California's Nurse-to-patient Ratio Law -- Update

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You are reading page 5 of California's Nurse-to-patient Ratio Law -- Update

Gomer

415 Posts

Spacenurse, I predict that beds/units/maybe hospitals will close if this bill passes. I may be wrong, but we shall see in a few months how this economical effects Calif. healthcare.

pickledpepperRN

4,491 Posts

Too bad if the richest country in the world and California with the fourth largest economy in the world cannot afford to staff safely.

Any chance the Insurance industry (with the BIG) buildings and ZERO caregivers has anything to do with it?

Maybe those CEOs $$$ taken from our tax and insurance payments have something to do with it.

How is the California economy at this time?

New York State Nurses Association

REPORT: December 2002

Study Shows Inadequate RN Staffing Harms Patients

by Anne Schott

In hospitals where RNs had to care for more than four patients, mortality rates rose significantly, according to a new study published in the Journal of the American Medical Association. Each additional patient a nurse had to care for led to a seven percent increase in the likelihood the patient would die within 30 days of admission. Patients of a nurse caring for six patients had a 14% greater chance of dying, and patients of a nurse caring for eight patients had a 31% greater chance of dying.

"These numbers are alarming when you recognize that nurses are routinely required to care for eight seriously ill patients," said NYSNA Deputy Executive Director Tina Gerardi. "Hospitals that have accused nurses of exaggerating and described their complaints about poor staffing as merely "anecdotal" need to open their eyes. A growing body of research is now substantiating exactly what nurses have been saying. Poor staffing puts patients at risk."

Staffing Affects Burnout -

The study also found that as the nurse's workload rose, job dissatisfaction and burnout rose as well. An increase of just one patient per nurse increased burnout by 23% and job dissatisfaction by 15%. Forty-three percent of the nurses studied had high burnout scores, and a similar proportion was dissatisfied with their current jobs.

Citing an earlier study, the researchers report that 40% of hospital nurses have burnout levels above the norms for health care workers in general, and that job dissatisfaction among hospital nurses is four times greater than the average for all US workers. One in five hospital nurses say they plan to leave their current jobs within a year. No wonder there's a nursing shortage.

The consequences of poor staffing radiate beyond patients and nurses. The researchers cite recently published figures that show replacing a medical/surgical nurse costs $42,000 and replacing a specialty nurse costs $64,000. "The heavy workloads that lead to nurse dissatisfaction and burnout are not only exacerbating the nursing shortage." Gerardi said. " They are also wasting precious healthcare dollars. It makes no sense to over burden nurses and drive them from the profession, when it is both difficult and expensive to replace them."

Thousands of Patients Studied-

To arrive at their results, researchers at the University of Pennsylvania, led by Linda Aiken, studied 232,342 general, orthopedic, and vascular surgery patients and 10,184 staff nurses at 168 Pennsylvania hospitals.

They examined risk-adjusted surgical mortality rates and rates of "failure-to-rescue," which is defined as deaths in patients who develop serious complications. The study controlled for hospital characteristics of size, teaching status, and technology. Patients in the study were discharged from the hospital between April 1, 1998 and November 30, 1999.

Research Receives Wide Publicity -

Newspapers across the country reported on this study, which is just the latest addition to a growing body of data that links RN staffing to patient outcomes. In an editorial, The New York Times suggested that "hospitals report their patient-nurse ratios so that prospective patients can decide where to take their chances." Since 1997 NYSNA has been lobbying for legislation that would require hospitals to disclose their patient-nurse ratios, a measure strongly opposed by the hospital industry. The full text of the research study is in the Journal of the American Medical Association, October 23/30, 2002; or on the Web: http://www.jama.com.

http://www.NYSNA.org

pickledpepperRN

4,491 Posts

Nurse-Staffing Levels and the Quality of Care in Hospitals

Jack Needleman, Ph.D., Peter Buerhaus, Ph.D., R.N., Soeren Mattke, M.D., M.P.H., Maureen Stewart, B.A., and Katya Zelevinsky

ABSTRACT

Background

It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die.

Methods We used administrative data from 1997 for 799 hospitals in 11 states(covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients'outcomes. We conducted regression analyses in which we controlled for patients' risk of adverse outcomes,

differences in the nursing care needed for each hospital's patients and other variables.

Results The mean number ofhours of nursing care per patient-day was 11.4, of which 7.8 hours were provided by registered nurses, 1.2 hours by

licensed practical nurses, and 2.4 hours by nurses' aides.

Among medical patients, a higher proportion of hours of care per day provided by registered nurses and a greater absolute number of hours of

care per day provided by registered nurses were

associated with a shorter length of stay (P=0.01 and P

respectively) and lower rates of both urinary tract infections (P

respectively) and upper gastrointestinal bleeding

(P=0.03 and P=0.007, respectively).

