Hospital industry seminars advise administrators how to evade RN ratios

Selected sections from this DHS “Final Statement of Reasons”

http://www.applications.dhs.ca.gov/r...1=Begin+Search

In October of 2002 Linda Aiken, PhD, RN et. al. published a study in the Journal of the American Medical Association entitled “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction”. The study was designed to determine the association, if any, between nurse-to-patient ratios and risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, as well as nurse-reported job dissatisfaction and job-related burnout (Exhibit V-2). (“Failure-to-rescue” refers to the licensed nurse’s failure to respond quickly and intervene effectively when patients (in this study, post-surgical patients) begin to develop signs and symptoms of serious complications. Failure to rescue, then, results in increased patient mortality.) The likelihood of failure-to-rescue was expressed as odds ratios (ORs), after patient and hospital characteristics were controlled for. The study concluded that the OR of failure-to-rescue was sizeable and significant, indicating that the odds of patient mortality increased by 7% for every additional patient in an average nurse’s workload and that the difference from 4 to 6 and from 4 to 8 patients per nurse would be accompanied by 14% and 31% increases in patient mortality, respectively. The study concluded, “If the staffing ratio in all hospitals was 8 patients per nurse rather than 6 patients per nurse, we would expect 2.6 additional deaths per 1000 patients and 9.5 additional deaths per 1000 patients with complications….Our results do not directly indicate how many nurses are needed to care for patients or whether there is some maximum ratio of patients per nurse above which hospitals should not venture. Our major point is that there are detectable differences in risk-adjusted mortality and failure-to-rescue rates across hospitals with different registered nurse staffing ratios.” The study also showed that nurses who worked in hospitals with the highest nurse-to-patient ratios were more than twice as likely as nurses who worked at lower ratios to report burnout and job dissatisfaction, and four times as likely to report that they intended to leave their current jobs within one year. If that increase in stated intentions truly resulted in resignations, given the high (and steadily increasing) cost of replacing nursing staff, then improving staffing may not only prevent patient deaths but may also improve staff retention and decrease hospital costs.

The positive impact of changes in workload on the nursing workforce was recently demonstrated in the state of Victoria, Australia. After intense lobbying and political pressure from the Australian Nurses Association, the Victorian Ministry for Health, which is responsible for the operation of acute care hospitals there, adopted the union-backed nurse-to-patient ratios effective December 1, 2000. For medical/surgical units, those ratios varied from 1:4 to 1:6, with more patients permitted on the night shift; for emergency departments the ratio was 1:3 at all times, and the triage and charge nurses were not counted in the ratios. The Victorian government also committed to--and funded--re-entry and refresher programs for nurses who wished to return to the workforce, as well as a vigorous advertising recruitment campaign. In addition, Victoria mandated a 12.5% pay increase over three years, paid study leave, and financial rewards based on education. The results were impressive. In 1999, Victoria’s hospitals had approximately 20,000 full-time equivalent nursing positions, with 1300 of those positions vacant. By October, 2001, there were an additional 2650 full-time equivalent nurses employed in Victoria’s hospitals—half filling the vacancies and the other half to staff up to meet the ratios (Exhibits J, K, and L).

Are you saying that the AHA classes were not how to avoid obeying the law?
They were about how it is impossible to comply?

I remember when our RN staffing was cut in half. We were told to 'trust' the unlicensed personnel.
We were told to embrace change!
Think outside the box!

Why not rise to the challenge?

Do nurses get cancelled for low census days or sent home early?

“If the staffing ratio in all hospitals was 8 patients per nurse rather than 6 patients per nurse, we would expect 2.6 additional deaths per 1000 patients and 9.5 additional deaths per 1000 patients with complications..." From the NEJM article by Dr. Linda Aiken.

Not enough nurses? Come on, be positive. It is a new day in the 21st century! Lets make hospitals safe for patients!