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CEO Says More Nurses Won't Improve Care

Nurses Article   (14,715 Views 141 Replies 1,332 Words)
by Nurse Beth Nurse Beth, MSN (Advice Column) Writer Innovator Expert

Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

15 Followers; 89 Articles; 228,477 Visitors; 1,838 Posts

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Illinois is poised to adopt safe staffing ratios even as a hospital CEO publicly puts profits before patients. Mark Gridley, CEO of FHN Memorial, thinks fewer nurses are better and claims that Illinois already has optimal staffing levels of registered nurses.

CEO Says More Nurses Won't Improve Care

The fight for safe patient staffing is being waged right now in Illinois. The Safe Patient Limits Act, HB 2604, which calls for safe nurse-patient ratios, will be voted on this week in Springfield, Illinois in the House of Representatives.

The bill requires:

  • One nurse for every four patients in Med Surg 
  • One nurse for every three patients in Stepdown, ED, or intermediate care units
  • One nurse for every two patients in ICU

If it passes, Illinois will be on its way to joining California as the only state with mandated safe staffing (nurse-patient ratios).

It won’t pass if the American Hospital Association (AHA), hospital CEOs, and even the American Nurses Association (ANA) have their way. Doris Carroll, Vice President of the Illinois Nurses Association, flatly states that “Not one CEO (in Illinois) is in favor of the safe staffing legislation”.  

It has a good chance of passing if Illinois nurses call their legislators (see below) today.

Mark Gridley, CEO of  FHN Memorial Hospital, raised the ire of Illinois nurses in a public statement opposing the bill. He used predictable arguments and unsubstantiated claims that are intended to mislead nurses and the public.

More Nurses Won’t Improve Patient Care

The CEO, who says that he worked as an LPN prior to becoming a CEO, declared that “increasing the number of nurses won’t improve care”.

Does Mr. Gridley really believe that fewer nurses result in improved care? At what ratio does he determine that "more nurses won't improve care"?  One nurse to six patients? One nurse to eight patients?

It has been proven over and over in the literature that lower ratios are associated with significantly lower mortality. 

It is concerning that evidence can be ignored in lieu of sweeping statements. Especially when rhetoric is valued over evidence by a hospital CEO.

There are Not Enough Nurses

According to the Illinois Center for Nursing Workforce Survey, there were 176,974 registered nurses in Illinois in 2016.

According to the federal Health Services and Resources Administration (HRSA), an agency of the US Department of Health and Human Services, 139, 400 registered nurses will be needed in Illinois by 2030.

HRSA projects an overage of registered nurses in Illinois, yet the CEO of Fairhaven hospital claims that Illinois has an “anticipated shortage of 21,000 nurses in 2020”.  

While different numbers and predictive models can be used to support different arguments, mandated safe staffing ratios in California not only improved staffing, it alleviated the severe nursing shortage at the time (Aiken,2010).

There’s Not Enough Money

Mark Gridley then states that staff would have to be cut in other areas. This is intended to frighten nurses, and perhaps to serve as a veiled warning, but it is unfounded. HB 2604 specifically prohibits cutting staff.

Dall and colleagues (2009) determined that ” hospitals with greater nurse staffing levels resulted in cost savings due to reductions in hospital-acquired infections, shorter lengths of stay and improved productivity”.  

Hospitals with a higher nurse-patient ratio that focus on retaining nurses have a competitive edge. Nurses report less burnout and job dissatisfaction when the quality of care is higher, as in hospitals with safe staffing ratios (Everhart, et al., 2013).

Staffing Committees Are All We Need

“Illinois already has laws...to ensure safe, optimum nurse staffing levels”, Mark Gridley.

Illinois nurses strongly disagree. Seven states, including Illinois, have legislation in place that requires hospitals to have staffing committees. Staffing committees are to include bedside nurses as well as management to create staffing plans specific to each unit. Staffing plans are to take into consideration:

  • Intensity of patient care
  • Admissions, discharges and transfers
  • Level of experience of staff
  • Physical layout of the unit
  • Availability of resources (ancillary staff, technology)

It sounds good in theory, and theory is where it remains. According to the ANA-Illinois, over 70% of nurses say the staffing plans are not being used. Nurses say that staffing committee meetings lack accountability, are hijacked by management, are not taken seriously, and serve as lip service only.