A higher proportion of hours of care provided by registered nurses was also associated with lower

rates of pneumonia (P=0.001), shock or cardiac arrest(P=0.007), and "failure torescue," which was defined as death from pneumonia, shockor cardiac arrest, upper gastrointestinal bleeding, sepsis, or deep venous thrombosis (P=0.05). Among surgical patients, a higher proportion of care provided by

registered nurses was associated with lower rates of urinary tract infections (P=0.04), and a greater number of hours of care per day provided by registered nurses was associated with lower rates of

"failure to rescue" (P=0.008).We found no associations

between increased levels of

staffing by registered nurses and the rate of in-hospital death or between increased staffingby licensed practical nurses or nurses' aides and the rate ofadverse outcomes.

Conclusions. A higher proportion of hours of nursingcare provided by registered

nurses and a greater number ofhours of care by registered nurses per day are associated

with better care for hospitalized

patients.

Source Information

From the Department of Health Policy

and Management, Harvard School of

Public Health, Boston (J.N., S.M., M.S.,

K.Z.); the School

of Nursing, Nashville (P.B.); and Abt

Associates, Cambridge, Mass. (S.M.).

Address reprint requests to Dr.Needleman at the Harvard School of Public Health, Department of Health Policy and Management, Rm. 305, 677

Huntington Ave., Boston, MA 02115, or

at [email protected].

pickledpepperRN

4,491 Posts

Shortage article:

http://www.revolutionmag.com/engineering.html

"Just as the industry has created this crisis, it can help to resolve it. The industry can do its part to alleviate the RN

shortage by adopting in word and practice a few simple principles:

* Value patients as human beings and not as "covered lives."

* Rather than expending resources fighting RNs and patients on safe staffing ratios, use those resources to

enhance the ratios. The market is not able to set ratios that are safe for patients or that will assure

adequate numbers of RNs.

* Trust in the professional judgment and skills of the bedside nurse to advocate for the patient.

* Terminate all contracts with management consultant deskilling programs and invest those hundreds of

millions into preventative care and improving nurse-to-patient ratios.

* When RNs testify that many health care restructuring programs are a form of patient endangerment -

listen.

* Accept that a profession dominated by women can and should earn a living wage commensurate with

skills and dedication.

* Promote direct caregiver role models as opposed to nurse executive models. The archetypal nurse

executive may appeal to an MBA student but is decidedly less appealing to those who value nursing as a

noble and hands-on calling.

* Adopt RN work schedules that allow RNs some semblance of a normal life.

* Provide RNs with adequate retirement and health benefits.

* Provide increased funding for RN scholarships.

* Expand educational and training opportunities for generalist RNs to learn specialty skills, and for LPNs,

LVNs and aides to become RNs.

* Work with nursing unions on projects to develop new programs for the future of nursing.

Most importantly, do whatever it takes to restore the traumatic loss of RN faith in the industry that they see as

having forsaken both them and their patients in the pursuit of private wealth over and above public health.

That trust must be earned. It cannot be purchased with sign-on bonuses and certainly not with broken promises.

The path back to that lost trust will be difficult. Common decency, an industry reaffirmation of the centrality of

patient health in its mission and a commitment to the nursing profession that has made the industry one of the

wealthiest in the nation demand it. "

pickledpepperRN

4,491 Posts

Originally posted by Gomer

Spacenurse, I predict that beds/units/maybe hospitals will close if this bill passes. I may be wrong, but we shall see in a few months how this economical effects Calif. healthcare.

That is what the Healthcare Association and Organization of Nurse Leaders say. They are the union for the hospital industry.

http://www.calhealth.org/calanswers/

California Healthcare Association

MEDIA STATEMENT

January 22, 2002

California Hospitals Remain Committed to Providing Appropriate Nurse Staffing to Meet

Needs of Patients

Proposed Nurse Ratios Add Focus to Nursing Shortage,

Financial Pressures on Hospitals

C. Duane Dauner

President

California Healthcare Association

Governor Gray Davis today released a set of proposed nurse staffing ratios, as required by state law (AB 394, 1999). The

proposed ratios are the first-ever attempt by any state in the nation to establish a predetermined ratio of nurses to patients in

the various services of acute-care hospitals. These proposed ratios will be subject to the normal state regulatory process.

This process will involve numerous opportunities for public input.

The Governor's announcement represents more than two years' of work by the state Department of Health Services (DHS),

which was charged with developing the proposed ratios. DHS' efforts were far from easy, since research on staffing ratios is

limited.

California's hospitals already do whatever is necessary to provide adequate nurse staffing to meet the needs of their

patients. This includes staffing based on the acuity of the patients' condition, innovative recruitment and retention efforts, and

the use of nurse registries and traveling RNs. Whatever staffing standards are ultimately adopted following the regulatory

process, California's hospitals will comply with the new law.

However, because we face the most serious nursing shortage in the nation, some hospitals may have to shut down some

services or significantly reduce the capacity of their services in order to comply with the law. Statewide, California hospitals

currently are operating with a more than 15 percent RN vacancy rate - meaning that more than one out of every 6 nursing

positions in hospitals is not filled with regular hospital employees. Nurse registry and traveling nurses are used to fill the

gap.

California hospitals are under severe financial stress. Nearly two out of every three hospitals lose money on operations.

