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.
herring_RN, ASN, BSN
3,651 Posts
In California even the hospitals with greedy dishonest management staff the maximum number allowed by law to every nurse most days.
At one hospital where I went as a registry nurse I witnessed a nurse fill out an ADO. She had others who agreed sign it. Then she called the physician who had ordered Q 30 minuted vital signs, hourly I&O and such to tell him that she was assigned four patients and was to receive his other patient post op from the OR. That doctor told the supervisor, who had been handed the ADO, to get another nurse because his two patients could not safely share their nurse with three other patients. Within 20 minutes another registry nurse arrived.
The link below is from the Michigan Nurses Association. It states " As a patient advocate and in accordance with the Michigan Public Health Code, this is to confirm that I/we have notified you that, in my/our professional judgment, today's assignment is/was potentially unsafe and may place my/our license(s) and patients at risk. As a result, the facility/employer is responsible for any adverse effect on assigned staff and/or patient care. I/We will, under protest, provide care to the best of my/our ability in accordance with professional standards.
http://www.umpnc.org/uploads/2/7/3/0/2730318/ado_forminpt.pdf
Several nurses at that hospital told me that hospital used to use the same idea of staffing by numbers, but since the ratios went into effect that number in med-surg is five patients per nurse. Previously it was seven on days and ten on nights.
Seems even that facility meets the bare numeric number and usually ignores acuity.