I have enjoyed the discussion Wildtime and Charles about time studies and how they effect staffing levels. Both of you threw out some good information and made some good points. Nurses have got to be one of the most heavily studied professions on the planet! This comment by Charles especially rings true: "What most managers do not realize is that the staff (if honest)can tell them quite accurately what patients need in terms of staffing without having expensive time and motion studies."
Here's another type of study done to show the effect RN layoffs on patient care and hospital budgets:
Yale School of Nursing study highlights dangers posed to patients by RN layoffs
After a reduction in the registered nursing staff at an urban teaching hospital, patient falls increased substantially, and the hospital failed to realize any cost savings.
These findings emerge from an extensive study by Sharon Eck, a doctoral candidate at the Yale School of Nursing. Eck examined data from 19 units in the 800-bed hospital over a period ranging from six months before the change to two years after the hospital's reorganization. She reviewed staffing data, length of patient stay, patient falls, reports of medication errors and patient satisfaction surveys.
In the period when the hospital made the change to increased use of unlicenced personnel and reduced RN staffing, patient falls increased by 30 percent. They increased another 28 percent six months after the change before decreasing over time. Hospital patients often fall when they get up unassisted to go to the bathroom. Reporting of medication errors decreased sharply (55%) during the reorganization, then increased 67 percent six months later. Eck speculated that job insecurity may have caused under-reporting of errors during the reorganization, but acknowledged that the area needs further study.
Changes in the hospital's staff began in 1994. The reorganization design was never tested and analyzed in a health care setting.
"It's incomprehensible that we would make these kinds of changes in the way we care for very sick people without knowing if we would do harm," said Eck. "You wouldn't change the way you build bridges without testing a model. You would change the way you do air traffic control, the way you regulate emissions, and so on, without doing some study to test how the changes would work."
Eck added that different units showed different results, implying that a one-size-fits-all ratio of registered nurses to unlicenced personnel was not appropriate. "There's a difference between an obstetric unit, where a nurse is taking care of a generally healthy young woman, and a neurosurgical unit, where you have a 70-year-old man who has just had a stroke," said Eck.
The hospital labeled the staffing change "patient focused care" and predicted that a larger, unlicensed staff would be better able to give patients personal service and would thus result in greater patient satisfaction. But patient surveys showed no overall change in satisfaction.
The reorganization was also expected to reduce the cost of care, but did not. New expenses associated with the implementation of hospital redesign were estimated at $6.8 million. However, nursing costs did not decrease as a result. The study data do not clearly reveal why no cost savings arose. Eck raised the possibility that low morale and high turnover resulting from
the reorganization caused increased sick days, overtime and training expenses. She would like to do further work to test that hypothesis.
"Nurses have been studied extensively. We know that when nurses become dissatisfied with a health care organization, they walk," said Eck. "Part of the present nursing shortage can be linked to these kinds of radical changes."
The implications of the Yale School of Nursing study are that hospitals should do systematic measurement to evaluate their practices, that clinical innovations should be pilot tested, and that institutions should examine their organizational change policies.
In a relatively short period of time, the hospital decreased its nursing skill mix from 81 percent RN hours to 63 percent RN hours. The period of change was marked by dramatic increases in falls and increases in length of patient stay. Eck noted that the reduced force of registered nurses may have spent an increasing amount of their time supervising unlicenced personnel rather than providing patient care.