[santhony44]

I haven't read the studies, but I wonder about a couple of things. Someone else mentioned one: what is the condition of the patients upon admission? Are they already malnourished, immobile, incontinent, etc.? Did the study look at the condition of each patient's skin upon admission and exclude those who already had signs of ulcer formation, not to mention those with frank ulcers?

Also, is there a high percentage of high fall risk patients in the studies?

Well, I suppose there would be the support staff issue, too, a third thing.

Saying that improving staffing hasn't improved patient care just seems to defy common sense, which reminds me of the old saying:
figures don't lie, but liars can figure.

[forrester]

Originally Posted by lindarn

They are getting rid of support staff because they know that any patient assignment will be difficult without them. They want to set you up to fail to "prove" that staffing ratios don't improve patient outcomes. What better way to prevent staffing ratios from being implemented in other states but "prove" through "studies" that more nurses taking care of fewer patients (and more expensive to hospitals- $$$) don't do what they set out to do. California is being watched by nurses and hospitals all over the country over the staffing ratios. If ratios "fail" in California, (i.e. don't improve patient outcomes), then nurses trying to implement ratios in other states, will fail in their attempt. That is the agenda of cutting support staff.
JMHO, and my NY $0.02.

Lindarn, RN, BSN, CCRN
Spokane, Washington

Very formidable opposiotion:
California Hospital Association
American Hospital Association
Most, if not all, hospital corporations
California Association of Nurse Executives (Chapter of AHA)
American Association of Nurse Executives
Most, if not all, hospital administrations and their affiliate organizations

Have I left anyone out?
Oh yes, maybe competing unions too, since they want to see CNA/NNOC fail.

Let's make sure the data is collected by, and evaluated by, academics without associaiton ties. We need good data interpreted well.

NNOC needs to stay on top of who is evaluating the data and releasing reports. Good to be proactive with this stuff.

[Julia RN]

Thought this was a pretty comprehensive document

http://www.dpeaflcio.org/programs/fa...staffratio.htm

[forrester]

I've looked at the study claiming increases instead of reductions in patient falls and bed sores since the staffing ratio laws went into effect in California, and have a few comments to make.
1) The authors mention that ancillary staff had also declined.
2) The authors noted that restraint usage had declined

Both of these factors can contribute to falls.

3) It is way too soon to be analyzing data on the effects of staffing ratios in California. I understand many facilities have been incompliance for less than a year.

4) Each one of these authors is a member of CALNOC, the California version of the American Organization of Nurse Executives with only their statistician not citing membership. This organization is a puppet of the American Hospital Association. Consequently, this article must be assumed to be biased until proven otherwise.

CNA/NNOC can anticipate more of these "anti-staffing laws" "research" to come out and needs to be prepared.

Nursing journals need to start printing author affiliations when publishing "research" on controversial issues. We have already seen the issue addressed by medical journals in reference to the drug studies.

I would advise everyone to criitically look at published research and make sure it is coming from credible universities...and even then, check the affiliations of the authors. Many academics also belong to the AONE and its affiliate chapters.

I say again, the AONE is a chapter of the AHA. Both groups have opposed nursing issues related to mandatory staffing ratios.
The AONE opposed the reform to the Kentucky River decision by the NLRB.
They have openly spread false stories about hospital closures due to the staffing law.
The AONE cannot be trusted to support working nurses, and its members cannot be trusted to present unbiased research (again, until proven otherwise).

[forrester]

Originally Posted by Julia RN

Thought this was a pretty comprehensive document

http://www.dpeaflcio.org/programs/fa...staffratio.htm

Thanks, it is good.
The UAN also has some good information on its web site, but falls short of calling for fixed staffing ratios. It copies the terminology of the ANA, which is too vague and lets these facilities off the responsibility hook.

With floors as busy as they are in most major facilities, and with the in and out nature of our healthcare system, expecting that patient acuity systems (not that there are any real ones) can deal with this is, well, assinine.

Trouble with the unions is that they deal only with THEIR facilities.
We need to start thinking nationally.
So far, the CNA/NNOC is the only group advocating for bedside nurses using the mechanism of state law.
Too bad the ANA doesn't have the wherewithall to do it this directly on the national level.
Seems they trust nurse executives to make those decisions...jokes on them...or is it us????

[herring_RN]

From the article: http://ppn.sagepub.com/cgi/content/abstract/8/4/238

For hospital-acquired pressure ulcers, there was approximately a 14% reduction in the total period of study (14.0% on medical-surgical units and 14.5% on step-down units); however, on medical-surgical units the means were essentially the same in 2002 and 2004, with a decrease only occurring in 2006.

Step-down units demonstrated an increase between 2002 and 2004, with a nonsignificant decrease in 2006 for any ulcers as well as any hospital-acquired ulcers.

The ratios became effective on January 1, 2004.
http://www.dhs.ca.gov/lnc/NTP/default.htm

Why did these administrators of nursing article give the impression they were implemented in 2002?

They are averaging from 2002 to 2006.

For hospital aquired pressure ulcers there was approximately a 14% reduction in pressure ulcers. Why did they not consider this significant?

In med-surg units the decrease was only from 2004 to 2006 AFTER the ratios I think this IS significant.

On step down units pressure ulcers increased from 2002 to 2004, the two years PRECEDING THE RATIOS and decreased from 2004 to 2006 AFTER the ratios.
Why is this "nonsignificant?

[santhony44]

I'm not a researcher, nor a statistician.

I thought, though, that the article at least implied that patients were very likely sicker after ratios than before. It also seemed to say that there was less support staff.

You can't just look at numbers of nurses and numbers of patients only. Any nurse who's ever practiced knows that's way too simplistic. I could have a patient assignment of six and spend half my shift sitting around with my feet up; you could have a patient assignment of six and be lucky to get to go to the bathroom. You have to look at the patients' ages, diagnoses, levels of functioning, meds, IVs, tests, your support staff, whether they are private or staff patients, etc etc etc. Lots and lots of variables here.

I guess I'm saying that I don't think this study showed much of anything, really.