Hospitals with staffing committees are free to staff 1 RN for every 6-7 Med Surg patients, or 8, or however many they see fit.

Ratios Are Inflexible

Ratios are not inflexible. On the contrary, nothing in the Safe Patient Limits Act precludes the use of patient acuity systems and nothing precludes a facility from assigning fewer patients that the Act requires.

As an example of how flexible ratios are,  a Med Surg nurse in a mid-sized CA hospital who is assigned a patient with continuous bladder irrigation will only have 3 patients, even though ratios call for 5 patients. Ratios are not inflexible unless  hospital administrators want them to be.

It would be interesting to know the staffing assignments at FHN Memorial, and for Mark Gridley to give examples of the staffing flexibility in his facility.

Hospitals Will Close or Reduce Services

Critics say hospitals will close or reduce services.

Acquisitions, takeovers, mergers and closures are taking place in all of the 49 states that do not have mandated nurse-patient ratios. Hospitals all over the country have merged or closed due to decreased reimbursement and low patient volume, for example, a 25-bed hospital in Celine, TN, that recently closed on March 1, 2019.

According to Linda Aiken  “There is no evidence that hospitals closed as a result of the legislation (in California).  Indeed, there is very good scientific evidence that staffing improved even in safety-net hospitals that long had poor staffing.”

Consider this- if the surgery department had surgeries scheduled but didn’t have adequate nursing staff, should they cancel cases? The answer is yes. Only safe services should be provided.

Illinois nurses, the time to speak up is today. If you are reading this, call your legislator now. Leave a voicemail. You are a constituent, and your opinion matters.

Call to Action

The Illinois Who is your State Rep? Follow this link and enter your address information into this link: https://bit.ly/2FtE2A3.  

Here is a script (thanks to Doris Carroll):

Hello Representative _________,

My name is ___________,

I have been a constituent in your district for ___ years. I’ve been a nurse for ___ years.

I am calling today to ask that you please vote Yes on the Safe Patient Limits act, House Bill 2604, which ensures that there is a maximum number of patients any one nurse can be assigned depending on her unit. Unsafe staffing costs patients their lives. Please put patients over profits. Please Vote Yes on HB 2604!

References

Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L., Seago, J. A., ... & Smith, H. L. (2010). Implications of the California nurse staffing mandate for other states. Health services research, 45(4), 904-921.

Dall T, Chen Y, Seifert R, Maddox P, Hagan P. The economic value of professional nursing. Medical Care. 2009;47(1):97–104. [PubMed] [Google Scholar]

Everhart, D., Neff, D., Al-Amin, M., Nogle, J., & Weech-Maldonado, R. (2013). The effects of nurse staffing on hospital financial performance: Competitive versus less competitive markets. Health care management review, 38(2), 146.

U. S. Department of Health and Human Services, Health Resources and Services Administration (201) Supply and Demand Projections of the Nursing Workforce:2014-2030.

 

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

15 Followers; 89 Articles; 228,477 Visitors; 1,838 Posts

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3,721 Visitors; 459 Posts

Good luck! It didn't pass in Massachusetts!

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klone has 13 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

3 Followers; 114,280 Visitors; 13,219 Posts

9 hours ago, Nurse Beth said:
If it passes, Illinois will be on its way to joining California as the only state with mandated safe staffing.

This is an incorrect statement. Oregon has mandated safe staffing laws, and has for 2 years. The difference is that Oregon's laws don't mandate specific numbers, but rather require that every hospital has a staffing council comprised of STAFF NURSES, wherein THEY determine what safe staffing looks like in each department, and then the facility is mandated to follow the staffing policies set by the staffing council.

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Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

15 Followers; 89 Articles; 228,477 Visitors; 1,838 Posts

16 minutes ago, klone said:

This is an incorrect statement. Oregon has mandated safe staffing laws, and has for 2 years. The difference is that Oregon's laws don't mandate specific numbers, but rather require that every hospital has a staffing council comprised of STAFF NURSES, wherein THEY determine what safe staffing looks like in each department, and then the facility is mandated to follow the staffing policies set by the staffing council.

