CEO Says More Nurses Won't Improve Care

Illinois is poised to adopt safe staffing ratios even as a hospital CEO publicly puts profits before patients. Mark Gridley, CEO of FHN Memorial, thinks fewer nurses are better and claims that Illinois already has optimal staffing levels of registered nurses. Nurses General Nursing Article

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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.

And since the ANA does not support nurses, it’s time to leave them behind and take all our money with us. There are other, better organizations that will fight for us.

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3 minutes ago, ICU/EMTP said:

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?

Even though the idea of safe staffing levels is logical and reasonable, the soulless, greedy piece of suit trash that you refer to (great definition BTW), even have their own flawed research that refutes these facts-unbelievable!

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Specializes in Critical care, tele, Medical-Surgical.
On 4/9/2019 at 10:00 PM, Fyles said:

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.

I am a California nurse who with thousands of fellow nurses worked for our ratio law and regulations. It took several attempts in the state legislature and one failed ballot initiative. I am praying for the sake of patients and nurses that it wins. Link to regulations is below:

https://govt.westlaw.com/calregs/Document/I8612C410941F11E29091E6B951DDF6CE?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

I was a hospital LVN for a decade before earning my RN.

I think hospitals would be wise to use LVNs on many units. For example on a telemetry unit the ratio is four or fewer patients per RN at all times. When patients need tube feedings, dressing changes, PRN medications, catheter insertions, suctioning, and other procedures the hospital must add staff to meet the needs of each patient. Because the needs of one or more patients require additional staff and patient needs require the skills of a licensed nurse assigning an LVN/LPN OR an additional RN is needed. A CNA or unlicensed staff cannot meet the needs of such patients.

My opinion is that on a unit where such patient are common having an LVN scheduled improves patient care.

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17 minutes ago, morelostthanfound said:

Even though the idea of safe staffing levels is logical and reasonable, the soulless, greedy piece of suit trash that you refer to (great definition BTW), even have their own flawed research that refutes these facts-unbelievable!

I know! I’ve seen it and it’s as pathetic as their denial of patient safety. Paid-for junk science. The best part is that <more staff=higher safety and satisfaction> has been proven by multiple studies in EVERY part of the hospital. From MS to ICU to the ED. Don’t we all wonder why nobody worth a crap ever makes it into management? Don’t wonder. They are kept out on purpose.

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Specializes in Critical care, tele, Medical-Surgical.
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....

I cannot find ONE evidenced based study that shows nursing care is not improved with sufficient staff.

Quote

Health Services Research, August 2010

The researchers surveyed 22,336 RNs in California and two comparable states, Pennsylvania and New Jersey, with striking results, including: if they matched California state-mandated ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths.

“Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year,” according to Linda Aiken, the study’s lead author.

California RNs report having significantly more time to spend with patients, and their hospitals are far more likely to have enough RNs on staff to provide quality patient care. Fewer California RNs say their workload caused them to miss changes in patient conditions than New Jersey or Pennsylvania RNs

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908200/

Quote

"Studies involving RN staffing have shown that when the nursing workload is high, nurses' surveillance of patients is impaired, and the risk of adverse events increases." "… We found that the risk of death increased with increasing exposure to shifts in which RN hours were 8 hours or more below target staffing levels or there was high turnover. We estimate that the risk of death increased by 2% for each below-target shift and 4% for each high-turnover shift to which a patient was exposed."

New England Journal of Medicine, March 17, 2011

https://www.nejm.org/doi/full/10.1056/NEJMsa1001025

Quote

Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs.

Med Care. 2014 Nov.

Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs.

http://www.ncbi.nlm.nih.gov/pubmed/25304017

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1 hour ago, ICU/EMTP said:

And since the ANA does not support nurses, it’s time to leave them behind and take all our money with us. There are other, better organizations that will fight for us.

Hey, I just got a call back from the ANA.

The gentleman I spoke with, pushed me towards the hospital committee approach towards staffing, as their official position.

I told him I thought that was like allowing the fox, to guard the hen house.

And we agreed there are potential problems with that model for staffing.

He referred me to another ANA staffer, who will likely call me tomorrow.

I also expressed that the reason why I joined ANA two years ago, was to get something done on safe staffing in my state, KY.

