Bill would require nurse-to-patient ratios in Michigan hospitals

[herring_RN, ASN, BSN]

The Michigan Nurses Association joined Democratic lawmakers Monday in their push to make Michigan the second state to mandate hospital staffing levels, but hospital officials expressed concern the requirement could backfire due to higher costs.

Democratic Sen. Rebekah Warren of Ann Arbor and Rep. Jon Switalski of Warren recently introduced legislation that would require Michigan hospitals to develop and implement staffing plans and meet statewide minimum nurse-to-patient ratio requirements, depending on the type of patient.

The bills would, for example, require hospitals to have one nurse for every patient in critical care units and one nurse for every four patients in pediatric units. It also would ban mandatory overtime for nurses except in emergencies.

Dr. Laurence Rosen, a health care researcher at Public Policy Associates in Lansing, said research shows low nurse staffing levels are associated with higher death rates and can also cause patient complications such as blood stream infection and hospital induced pneumonia.

The Michigan Nurses Association agreed. It represents about 2,200 nurses and other health care professionals at Sparrow Hospital in Lansing, where nurse-to-patient ratios were inked in a 2010 employee contract and continued under an extension ratified last month. ...

http://www.lansingstatejournal.com/viewart/20130304/BUSINESS/303040053/Bill-would-require-nurse-patient-ratios-Michigan-hospitals

[SoldierNurse22, BSN, RN]

This would be awesome. By the time I got home, I could be seeing ratios similar to those I've had in the military if this passes!

[timmedico]

Of course it's a higher cost to hospitals...or perhaps the people who own these hospitals. This legislation would benefit all of us!

[SoldierNurse22, BSN, RN]

Of course it's a higher cost to hospitals...or perhaps the people who own these hospitals. This legislation would benefit all of us!

You're right--the out of pocket costs initially would be higher for hospitals in the sense of hiring and training more employees.

But long-term, the number of problems avoided (falls, infection, lawsuits, high turnover resulting in more money going to recruit/train new nurses, etc) by having adequate staffing more than makes up for the money shelled out for additional nurses/ancillary staff.

[Sugarcoma, RN]

I would love to see this happen. Michigan sorely needs it. The ratios at some area hospitals are absolutely outrageous for the acuity.

There was a similar bill proposed not too long ago, not sure whatever happened with that one. I am tired of being tripled in the ICU and still being expected to handle code/rapid calls. I was very tired of having 9 or 10 patient's on med-surg. Maybe this means we could have lunch breaks???? Dare to dream.

[Mully]

"The bills would, for example, require hospitals to have one nurse for every patient in critical care units..."

Maybe this is why the last one wasn't taken seriously.

[Anne36, LPN]

Wow, what about Long Term Care? Guess where all those patients with Picc lines and IV antibiotics are being discharged to? Figures there would be nothing in the bill about LTC. I'lll have 40 residents and about 5 of them suck up all my time so that I only have 60 seconds to spend on the other 35 that I do my med pass on and have no time to assess, or chart on unless an emergency comes up.

[Music in My Heart]

I work in California and hear stories from my colleagues about the pre-ratio days.

Now, we have floats cover lunches and close pods if we're understaffed, not just keep piling 'em on.

Unfortunately, the data regarding outcomes is ambiguous.

[30yearnurse4u]

This is a legal battle that no one should be involved with. California has had its share of very difficult circumstances with nursing unions. Hospitals of course see the expenses rise and when in collective bargaining, they are mandated, but are always trying to find a way out. However, the real situation still remains that they don't have enough nurses to make the ratios work. Then they bring in travel nurses, float pools, etc. The outcome of this is fragmented patient care. I see the solution as working hard at productivity studies which use actual nurse numbers. It takes some sophisticated process redesign, and most hospitals are not equipped through their nursing leadership knowledge to actually come up with floor by floor productivity systems. I even worked at a hospital where consultants had come in and done all the numbers. The CEO shelved the plan by putting all the data on a shelf, and nothing changed. Then the CEO went after everyone to do a better job at staffing. It is a difficult journey, this mandated ratio stuff. I simply wouldn't work in a state that mandates ratios, because your life as a nurse will be difficult - and nursing is difficult enough.

[Music in My Heart]

This is a legal battle that no one should be involved with. California has had its share of very difficult circumstances with nursing unions. Hospitals of course see the expenses rise and when in collective bargaining, they are mandated, but are always trying to find a way out. However, the real situation still remains that they don't have enough nurses to make the ratios work.

Simply not true... perhaps early on, but not now.

Then they bring in travel nurses, float pools, etc. The outcome of this is fragmented patient care.

I can only speak of the three hospitals I've worked at and four others locally of which I have inside knowledge... float pools, yes... travelers, no. Care is less fragmented than simply overwhelming the nurses with too many patients.

I see the solution as working hard at productivity studies which use actual nurse numbers. It takes some sophisticated process redesign, and most hospitals are not equipped through their nursing leadership knowledge to actually come up with floor by floor productivity systems. I even worked at a hospital where consultants had come in and done all the numbers. The CEO shelved the plan by putting all the data on a shelf, and nothing changed. Then the CEO went after everyone to do a better job at staffing.

I've significant experience in process control, resource allocation, and modeling and I've not seen any acuity based staffing model that provides sufficient flexibility, predictability, and accuracy... not to mention that any model can be ignored when staffing is low and the ratios can be arbitrarily set as management sees fit unless they're codified by contract or by law.

It is a difficult journey, this mandated ratio stuff.

Not for the staff nurses, it's not.

I simply wouldn't work in a state that mandates ratios

Your loss...

because your life as a nurse will be difficult

And how is that? I view my life as easier knowing that I will have no more than four patients... two if at least one is ICU. My life is made easier knowing that when I report off for lunch, tasks are still being completed. Regularly, labs are drawn, meds are given, new patients written up... whatever... the process keeps churning, it doesn't just build up while I'm gone because I'm being "covered" by someone who still has their own assignment.

While you wouldn't work in a state *with* mandated ratios, I wouldn't want to work in a state *without* them.

To each his/her own, I suppose.

[wanderlust99]

I work in CA and MANY hospitals do NOT follow the state laws about ratios or breaks. More commonly they follow ratio laws but not breaks, especially in southern California. This is my experience after working in 12 hospitals in CA as a traveler.

I still think the key is working for a good hospital. Even in states where there are no nurse to patient ratios, many hospitals still have a 1:4 rule that isn't broken.

CA is full of it.

[goalienrse]

Wow, what about Long Term Care? Guess where all those patients with Picc lines and IV antibiotics are being discharged to? Figures there would be nothing in the bill about LTC. I'lll have 40 residents and about 5 of them suck up all my time so that I only have 60 seconds to spend on the other 35 that I do my med pass on and have no time to assess, or chart on unless an emergency comes up.

LTC nurse in MI too.

I was thinking the same thing.