Correct, I will change the language to say "only CA has mandated nurse-patient ratios". 

Oregon has Staffing Committees which, when run as intended, allow nurses to have a say in staffing plans. Unfortunately, in the 7 states with Staffing Committees, the committees are typically weak and subject to over ride by members who are managers or admin.

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klone has 13 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

3 Followers; 114,280 Visitors; 13,219 Posts

Oregon's staffing laws require that an equal number of staff nurses and managers must be present to vote on all staffing plans or other issues that require a vote. So, per the laws, it's not possible for management to override the staff nurses or take over the committee.

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Nurse Beth has 30 years experience as a MSN and specializes in Med Surg, Tele, ICU, Ortho.

15 Followers; 89 Articles; 228,477 Visitors; 1,838 Posts

43 minutes ago, klone said:

Oregon's staffing laws require that an equal number of staff nurses and managers must be present to vote on all staffing plans or other issues that require a vote. So, per the laws, it's not possible for management to override the staff nurses or take over the committee.

That is great, I wonder what the difference is Illinois and other states that it doesn't work. It seems Oregon's law is very structured with reporting requirements if hospitals do not follow their staffing plans, is that right?

What kind of staffing do you see on Tele floors?

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Daisy4RN has 20 years experience and specializes in Travel, Home Health, Med-Surg.

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I hope for the sake of patients and nurses in Illinois this passes. It wont make things perfect but it is a step in the right direction. I was in California when ratios were implemented and while some hospitals did decrease other ancillary staff, and did (and still do) play with acuity it still was better for nurses, less patients to prioritize so better care and less stress. Also, if I remember correctly there was a phase in so hospitals had time to hire more nurses without it being a problem. There are still problems IMO with too many middle management (or CEO's like Emergent states) but still better. I have been on, and heard from others, that those staffing committees dont always work because staff nurses are either afraid to speak out (for fear of retribution), or bc of quid pro quo reasons. Mandated ratios are the only way to go as a first step. I still wonder why they didn't, and still haven't, included LTC/SNF's!

PS: I cant believe what a weasel that CEO is!!

Edited by Daisy4RN
PS

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morelostthanfound has 27 years experience as a BSN and specializes in CVOR, General/Trauma Surgery.

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Just a lot of hot air and fear mongering from another stuffed shirt, company 'yes man' administrator who is worried that his enormously inflated salary and benefits package may be cut or he may have to trim his deadwood support staff like the assistant to the assistant CEO, or the assistant to the assistant to the assistant CEO...

Edited by morelostthanfound

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Emergent has 25 years experience.

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47 minutes ago, Daisy4RN said:

 

PS: I cant believe what a weasel that CEO is!!

I can't believe that you can't believe that!!! 🙀

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OUxPhys has 4 years experience as a BSN, RN and specializes in Cardiology.

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Hospitals wont call true stepdown units “stepdowns” so they dont have to enforce a 3:1 ratio.

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klone has 13 years experience as a MSN, RN and specializes in Women's Health/OB Leadership.

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1 hour ago, Nurse Beth said:

That is great, I wonder what the difference is Illinois and other states that it doesn't work. It seems Oregon's law is very structured with reporting requirements if hospitals do not follow their staffing plans, is that right?

What kind of staffing do you see on Tele floors?

The state surveys all the hospitals annually to make sure they're in compliance with the laws and the hospital staffing plans. It's an incredibly detailed, lengthy, arduous survey, from which no hospital has survived unscathed thus far. 

As an example, if a department's staffing plan states that there is no more than a 5:1 ratio, and a nurse goes on break, she needs to have someone without a patient assignment watch her patients for that 15 or 30 minute period. She can't have a "break buddy" who watches her patients for her, because then that nurse is actually responsible for 10 patients for that 15-minute time period, which is in violation of the staffing plan. If you google "Oregon nurses break buddy" you can probably read news articles about it. Several hospitals were cited for using the "break buddy" system.

I can't answer your question about staffing on anything other than OB, sorry!

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