Nursing shortage, patient care

[billhogan]

I'm a journalist (not a nurse) who's working on a story about how older patients--and their family members and friends--can assess, in advance, the quality of nursing care at a hospital. I'd also like to offer some practical advice on what people can do to help the nursing staff and minimize the chances of medication mistakes or other problems during a hospital stay.

I'd be grateful for your help.

Merely as a discussion-starter, I offer an R.N.'s advice on improving a hospital stay, as reported in a recent issue of Consumer Reports: "My biggest piece of advice is to have someone with the patient to make those obnoxious demands."

Many, many thanks.

[-jt]

Some hospitals have report cards that you can review before choosing which hospital to go to. Some hospital report cards can even be found online. Most are pretty simple and dont tell you much though. The best way to assess the quality of a facility is to have state law that requires disclosure, and not many states do.

NY state has legislation pending, written by the NY State Nurses Assoc, that would require hospitals and nursing homes to disclose and report RN-to-patient staffing ratios and the actual mix of licensed and unlicensed personnel. The bill also calls for facilities to disclose information indicating the quality of nursing care, such as the incidence of hospital-acquired infections, patient falls, and pressure ulcers (bed sores) so that public knowledge of staffing practices will help put "market pressure" on facilities to make improvements. Needless to say, the hospital assoc is lobbying hard against that bill (wonder why?).

There is also a similar federal bill, put forth to Congress by the American Nurses Assoc, that would do the same on a national level - requiring this public disclosure of all states. The Patient Safety Act, (H.R.1804/S.863) would require health care institutions to make public specified information on RN staffing levels, staffing mix and patient outcomes. At a minimum, they would have to disclose to the public:

the number of registered nurses providing direct care;

numbers of unlicensed personnel utilized to provide direct patient care;

average number of patients per registered nurse providing direct patient care;

patient mortality (death) rate;

incidence of adverse patient care incidents (complications);

methods used for determining and adjusting staffing levels and patient care needs.

In addition, health care institutions would have to make public data regarding all complaints filed with the state agency, the Health Care Financing Administration or an accrediting agency related to Medicare conditions of participation. The agency would then have to make public the results of any investigations or finding related to the complaint.

Since recent studies have demonstrated a direct relationship between RN staffing levels and positive patient outcomes, this legislation is intended to allow consumers and researchers to have ready access to information on this issue and that would answer your question. But it should be of no surprise to know that this bill too is meeting strong resistance from the hospital assocs' lobbyists in DC.

Anybody who might ever be a pt or have a loved one in the hospital should contact their Congressman & Senator and demand they support that bill & pass it into law.

In the meantime, you can try calling the hospital and doctor and ask for their RN-to-pt staffing ratios, staffing mix, complication/infection rates, and all those other questions addressed in the bill. But if its not the law in your state that they have to disclose this info, you probably wont get a direct answer. This is not information hospitals want the public to be aware of.

You also asked us for "first hand experiences". On which issue?

[Zee_RN, BSN, RN]

First hand experience. Ratio on med-surg unit: 1RN, 9 Patients (1 nursing assistant who covers my 9 patients and another RNs 9 patients too):

Call bell ringsm, patient states: "Nurse, I'm having crushing chest pain!"

RN runs to nursing station to get the appropriate medication (sublingual nitroglycerin):

Family member of another patient standing in hall: "NURSE!!! NURSE!!!"

RN pauses: "Yes?"

Family member: "My mother needs more ice water now!"

RN: "I'm sorry, I'm dealing with an emergency right now, I'll be back as soon as I can."

Family member: "I don't care what you're dealing with, my mother deserves attention too!!"

RN: "I'm sorry, I'm dealing with an emergency right now." and runs back to chest pain room.

Family member files a complaint with management.