Thus far, there has been no action, and I may need to rethink my membership.

I'll keep you all posted!

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Specializes in APRN / Critical Care Neuro.

The hospital committee approach is not going to work. It is the best way though. I am an ICU nurse but have worked the floors. I have had a 1:1 patient run me blind into the ground trying to keep him alive. I have also had 6 patients and had time to eat lunch and do my nails. Every patient is different and the real answer to ratios for each unit is a team approach. It is also management respecting a nurse who is protecting her license and not automatically assuming she is trying to be lazy.

They do assume laziness. I have flat out refused an assignment. Was told I could quit, called her bluff and was apologized to afterwards. You have to be willing to go there to have THAT conversation. Stand up for what you believe or fall for anything. That being said, I have had plenty of unsafe days where I have bitten off, chewed, swallowed and repeat....for the full 12 hours. It is rough. If you do not have good management in place that listens you are screwed. If you are management and you don't have good, appropriately trained nurses you are screwed. We have to learn to help each other and asking the government to come and force that is at best sad because their history of intervening and fixing anything sucks.

But...perhaps a simple ratio law will start a more positive conversation since neither side trusts the other further than they can be thrown....

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Acuity should be the greatest determiner of staffing ratios. Experience is also extremely important. Therefore, the ratios can be different every day, every shift, and for every nurse. The nurse/patient ratio is a good start, but it sure takes more than that to keep patients...and nurses...safe. The CEO's opinion is useless. He simply is trying to keep his salary, benefits and bonuses way, way up there, while nurses and ancillary staff (of whom are becoming fewer and fewer) do the drudge work. The correct number of nurses per patients does save lives. Specialized care always does. And, that is what we should be giving. Nursing breaks (whenever one is fortunate enough to get one) are worrisome. The covering nurse and the combined patients are in danger during those times. We who have staffed the floors KNOW what truly happens. Is is frightening. Once, I was on Tele with 13 patients to care for. When I called the supervisor for help, she asked what I wanted her to do. I responded that I wanted her to help me. She turned her back on me and walked away. That was the straw for me. I quit, and went to work for an agency, doing pediatric home care. One little patient at a time.

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Specializes in Nephrology, Cardiology, ER, ICU.
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?

Just to address this. Here is the site for the IL Nurses Association/ANA

https://www.ana-illinois.org/about-ana-illinois/

"ANA-Illinois, together with our national partner, the American Nurses Association (ANA), will continue to build a community of nurses dedicated to advancing their profession and providing safe, affordable healthcare."

They are actually one organization. And yes, I too got the text messages

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19 minutes ago, traumaRUs said:

Just to address this. Here is the site for the IL Nurses Association/ANA

https://www.ana-illinois.org/about-ana-illinois/

"ANA-Illinois, together with our national partner, the American Nurses Association (ANA), will continue to build a community of nurses dedicated to advancing their profession and providing safe, affordable healthcare."

They are actually one organization. And yes, I too got the text messages

I got a call back from a second person at ANA.

I was told that the ANA doesn't take a position on statewide initiatives, unless specifically asked.

I was also told again, that ANA supports the hospital committee proposal.

But, without enforcement teeth, the committee idea doesn't amount to much, does it?

Nurses need to be registered to vote, and they need to vote for people who support issues of importance to nurses.

I don't know what texts you are referring to. I don't live or work in IL.

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Oregon-our management says it’s cheaper to pay the fines than hire more staff and decrease ratios. We have acuity tools that do absolutely nothing. We have a staffing committee-no progress. Five total cares, with dementia, an insulin drip, and another on a heparin drip, add an actively withdrawing CIWA and all on tele is the same ratio as a post-op after an elective surgery with very few co-morbidities, and the same ratio as an A/O Independent admitted for OBS with PNA. Our only different ratios are on a Stroke floor and oncology-however, doesn’t matter if it’s regular Med-Surg pts or actual chemo/stroke pts-ratio is static. Constantly understaffed CNA’s which are a 15-1 ratio on our floor and no unit secretary. This month they are taking away our equipment runner. Next they plan to decrease the amount of hours our unit secretaries work so we only have them for 12 hours instead of 16...

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It's obvious this CEO isn't a Nurse!

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