CEO Says More Nurses Won't Improve Care

[Nurse Beth]

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.

[guest52816]

27 minutes ago, klone said:

There are.

Who is in charge of enforcement?

Did you post that hospitals just pay the fines because it is cheaper?

Someone did.

I don't recall who, or which state.

Nurses need to march on the Capital city and demand stiff penalties for repeated non-compliance.

[guest52816]

21 minutes ago, Doris Carroll said:

I feel such frustration reading your comments. Yes. Like Cher in Moonstruck I want to slap them and say “ Snap out of it!” Because those who stand back, leave you hanging, kowtow to admin and/or complain are people who feel powerless. I’m told we need to educate—give them the tools to realize the power they have as long as we are unified. I then do continue to educate. Rarely do I see others step up. Those who believe unions are not professional— right. Go ahead and keep beating that dead horse. But I’ve found the brain drain, the emotional drain is taxing. I’ve rarely been the follower. And I have a big mouth. So I’m easily rattled by apathy. This is our time. I won’t want to hear 30 yrs from now that staffing remains the same. ??

I have a big mouth too.

There are no unions where I am.

[klone, MSN, RN]

5 minutes ago, Lil Nel said:

Who is in charge of enforcement?

Did you post that hospitals just pay the fines because it is cheaper?

Someone did.

I don't recall who, or which state.

Nurses need to march on the Capital city and demand stiff penalties for repeated non-compliance.

The Oregon Health Authority is in charge of enforcement. No, I did not say that hospitals just pay the fines because it's cheaper.

[guest52816]

On 4/11/2019 at 9:32 PM, klone said:

The Oregon Health Authority is in charge of enforcement. No, I did not say that hospitals just pay the fines because it's cheaper.

Thanks for all of your input.

You and Triciaj have valuable experience with this staffing system.

[guest52816]

Where I currently work, there is a staffing matrix.

That simply means that x number of patients, require x number of nurses.

No consideration of acuity.

No consideration of staff skill level.

When patients say to me: Oh, you are short staffed.

I tell them: No, according to the matrix, we have enough staff.

Of course, I educate them as to what the matrix is.

[klone, MSN, RN]

15 minutes ago, Lil Nel said:

Where I currently work, there is a staffing matrix.

That simply means that x number of patients, require x number of nurses.

No consideration of acuity.

No consideration of staff skill level.

When patients say to me: Oh, you are short staffed.

I tell them: No, according to the matrix, we have enough staff.

Of course, I educate them as to what the matrix is.

That's why I am in favor of an acuity-based staffing matrix, rather than a mandated set ratio. Because if you have a set ratio, THAT is what administration will focus on. "Sorry, your ratio is 6:1. That's what you get, period, end of story." But if you have a staffing plan that's based on patient acuity, there may be times when 6:1 is a completely inappropriate ratio, and it should be 5:1 or 4:1, because you have a patient who has higher needs and requires more intense care. An acuity-based staffing matrix, created with the input of the nurses who actually work with the patients, rather than legislators, makes more sense.

An example from my world - there are times when we could have 6 patients and require 2 nurses. There are times when we have 6 patients and require 7 nurses. Staffing only by ratios is completely inappropriate.

[guest52816]

20 minutes ago, klone said:

That's why I am in favor of an acuity-based staffing matrix, rather than a mandated set ratio. Because if you have a set ratio, THAT is what administration will focus on. "Sorry, your ratio is 6:1. That's what you get, period, end of story." But if you have a staffing plan that's based on patient acuity, there may be times when 6:1 is a completely inappropriate ratio, and it should be 5:1 or 4:1, because you have a patient who has higher needs and requires more intense care. An acuity-based staffing matrix, created with the input of the nurses who actually work with the patients, rather than legislators, makes more sense.

An example from my world - there are times when we could have 6 patients and require 2 nurses. There are times when we have 6 patients and require 7 nurses. Staffing only by ratios is completely inappropriate.

Well, if it actually worked, it would be good.

I had a med-surge job that had us chart on acuity, at the end of each shift.

Never mind that they NEVER staffed according to acuity!!!

So, I stopped charting the item. It was useless.

[Daisy4RN]

IMO the best approach would be a combination of the both. Mandated ratios in order to provide a maximum number of patients for a nurse, and also use appropriate acuity so any nurse would not need to have the maximum for highly acute patients. As others have pointed out, using acuity tools are not always enforced for various reasons, therefore start with mandated ratios and go from there. That way when admin plays with the acuity (and they do) you at least have the backup of ratios.

[klone, MSN, RN]

On 4/11/2019 at 10:18 PM, Lil Nel said:

Never mind that they NEVER staffed according to acuity!!!

That's the problem. Nothing is going to work, even mandated ratios, if the facility doesn't follow the law.

[Daisy4RN]

7 minutes ago, klone said:

That's the problem. Nothing is going to work, even mandated ratios, if the facility doesn't follow the law.

If the ratios are mandated by law then they have to follow the law. Acuity tools are not mandated by law, and even if they were they are very subjective thus easily manipulated.

[klone, MSN, RN]

7 minutes ago, Daisy4RN said:

If the ratios are mandated by law then they have to follow the law. Acuity tools are not mandated by law, and even if they were they are very subjective thus easily manipulated.

In Oregon, staffing the unit based on the unit's staffing plan (which was created by the nurses who work in that department and includes an acuity tool) is mandated by law. The acuity tool is filled out by the charge nurse each shift. And no, it's not subjective. Being on a critical drip, or requiring blood products on that shift, or having certain comorbidities, is not subjective.

[Daisy4RN]

1 minute ago, klone said:

In Oregon, staffing based on the staffing plan (created by the nurses who work in that department) is mandated by law. The acuity tool is filled out by the charge nurse each shift. And no, it's not subjective. Being on a critical drip, or requiring blood products on that shift, or having certain comorbidities, is not subjective.

I have filled out many of those tools and even though there are certain objective reasons for high acuity ( drips, blood, chemo etc) there are still some that are also subjective, thus easily manipulated. Just because they work in some places (if they do) doesnt mean they work in others.