Robert Wingo RN BSN NI-BC

🌟 Facilitator Spotlight! We’re excited to have Janie Robinson, PhD, and Linda Yoder, PhD, as the facilitators for the AMSN Journal Writing Workshop! Join us to strengthen your writing skills, spark new ideas, and move your scholarship forward. ✍️✨ amsn.org/Events/AMSN-Jo…

Hey, @NewsmanChris. Mandated ratios, while well-intentioned, often overlook key aspects of nursing operations that can undermine their effectiveness or create unintended consequences. Ratios ignore the critical role of unlicensed support staff (e.g., nursing assistants) in care delivery. Under current reimbursement models, where nursing often receives a fixed "bucket" of money based on average daily census, hospitals must back into budgets without added funding. Mandating more RNs can lead to cuts in support staff, forcing nurses to handle delegable tasks like answering call lights, toileting, feeding, bathing, repositioning, and skin care. Imagine a busy med-surg unit where ratios force those reductions: suddenly RNs spend more time on basic tasks, leaving less for assessments, patient teaching, or coordinating complex care. Neglecting those basics risks adverse events like falls or pressure injuries, potentially offsetting some safety gains. Adverse events can also increase costs, decrease reimbursment, and cause the facility to run afoul of regulatory and accreditation agencies. Ratios could also lead to reductions in replacement time, limiting the resources available to provide coverage for time off, education, and administrative tasks, which in turn increases fatigue, reduces competency maintenance, and weakens overall care environment support. Furthermore, rigid mandated ratios do not account for innovative care delivery models such as virtual nursing, where remote nurses handle supportive tasks like monitoring, education, admissions/discharges, documentation, and safety observation via technology. These hybrid approaches can redistribute workload, enhance efficiency, and allow bedside nurses to focus on higher-acuity or hands-on needs in some settings, but fixed ratios typically exclude or undervalue virtual contributions toward compliance, potentially discouraging investment in models that could better leverage scarce nursing talent and emerging technology while preserving the quality of direct patient care. Ratios can also limit flexibility by locking in arbitrary numbers that do not account for patient acuity, condition severity, stability, or intensity of needs. They risk becoming rigid traps that hinder truly tailored, acuity- and workload-based staffing. Would be happy to discuss more if you like!

Nurses at UPMC Magee Women’s Hosptial are pushing for staffing standards. They say it will help patient care. UPMC says staff ratios don’t fix the underlying issue of a nurse shortage. @KDKA

A new champion has emerged xratios.app

Op-ed @USATODAY with @PaulaMutoMD: End the ACA subsidies and give patients their power back The third-party payment system has stripped power from patients, distorted incentives and disrupted markets. It doesn’t trust patients to choose, doctors to care or entrepreneurs to innovate. Prices remain hidden from patients because someone else is paying. Patients, unable to benefit from lower prices or better health, exert little downward pressure on price or upward pressure on quality ‒ unlike consumers in other markets. The result: high prices, low quality and stagnant innovation prevail, all at the expense of patients. As insurers and government programs seize control of health care dollars, medicine has become a compliance industry rather than a healing profession. Heavy compliance burdens fuel consolidation. Instead of private practice, more than three-quarters of physicians are now employed by hospitals/health systems and other corporate entities, with incentives tied to following corporate orders rather than improving patient outcomes. Worse, policymakers often misdiagnose these predictable consequences of policy failures as a need for more central planning ‒ further distorting incentives, compounding money-grabbing opportunities, and leaving patients worse off clinically and financially. Health care begins with the patient. In control of their dollars, patients make the best choices. When they pay directly, care happens faster. Providers must satisfy patients to earn their business ‒ aligning incentives, fostering competition and innovation, and creating a dynamic, vibrant marketplace for care. Imagine Americans receiving deposits into health savings accounts (HSAs) to pay for cash transactions and premiums for patient-driven insurance plans, backed by taxpayer-funded reinsurance as a safety net. If an Electronic Benefits Transfer (EBT) card can buy groceries, why shouldn’t it cover a dental exam or a visit to an endocrinologist? Disadvantaged Americans should also receive subsidies through their HSAs, where funds are transferrable, inheritable and eligible for tax-deductible charitable contributions ‒ thereby incentivizing comparison shopping, promoting healthy living and transforming health care philanthropy. Whoever pays holds the power. Funding patients directly would align incentives across the health care system, forcing all players to demonstrate and deliver value to individual patients in order to earn their business. Competition, innovation, price and quality transparency, and patient education would naturally follow, fostering vibrant markets that best serve patients’ diverse needs. Health care unaffordability is undermining both Americans’ well-being and America’s global leadership. The solution is simple: Patients must gain control of their earned or subsidized health care dollars. The power of free people and free markets can unleash American dynamism, uplift patients and ignite market transformations capable of defeating any entrenched special interest. Fund the patient.

In 1965 Congress gave theology degrees higher federal loan limits than nursing. In 2025 they kept it that way. Result: nursing grad students now face $20.5k/yr caps while future pastors get $50k/yr. This is costing America $200–300B a year and is officially a national-security crisis. Read it: linkedin.com/pulse/nurses-u… @ANANursingWorld @realDonaldTrump @JDVance @AACNursing @usedgov @AHANews @DeptVetAffairs @SenDuckworth @SecCardona @tweetAONL

If healthcare is a right, government must control it. If healthcare is a market, physicians must control it. That belief determines everything else. Which one do you believe?

This looks like another great health policy conference from @JHU_HBHI @GeBaiDC

If ur interested in transforming healthcare…take time to listen to podcast below….for me, personally, having worked in hc and like many….having dealt with the challenges of medical insurance…..this discussion is very encouraging…..

NHS nurse pay 2026-27: ministers plan award of 2.5% RCN general secretary Nicola Ranger said the government’s position risked ‘further insulting’ nursing staff, after two-thirds of college members having said this year’s pay rise of 5.5% was unacceptable rcni.com/nursing-standa…

The highlight of my week is that I got to teach 2 monks how to change a flat tire. 🚗

@ScholarshipfPhd Nursing budget flaws

Explain your research in 3 words or less.

I have 25+ years of experience in nurse staffing and scheduling, and nursing is a hot mess for many reasons. The biggest issue is with the way nursing is paid for. For budgeting purposes, nurses are treated similarly to housekeeping staff in hotels, and their costs are included in the daily hospital room rate charge. As a result, nurses are seen as a cost by finance that has to be cut, managed, and constrained. Nurses are the only healthcare professionals in hospitals who cannot bill for their services. There are also systemic flaws in the budgeting formulas that many hospitals use, resulting in a 2-10% shortfall in their budgets for the resources needed to provide patient care, time off, and education. To add insult to injury, there's an industry-wide problem with how hospitals mismanage their available nurses, which exacerbates the understaffing issue. I'm working to try to fix/address some of these issues, but it's an uphill slog because of the "We've always done it this way..." mentality from many nursing and healthcare leaders. There's much more to the issue.. I could type/talk for days on the problem(s), but these 3 of the top issues from my perspective/research.

All my nurse friends are reporting their hospitals are so understaffed. When my ma was in the E.R. , I had to bathe her myself because no one was available. It was a ghost town in there. Odd, they charge the same prices for .5% of the care they used to give.

@nursesam2019 😂🦄

@In4maticsNurse 😂😂 I literally call it my horn 🥲

I have a Pilar cyst right on my part and it’s huge 🥲 all the hair around it fell out and it’s super noticeable I am so embarrassed and my self esteem is so low 😔😔 I can’t wait for it to be gone