Manufacturing money to pay for more nurses is not possible, and the continual ratcheting down of payments to hospitals by

government agencies and private payors is making the situation even worse. Several California schools of nursing have

closed or cut back their enrollment, thereby reducing the number of nurses who are available. With an average age of 47

years, the California RN workforce is headed for disaster.

Once the proposed staffing ratios are in effect, the nursing shortage may become even more acute and access to patient

care services may be jeopardized. For example, if a hospital has 10 treatment bays in its Emergency Department (ED) but

only has enough nurses to staff five of those beds and be in compliance with the law, half of the hospital's ED capacity may

have to be taken out of service. The net result would be less access to emergency care services in a local community.

The California Healthcare Association (CHA) has consistently maintained that it is in the best interest of patients to base

staffing decisions on the actual needs of patients at any given time. Patients' conditions often change by the hour, and

hospitals face a continual turnover of patients with diverse medical needs, all of which impact staffing requirements.

Hospitals have deployed nurses on this basis for more than a decade.

CHA will analyze the proposed nurse staffing ratios released today and will comment and provide input to DHS officials

throughout the regulatory process. Contact: Jan Emerson, (916) 552-7516.

Home | Nurse Staffing Ratios | Cost to Hospitals

© Copyright California Healthcare Association 2001. A

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pickledpepperRN

4,491 Posts

The letter that lead to the lawsuit that lead to this thread, ( that died in the house that greed built).

http://www.calhealth.org/calanswers/

August 2, 2000

Brenda Klutz

Deputy Director

California Department of Health Services

Post Office Box 942732

1800 - 3rd Street, Suite 210

Sacramento, California 94234-7320

Dear Brenda:

As the California Healthcare Association (CHA) and Association of California Nurse Leaders (ACNL) attempt to provide recommendations regarding the implementation of AB 394 and nurse staffing ratios, we continue to have significant concerns about the lack of statistically significant data on which to base our recommendations. To date, there are no studies that define or suggest appropriate ratios.

The California Nursing Outcomes Coalition (CalNOC) is currently engaged in a process that correlates patient falls, skin ulcers and satisfaction with skill mix and hours per patient day (HPPD). CalNOC has the largest database and is the only real-time project of this kind. In the near future, it will have the ability to scientifically determine if HPPD and skill mix actually affect outcomes. Considering the enormous implications nurse-to-patient ratios will have on hospitals, the workforce, and the health care provided to the citizens of California it would be our suggestion that the department delay implementation of AB 394 until CalNOC can provide evidence based on data relative to nurse/patient ratios. Recognizing that AB 394 demands implementation by 1/1/01, which will most likely be changed to 1/1/02, we suggest a process that would provide for additional decisions to be made once the data is available. This will allow staffing to be based on factual information.

Enclosed, please find recommended standardized definitions, minimal ratios and related information. We look forward to discussing our proposal with the Department.

Thank you for your consideration of our proposal.

Sincerely,

C. Duane DaunerPatricia McFarland, MS, RN

PresidentExecutive Director

California Healthcare AssociationAssociation of California Nurse Leaders

CDD/DFH:jj

Attachments

cc: The Honorable Sheila Kuehl

Susan Kennedy

Diana M. Bontá, R.N., Dr.PH

Gina Henning

http://www.calhealth.org/

http://www.calhealth.org/public/chpac/index.html

pickledpepperRN

4,491 Posts

Ventilator related death or permanent brain and/or kidney damage is reportable to the JCAHO.

It is one "Failure to Rescue" attributed to competence and staffing. Below is part of their report:

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PARTIAL REPORT FROM THE JCAHO:

Preventing ventilator-related deaths and injuries

As of January 2002, the Joint Commission has reviewed 23 reports of deaths or injuries related to long term ventilation--19 events resulted in death and four in coma. Of the 23 cases, 65 percent were related to the malfunction or misuse of an alarm or an inadequate alarm; 52 percent were related to a tubing disconnect; and 26 percent were related to dislodged airway tube. A small percentage of the cases were related to an incorrect tubing connection or wrong ventilator setting. None of the cases were related to ventilator malfunctions. As the percentages indicate, ventilator-related deaths and injuries are often related to multiple failures that lead to negative outcomes. The majority of the cases occurred in hospital Intensive Care Units (ICUs), followed by long term care facilities and hospital chronic ventilator units.

Root causes

Root cause analysis of the 23 cases reveals the following contributing factors:

Staffing

Inadequate orientation/training process87 percent

Insufficient staffing levels35 percent

Communication breakdown

Among staff members70 percent

With patient/family9 percent

Incomplete patient assessment

Room design limits observation30 percent

Delayed or no response to alarm22 percent

Monitor change not recognized13 percent

Equipment

Alarm off or set incorrectly22 percent

No alarm for certain disconnects22 percent

Alarm no audible in all areas22 percent

No testing of alarms13 percent

Restraint failure (escape)13 percent

Distraction (environmental noise)22 percent

Cultural (hierarchy/intimidation)13 percent

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