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.

[guest52816]

2 hours ago, ZenLover said:

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....

My friend, who works day shift at my facility, has refused a patient admission and threatened to quit.

The powers that be, begged her to stay, and got her another nurse.

But like you stated, nurses have to be ready to quit.

My friend sent an email to the CEO, when refusing the admission, and used the line, "unintetional neglect."

It worked!

Of course, that nurse was pulled from another unit, so it was a shuffling of the deck chairs on the Titanic.

[herring_RN, ASN, BSN]

Illinois RNs Applaud Lawmakers as They Move Gold-Standard Nurse-to-Patient Staffing Legislation to Full Assembly

The March 27 vote shows that lawmakers in the House Labor and Commerce Committee recognize H.B. 2604 addresses a patient safety crisis. Study after study clearly shows that unsafe staffing levels compromise patient health, and lead to preventable medical errors, avoidable complications, increased readmissions, and even death.

“We know that to provide the highest quality of care to our patients, we need time to take note of the tiniest details and to carefully monitor any changes in our patients,” said Maria Bell, RN. “We also know that RNs who are stretched too thin, with too many very sick patients, are literally running to treat their patients, going without breaks, food, or even a trip to the restroom, and patient care suffers. We are pleased that through the collective voice of our union, NNOC/NNU, we are being heard by those who can make a difference. We call on all lawmakers to pass the Safe Patient Limits Act and make all Illinois patients safer.”...

... Safe staffing is also critical for the health and safety of nurses. A 2015 study in the International Archives of Occupational and Environmental Health showed that the California safe staffing law was associated with nearly 56 percent fewer occupational injuries and illnesses per 10,000 RNs per year, a value nearly 32 percent lower than the expected rate without the law.

https://www.nationalnursesunited.org/press/illinois-rns-applaud-lawmakers-they-move-gold-standard-nurse-patient-staffing-legislation

[herring_RN, ASN, BSN]

One thing I did when our bill was introduced I'd bring stamped envelopes, stationary, and pens to hospital cafeterias. I had a "Safe Staffing" button and also brought handouts about the bill with the web address to find out more.

Nurses could write their own elected officials and let me mail the letters, or do their own later.

At parties and meetings, including CE classes we would call lawmakers on their breaks.

Two or more nurses would take an ironing board to a store. We had petitions for those who didn't want to write a letter. Many wrote their stories of what happened to them or loved ones when hospitalized on short staffed shifts. We needed at least one nurse to answer health questions. (Common answer was to explain what words meant or to advise a visit to a primary provider, clinic, or urgent care.)

The result? Better care, fewer inpatient deaths due to "Failure To Rescue. and increased patient and nurse satisfaction.

[traumaRUs, MSN, APRN]

1 hour ago, Lil Nel said:

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.

I've been receiving texts all weekend from National Nurses United to support this bill.

[klone, MSN, RN]

On 4/10/2019 at 5:51 PM, Lil Nel said:

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?

I really think that the best solution is, instead of treating patients like widgets with a one-size approach to ratios, the hospital committee approach where the FLOOR NURSES decide what safe staffing looks like, with an acuity-based staffing matrix that looks at the individual patients, rather than simply counting heads. And the law should require this, and provide the enforcement teeth (such as what Oregon has done, sorry to sound like a broken record).

[klone, MSN, RN]

1 hour ago, Ludie said:

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.

I guess your hospital didn't take it as seriously as ours. Because it worked well at the hospital where I worked (granted, it was in its infancy when I left). Or perhaps I live in an insulated little OB bubble where we have a professional organization that very clearly outlines the recommended ratios for the various types of patients we see, and the Oregon staffing laws specifically state that a department's staffing plan should be based on professional organizations' recommendations, whenever possible.

[klone, MSN, RN]

1 hour ago, crazyrn07 said:

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

The CEO *is* a nurse.

[herring_RN, ASN, BSN]

On 4/10/2019 at 7:54 PM, klone said:

I really think that the best solution is, instead of treating patients like widgets with a one-size approach to ratios, the hospital committee approach where the FLOOR NURSES decide what safe staffing looks like, with an acuity-based staffing matrix that looks at the individual patients, rather than simply counting heads. And the law should require this, and provide the enforcement teeth (such as what Oregon has done, sorry to sound like a broken record).

California ratios are NOT "One Size Fits All" The ratio is the floor, not the ceiling.

Please feel free to ask any questions. I will try to answer any questions about our California statutes and regulations.

