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.

[Nurse Beth, MSN]

18 minutes ago, Doris Carroll said:

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. ??

It's exactly how I felt talking to my colleague- a smart, incredibly good ED nurse- who voted against safe staffing. It's a David and Goliath fight, but once your eyes are opened, there's no going back.

Keep doing the right thing, you are an amazing nurse leader.

[Doris Carroll, BSN]

1 hour ago, tnbutterfly said:

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

Yes I am. My union, the Illinois Nurses Association, introduced the bill, collaborating with National Nurses United. This has been a work in progress. Ever since I became active with a handful of nurses in late 2015—one in TX, one in MA, one in SC, one in FL, and myself in IL. We formed www.NursesTakeDC.com. An annual rally/Lobby day in DC to support federal legislation for ratios and acuity. We will Rally again in 2020.

[Tenebrae, BSN, RN]

11 hours ago, Emergent said:

Fewer CEOs might improve care, IMHO...?

Cut out some more of the middle managers as well.

[RobbiRN, RN]

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?

[wondern, ASN]

CEO Says More Nurses Won't Improve Care-and 1+1 =11 too!

It does not make a lick of common sense no matter what scare tactics management or CEO's spins on it. I guess their main job is to cut costs on top of care. It's a team approach apparently.

Just ran across this while surfing.

http://smysofficial.com/nursing/2636/

[JKL33]

3 hours ago, RobbiRN said:

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

But wait! If the taxpayers just spend some more $billions or so on World's Best EMR, everyone could save so much money on clipboards. Actually with decision support and notifications and all those timers and stuff, they could probably get by with a couple of nurses. ??

[Beth Boynton]

AHHHHHHHHHHH!

Thanks for writing this, Beth.

Apparently Mark Gridley, CEO is not in favor of patient safety and lacks essential understanding of nursing skills and the necessary supports we need to provide consistent safe, compassionate, and ultimately cost-effective care. Or, perhaps he doesn't care and he is using his ignorant arguments as a convenient profit-making ploy.

For the record, I'm a fan of ratios AND a culture that is responsive to nurses' setting limits and asking for help.

Here are a couple of related articles that may be helpful in addressing Gridley's self-serving points. The first one recommends all leaders including CEOs be required to take a CNA course so they can pitch in any time!

An ‘Out-of-the-Box’ Plan that Would Help Nurse Staffing: Is this a Practical Idea or Too Crazy?

If We Add More Nurses and Nurses’ Assistants Will We Make More Money? Why This is the Wrong Question for Healthcare Leaders

Shortcuts in Medication Administration: Why Do We Do It Wrong If We Know How to Do It Right? (and We Do!)

Overstaff? A Counterintuitive Alternative Approach to Safe Nurse Staffing

[guest52816]

The original article posted by Nurse Beth, doesn't make it clear that IL Nurses Association is FOR the staffing bill, not against it.

The organization is separate from the ANA.

I know, because I just got off the phone with IL Nurses Association.

Does anybody know why ANA doesn't support it?

[RNMgrSarah]

Guaranteed not one person voting on this has worked on a hospital floor in the past 15 years if ever. They have no idea how dangerous it can be. I wonder if it was the CEO’s mother (or anyone else voting against) being one of 8 plus patients, if they would change their mind? I guess we could say, “sorry but one nurse has the flu and another is on PTO and it IS a Friday night so....she’ll just have to wait for that pain med.

[guest52816]

This is so troubling to me, as I am a member of the ANA.

I have read their web site information, but can't find a reason for not supporting a bill like this one.

So, I called the ANA, and left VM for two gentlemen, asking why they are not backing the bill.

We will see if I get a response.

[guest974915]

On 4/10/2019 at 1:46 PM, Lil Nel said:

The original article posted by Nurse Beth, doesn't make it clear that IL Nurses Association is FOR the staffing bill, not against it.

The organization is separate from the ANA.

I know, because I just got off the phone with IL Nurses Association.

Does anybody know why ANA doesn't support it?

I know! It's because the ANA is in bed, cozied up tight with some of the largest health care conglomerations that run/own some of our major hospital systems. The ANA, "to advance and protect the profession of nursing", while at the same time selling out its members wholesale in exchange for political favor-despicable!!

[ICU/EMTP, BSN, EMT-P]

Lol. Well I am just shocked!.. Safe staffing levels are the one irrefutable EBP that improves not only safety by satisfaction. It is also universally downplayed by every out-of-touch, soulless, greedy piece of suit trash in hospital administration. It’s absolutely pathetic. And as Nurses are so duty driven, they know they can continue to shaft us and we’ll simply work ourselves to death to make up the shortfall. How and where does it end?