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.

[Daisy4RN]

On 4/9/2019 at 6:14 PM, Emergent said:

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

Ha Ha, I guess I forgot my sarcasm emoji?. In case that one doesn't work and just bc I like ya, I will re-phrase lol.

I have absolutely no qualms in believing that this CEO is a total and complete weasel! ?

[LittleOldLadyWho, ADN, BSN, LPN, RN]

Well, since his LPN license is current, he can help out on the floor! Oh, he's not a registered nurse so a RN will have to cover him and he can have an extra patient, too. Isn't that how it works? Total cocky jerk.

[Nurse Beth, MSN]

7 hours ago, scuba nurse said:

Good luck! It didn't pass in Massachusetts!

I know but I think it takes perseverance. Also, if i'm not mistaken, MA did not allow for much of an implementation phase.

[Nurse Beth, MSN]

@klone Thanks for sharing. I still believe ratios is the best first step like @Daisy4RN said, but It is so nice to hear a positive experience.

This is how it should be- working together with mutual respect and common goals ?

[Doris Carroll, BSN]

The difference in Illinois? At my hospital my staffing committee chair is an NSICU of many years. The committee is 50/50. For 10 yrs now. Yet they just give us charts and blah blah blah. We have nurses come regularly to complain—management’s answer? Blah blah blah. It’s an exercise in futility.

[tnbutterfly - Mary, BSN]

Hello Doris. You are right in the thick of things in Illinois. We appreciate you sharing your insights.

[traumaRUs, MSN, APRN]

29 minutes ago, Doris Carroll said:

The difference in Illinois? At my hospital my staffing committee chair is an NSICU of many years. The committee is 50/50. For 10 yrs now. Yet they just give us charts and blah blah blah. We have nurses come regularly to complain—management’s answer? Blah blah blah. It’s an exercise in futility.

Doris - thanks so much for your comments. I'm an APN in Illinois and have kept up with the comments and of course the texts (lol)! I appreciate the even-handed comments from our state's nursing organizations. Its important for nurses to understand the ins/outs of this proposed legislation.

[Doris Carroll, BSN]

On 4/9/2019 at 4:09 PM, 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.

In Illinois, despite the law, many hospitals do not comply. No penalties in the law. The IHA lied to the nurses who co-wrote the law. Nurses call me to complain. In ICU 3-4 patients for example. Dangerous don’t you think?

On 4/9/2019 at 4:09 PM, 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.

[Doris Carroll, BSN]

40 minutes ago, Nurse Beth said:

I know but I think it takes perseverance. Also, if i'm not mistaken, MA did not allow for much of an implementation phase.

Actually nurses and the public read the law incorrectly in MA. Enactment on January 1 doesn’t mean they only had 37 days from Nov 6. It meant that hospitals would begin the process. And when the rumor mill starts, on a ballot referendum, it’s difficult then to manage the noise. When it goes through legislators technically it’s a smidge easier, finite audience.

[Nurse Beth, MSN]

On 4/9/2019 at 9:25 PM, Doris Carroll said:

Actually nurses and the public read the law incorrectly in MA. Enactment on January 1 doesn’t mean they only had 37 days from Nov 6. It meant that hospitals would begin the process. And when the rumor mill starts, on a ballot referendum, it’s difficult then to manage the noise. When it goes through legislators technically it’s a smidge easier, finite audience.

Interesting! I talked to a colleague of mine who was working in MA at the time and voted against the safe staffing. I was aghast. But she was convinced hospitals and mental health services would close. It's really, really hard to fight fear mongering.

[Doris Carroll, BSN]

Beth—how does a staff nurse vote against safe staffing? I’m. Just. Sad. That nurses would believe management, who maintain the unsafe staffing, who offer no alternative, who tell you we’re one big happy family, who watch new grads leave, who ignore our cries for help, who watch us go home exhausted, stressed, who turn a blind eye, who abandoned you and me, and our patients, willing to do nothing. Absolutely nothing. I hope I can continue with the same passion and determination to make our lives better. I won’t let them break me down. ??

[Fyles]

Since when do Licensed Practical Nurses not count as being a "real nurse"? All these news articles we're reading lately - even this one concerning safer staffing regulations- they never refer to LPNS.....it's always Registered Nurses. I've been an LPN for numerous years now, and in my time I've known other LPNS that literally ran circles around the RNs they worked with. Just because there are different nursing credentials that follow your name doesn't necessarily make you a "better nurse". Most RNs I've worked with have been excellent nurses, however there have been several that I've no idea how they passed their boards. I've had to teach RNs how to insert/remove Foley caths, how to do trach care, even how to correctly remove sutures....because during our work shifts, THEY came to me asking "can you do this for me?" When I asked them why, they claimed they didn't know how. So, each one teach one. But I'm not the one making $25+ an hour. If we need better nursing care at the bedside, we need to make sure our RNs are as knowledgeable on direct patient care as they are about paperwork/charting. Safe staffing is an issue across our nation, and one that could be greatly eased by staffing with Licensed Practical Nurses. There are many, many of us out here that would greatly love working in a hospital again....instead of being stuck working long term care....because our hospitals now say they "only hire Registered Nurses". There is not a shortage of nurses where I come from; there's a shortage of jobs in healthcare now that will actually hire LPNs instead of RNs. And that's a sad fact. We're all praying that this bill passes, and hopefully other states - including mine - will follow suit.