emphasize that the treatment of a patient should be divided into:
- 33 % is from dialysis nurses.
- 67 % is technical.
But, the day to day life of a dialysis nurse shows the opposite, a great example of this is the United States.
Many nurses have shown dissatisfaction for not having a minimum number of patients. To the point of having to resign for overstepping their boundaries between work and life, since they are not given the space to be with their family, have a social life or be able to rest.
That’s why the California state union pushed for Senate Bill 349 to create staffing ratios:
- 8 patients for every nurse.
- 3 patients for every patient care technician.
- 75 patients for every social worker.
However, currently, the staffing level in the state of California averages one dialysis nurse for every 12 patients and one technician for every 4 patients.
The pros and cons of Law 349
There is certainly going to be a great benefit to managing the number of dialysis nurses proposed by the union, but there are also downsides (financially for the state). Because dialysis providers emphasize that it would be too costly to hire more nurses.
Since to comply with this law would require the hiring of approximately 2 750 full-time equivalent nurses. However, in the most recent reports of registered nurses in the United States, a shortage of about 141 000 nurses is expected in California by 2030.
Looking at these numbers, the proposed ratios will not be able to meet these mandates.
On the other hand, the importance of encouraging a minimum number of patients cannot be overlooked. Given that those in favor say that nurse staffing is greatly reduced in dialysis clinics, creating a high-risk environment for infectious diseases, inadvertent needle detachments and other potential disasters.
Disadvantage of not having a minimum number of patients
- Not being able to rest.
- No time to eat.
- 18-hour shifts.
- Being on call for two or more days in a row.
- The possibility of being called at 3 a.m. to return to the clinical center after having worked 12 hours.
- Being underpaid for overtime.
- Being overworked, many nurses only last 4 or 5 weeks. This causes the remaining nurses to have more time to work.
- Decreased concentration, mood and mood problems.
- Lack of energy and motivation.
- Lack of control and coordination, more impulsivity.
- Muscle aches and/or headaches.
- Easier to suffer traffic accidents and problems with violence.
Advantages of having a minimal patient
- To have occupational health.
- Release of emotional tension and physical discomfort.
- Nursing work will not be seen as an overload.
- You will be able to balance your family, social and work life.
How much is the minimum rest for a dialysis nurse?
Hemodialysis is a life-sustaining treatment that imposes challenges, usually always under constant pressure, as in the case of acute dialysis.
So is it really cost-effective to set a minimum time between patients?
For example, in the United States, 15% (37 million people) suffer from kidney disease. And as a measure of this, eight of its states (Georgia, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, Texas and Utah) have implemented regulations requiring specific staffing ratios in dialysis centers.
However, the only one that has implemented a minimum rest break with the goal of improving quality of care has been the state of California.
This mandatory break time is 45 minutes between patient shifts, so that staff members have time to properly disengage patients and allow them to stabilize before leaving the clinic.
Kidney disease can affect people of any age, so dialysis nurses need to be comfortable working with children, the elderly and everyone in between. They also need to be constantly learning and applying values when caring for patients. But what if the system forgets the importance of caring for the health care staff as well?
Possibly, it will overload the dialysis nurse and cause them to not want to continue with their work or in the worst case cause some kind of pathology: stress, anger, depression or anxiety.
Therefore, it is of utmost importance to implement in Latin American countries, Europe and even the USA a minimum of patient, because not doing so will not only affect the dialysis nurse but also the patient.