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.

[klone, MSN, RN]

16 minutes ago, Daisy4RN said:

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.

To what advantage would the floor nurses manipulate the acuity tool? I mean, they would just be screwing themselves, no? It's not like you have the CEO or the finance person filling it out. It's filled out by the nurses working on the floor.

[Doris Carroll, BSN]

2 hours ago, Lil Nel said:

I have a big mouth too.

There are no unions where I am.

I’ll find one for you. Really.

[Doris Carroll, BSN]

1 hour 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.

And no one here in Illinois is saying that. Acuity and ratios. We have the Acuity law which needs MUCH strengthening. And now we are attempting to pass the ratios legislation. Please. Be informed. I am a former L&D RN. I see how administrators manipulate in a state with an Acuity staffing law in place for over 10 yrs.

[umbdude, MSN, APRN]

I haven't read all the replies, but I just want to say how disgusted I am with the ANA (actually, most organized nursing associations including AANP and regional NP associations). These organizations sided with the hospital and physician organizations to kill the patient safety bill in MA, and then went on with their BS's about patient safety.

AANP only focuses on PR campaigns and pumping out thousands of NPs annually from diploma mills regardless of quality. My local NP association wants FPA but has zero agenda on improving the sub-par NP education phenomenon.

I'm not a member of any of these organizations.

[Daisy4RN]

44 minutes ago, klone said:

To what advantage would the floor nurses manipulate the acuity tool? I mean, they would just be screwing themselves, no? It's not like you have the CEO or the finance person filling it out. It's filled out by the nurses working on the floor.

I have seen those acuity tools manipulated by the people who make them by taking reasons off (blood is no longer a reason for high acuity etc), by not adding reasons that should be on the tool to begin with (psych pt on PCU, PITA, things that require much time etc), and by some charge nurses in an attempt to appease management. They do not always work!!

[Nunya, BSN]

On 4/9/2019 at 5:43 PM, morelostthanfound said:

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...

Yes, follow the money. On Glass Door RNs are paid $31/hour, LPNs $16. CNAs and Patient Care Techs $10-11. Not that I think they'll hire more LPNs, CNAs or PCTs but RNs are way more expensive. I'll bet a thousand dollars if he or his family were in the hospital he'd rather have a nurse who had 3 other patients as opposed to 5 or 6. IT'S ALL ABOUT THE MONEY!!

[Nunya, BSN]

On 4/10/2019 at 10:22 AM, RobbiRN said:

I read Mark Gridley's April 6 statement referenced in this article.

He asserts: "According to many evidence-based studies, there is no conclusive evidence that staffing ratios improve quality or patient outcomes."

Really? Then why not just set your patient to nurse ratio at 50:1? You could use the extra money to hire a couple more suits with clipboards to track your five nurses' activity to make sure they are all working in compliance. You could also give yourself a bonus.

Next, Gridley argues: "Illinois already faces a severe nursing shortage and does not have enough nurses in the state today to meet the proposed mandates."

A shortage means we need more, not less, Mr. Gridley. Google the word "shortage."

He adds: "I speak from personal experience; I was a Licensed Practical Nurse for many years and understand the concerns and challenges of providing quality bedside care in a wide variety of settings and situations, to an even wider diversity of patients."

How long ago were you an LPN, Mr. Gridley? Was it before the last decade exploded the clutter and complexity of getting even the simplest tasks accomplished? Did you ever try going 12:1 on a medical unit while covering another nurse during her one thirty-minute break during a twelve hour shift? Did you ever work 6:1 in an ER with a STEMI, a CVA, and an unresponsive overdose all tossed into your mix within twenty minutes? When was the last time you did one of those "undercover boss" days, put on some scrubs, and tried to keep up with a real nurse for twelve hours?

He hasn't worked as a LPN since at least 2005 per LinkedIn...can't post both SS but was an administrator at Aurora Health Care from 05-10.

[traumaRUs, MSN, APRN]

7 hours ago, umbdude said:

I haven't read all the replies, but I just want to say how disgusted I am with the ANA (actually, most organized nursing associations including AANP and regional NP associations). These organizations sided with the hospital and physician organizations to kill the patient safety bill in MA, and then went on with their BS's about patient safety.

AANP only focuses on PR campaigns and pumping out thousands of NPs annually from diploma mills regardless of quality. My local NP association wants FPA but has zero agenda on improving the sub-par NP education phenomenon.

I'm not a member of any of these organizations.

I do agree with you on some points. However, if you don't speak up, join the organizations that are strong political action groups in your state then what result do you expect?

[guest52816]

On 4/11/2019 at 11:32 PM, Doris Carroll said:

I’ll find one for you. Really.

I am located in central KY.

Tell me which hospital here has a union.

I would apply at that hospital.

[RNMgrSarah]

I have lived in Jefferson county and now western KY. Pretty sure there is no hospital that has a nursing union in it besides the VA system.

[Doris Carroll, BSN]

On 4/12/2019 at 11:33 AM, RNMgrSarah said:

I have lived in Jefferson county and now western KY. Pretty sure there is no hospital that has a nursing union in it besides the VA system.

What I mean is if nurses are ready to organize, if you have 20 nurses representing different units in the hospital, who are ready to work hard to talk to their colleagues, what union representation can give you , then >50% of your staff willing to sign union cards, then you’re ready to bring a union in. Because a union is not the staff but it’s the nurses in that hospital who are the union. It means working to step out of your normal comfort zone to make it happen. Union staff can teach you the tools. But it’s you who must collectively push each other to get improved work conditions, etc. Yes it’s difficult. But it can happen.

On 4/12/2019 at 10:56 AM, Lil Nel said:

I am located in central KY.

Tell me which hospital here has a union.

I would apply at that hospital.

[guest52816]

On 4/12/2019 at 11:51 AM, Doris Carroll said:

What I mean is if nurses are ready to organize, if you have 20 nurses representing different units in the hospital, who are ready to work hard to talk to their colleagues, what union representation can give you , then >50% of your staff willing to sign union cards, then you’re ready to bring a union in. Because a union is not the staff but it’s the nurses in that hospital who are the union. It means working to step out of your normal comfort zone to make it happen. Union staff can teach you the tools. But it’s you who must collectively push each other to get improved work conditions, etc. Yes it’s difficult. But it can happen.

Okay. I get what you are saying.

However, I would be hard pressed to find 20 at my facility, who would be willing to step out and take action.

They are similar to triciaj's coworkers.

Willing to allow YOU to step out, but they themselves will cower in the corner.

It would be far easier, I think to organize nurses from around the state, to back legislation.