Quote from the California Code of Regulations:

Quote

... Hospitals shall provide staffing by licensed nurses, within the scope of their licensure in accordance with the following nurse-to-patient ratios. Licensed nurse means a registered nurse, licensed vocational nurse and, in psychiatric units only, a psychiatric technician. Staffing for care not requiring a licensed nurse is not included within these ratios and shall be determined pursuant to the patient classification system.

No hospital shall assign a licensed nurse to a nursing unit or clinical area unless that hospital determines that the licensed nurse has demonstrated current competence in providing care in that area, and has also received orientation to that hospital's clinical area sufficient to provide competent care to patients in that area. The policies and procedures of the hospital shall contain the hospital's criteria for making this determination.

Licensed nurse-to-patient ratios represent the maximum number of patients that shall be assigned to one licensed nurse at any one time. “Assigned” means the licensed nurse has responsibility for the provision of care to a particular patient within his/her scope of practice. There shall be no averaging of the number of patients and the total number of licensed nurses on the unit during any one shift nor over any period of time. Only licensed nurses providing direct patient care shall be included in the ratios...

... Nothing in this section shall prohibit a licensed nurse from assisting with specific tasks within the scope of his or her practice for a patient assigned to another nurse. “Assist” means that licensed nurses may provide patient care beyond their patient assignments if the tasks performed are specific and time-limited...

... In addition to the requirements of subsection (a), the hospital shall implement a patient classification system as defined in Section 70053.2 above for determining nursing care needs of individual patients that reflects the assessment, made by a registered nurse as specified at subsection 70215(a)(1), of patient requirements and provides for shift-by-shift staffing based on those requirements. The ratios specified in subsection (a) shall constitute the minimum number of registered nurses, licensed vocational nurses, and in the case of psychiatric units, psychiatric technicians, who shall be assigned to direct patient care.Additional staff in excess of these prescribed ratios, including non-licensed staff, shall be assigned in accordance with the hospital's documented patient classification system for determining nursing care requirements, considering factors that include the severity of the illness, the need for specialized equipment and technology, the complexity of clinical judgment needed to design, implement, and evaluate the patient care plan, the ability for self-care, and the licensure of the personnel required for care. The system developed by the hospital shall include, but not be limited to, the following elements:...

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

[herring_RN, ASN, BSN]

On 4/10/2019 at 3:25 PM, Lil Nel said:

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!

In 2012 the ANA House of Delegates voted for safe staffing to include ratios. I think an ANA member could get a copy of the resolution. It is probably in the "members only" part of the ANA website.

Quote

The Missouri Nurse — Summer 2012

ANA Reaffirms Dedication To Improving Staffing For RNs And Their Patients

The nurse staffing resolution identifies short-staffing as a top concern for direct care nurses that negatively affects patient care and nurse job satisfaction. It notes that staffing decisions remain largely outside of nurses' control, and that staffing plans lack enforcement mechanisms. The resolution requests ANA to "reaffirm its dedication" to advocating for a staffing process, directed by nurses, that is enforceable and that includes staffing principles, minimum nurse-to-patient ratios, data collection, and penalties for non-compliance in all health care settings where staffing is a challenge.

"Finding solutions to unsafe nurse staffing conditions is a top priority for ANA," said ANA President Karen A. Daley, PhD, MPH, RN, FAAN. "It is not acceptable to put patients at risk because of inadequate staffing. Research shows that higher levels of nurse staffing result in better patient outcomes, so our job is to make sufficient staffing a reality nationwide."

http://www.mlppubsonline.com/article/ANA_Reaffirms_Dedication_To_Improving_Staffing_For_RNs_And_Their_Patients/1164993/124641/article.html

[guest52816]

On 4/10/2019 at 7:54 PM, klone said:

I really think that the best solution is, instead of treating patients like widgets with a one-size approach to ratios, the hospital committee approach where the FLOOR NURSES decide what safe staffing looks like, with an acuity-based staffing matrix that looks at the individual patients, rather than simply counting heads. And the law should require this, and provide the enforcement teeth (such as what Oregon has done, sorry to sound like a broken record).

I agree.

It is probably the best approach.

But several states already take this approach, apparently, with poor results because of the lack of enforcement, or ramifications from non-enforcement.

[guest52816]

From today's NY Times, is a story about nurses at three NYC hospitals who were on the verge of striking over staffing issues.

The hospitals agreed to ratios.

Read the story.

The nurses had a union backing them.

The hospitals will be filling 800 vacant nursing jobs.

Yes, 800!!!!!!!

Plus hiring additional nurses.

[ICU/EMTP, BSN, EMT-P]

Too many folks here that seem to be part of the problem. Now we know why we can’t move forward.