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.

[LockportRN]

7 hours ago, morelostthanfound said:

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!!

Sigh, I have long suspected this as too many times they appear to back them up and not us nurses.

[herring_RN, ASN, BSN]

1 hour ago, Lil Nel said:

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.

Quote

Facing Nurses Strike, New York Hospitals Reach Landmark Deal on Staffing

For several weeks, New York City has been at the center of a national debate about how many nurses should be on duty at hospitals.

Nurses unions have pressed for rules setting minimum staffing levels, arguing that having too few nurses leaves patients at risk. Hospital officials have countered that they need flexibility in deploying their workers and should not be bound by rigid ratios.

That dispute spurred more than 10,000 nurses to threaten to walk off their jobs this month at three of New York’s biggest hospital systems.

But on Tuesday, the union that represents the nurses said it reached a groundbreaking agreement with the hospitals that would lead to the hiring of 1,450 additional nurses and for the first time establish minimum ratios of nurses to patients....

https://www.nytimes.com/2019/04/10/nyregion/nurses-strike-nyc.html

This article doesn't mention STAFFING. I think it must be a business oriented publication.

Quote

After strike postponed, 10,000 NYC nurses, 3 health systems reach tentative labor deal

The tentative four-year collective bargaining agreement covers nurses at Montefiore, Mount Sinai and NewYork-Presbyterian systems...

... It includes across-the-board wage increases of 3 percent in each year of the contract and full retroactive pay, as well as $100 million to hire nurses at New York-Presbyterian Hospital and Montefiore Medical Center and Mount Sinai Hospital, Mount Sinai West and Mount Sinai St. Luke’s hospitals, according to news releases from the alliance and union...

https://www.beckershospitalreview.com/human-capital-and-risk/after-postponing-strike-10-000-nyc-nurses-3-health-systems-reach-tentative-labor-deal.html

[muffylpn]

I just wonder as it does not say. Will it be a similar law to Calfornia, because they included ALL nurses where as Massachusetts only considered in their bill that Rns were nurses

[JKL33]

41 minutes ago, LovingLife123 said:

Do you know when I got my break that day? I took 15 minutes at 1700 so I could at least get a little food in me. But it got counted as my 30 so I don’t get yelled at for not taking my break.

No way. Absolutely no.

I will go out of my way for patients, too. But I absolutely will not work without getting paid unless it is a personal act of charity.

[herring_RN, ASN, BSN]

On 4/10/2019 at 10:07 PM, muffylpn said:

I just wonder as it does not say. Will it be a similar law to Calfornia, because they included ALL nurses where as Massachusetts only considered in their bill that Rns were nurses

My answer will be in two posts.

California law and hospital regulations define the scope of practice for nurses, RN and LVN. When you read it please keep in mind that with regard to the law "shall" means "must". These regulations make it clear that in an acute care hospital a registered nurse must DIRECTLY provide all elements of the Nursing Process. That RN is responsible for the nursing care provided to each patient.

So if the telemetry RN is assigned four patients and is also assigned to supervise four patients also assigned to an LVN/LPN the RN is responsible for eight patients.

Here is the section:

Quote

Planning and Implementing Patient Care.

(a) A registered nurse shall directly provide:

(1) Ongoing patient assessments as defined in the Business and Professions Code, section 2725(b)(4). Such assessments shall be performed, and the findings documented in the patient's medical record, for each shift, and upon receipt of the patient when he/she is transferred to another patient care area.

(2) The planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing staff, or may be assigned to unlicensed staff, subject to any limitations of their licensure, certification, level of validated competency, and/or regulation.

(3) The assessment, planning, implementation, and evaluation of patient education, including ongoing discharge teaching of each patient. Any assignment of specific patient education tasks to patient care personnel shall be made by the registered nurse responsible for the patient.

(b) The planning and delivery of patient care shall reflect all elements of the nursing process: assessment, nursing diagnosis, planning, intervention, evaluation and, as circumstances require, patient advocacy, and shall be initiated by a registered nurse at the time of admission.

(c) The nursing plan for the patient's care shall be discussed with and developed as a result of coordination with the patient, the patient's family, or other representatives, when appropriate, and staff of other disciplines involved in the care of the patient.

(d) Information related to the patient's initial assessment and reassessments, nursing diagnosis, plan, intervention, evaluation, and patient advocacy shall be permanently recorded in the patient's medical record.

https://govt.westlaw.com/calregs/Document/IFD69DB90621311E2998CBB33624929B8?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)

My experience has been in critical care, telemetry, step-down, and med/surg. Many hospitals would assign the maximum number of patients to an RN and to an LVN. With an ideal RN-LVN team who both know each others experience and competencies it may work out OK. All too often it became unsafe.

[herring_RN, ASN, BSN]

(continued)

Please open this because there is a lot of information and examples I didn't quote as well as charts and such. Here is a newspaper article by a reporter who clearly listened to the nurses who contacted him:

Quote

Nurses challenge staffing

Hospital says state requirements are met; RNs say team-nursing approach overburdens their workload

Team nursing — a pilot program in place at Henry Mayo Newhall Memorial Hospital for more than a year — stretches registered nurses too thin and poses a danger to patients, registered nurses say...

... “Henry Mayo (Newhall Memorial Hospital) meets all state, professional and licensing requirements for nursing ratios,” said Larry Kidd, a registered nurse who serves in a management capacity as chief nursing officer and vice president for patient care services...

A committee representing registered nurses sent a letter to Kidd on Monday requesting that the hospital cease its team nursing practice.

“The team-nursing program is unsafe for our patients,” reads the letter, signed by eight registered nurses. “It significantly increases the workload of each RN while reducing the amount of time each RN can spend providing direct primary care for his or her assigned patients.”...

http://archive.signalscv.com/archives/41951/

Here is the article later that year:

Quote

Henry Mayo nurses ratify new contract

Nurses at Henry Mayo Newhall Memorial Hospital have overwhelmingly accepted a new contract for higher wages and an end to a nursing strategy called "team nursing," officials on both sides of the bargaining table confirmed Thursday.

The hospital's 450 registered nurses, who have been working without a contract since February, voted Wednesday to accept a tentative agreement, said Louie Rada, spokesman for the California Nurses Association and the National Nurses United, with which local nurses are affiliated....

Last April, hospital administrators announced they would abandon their team nursing program and introduce a more intimate model that allows nurses more time with fewer patients, hospital officials announced at the time....

... Under team nursing, a registered nurse was teamed with a licensed vocational nurse, or LVN. Together, the team handled more patients than an RN would handle by himself or herself.

The hospital's registered nurses opposed the team nursing model, saying it increased their workload and potentially endangered patient safety.

The new contract spells out a patient care mandate as a "primary nursing care concept."...

http://archive.signalscv.com/archives/65291/

[Doris Carroll, BSN]

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?

Yes. Long standing position is the ANA supports staffing committees with equal #s of management and bedside RNs. It’s not working in the 7 states that have those staffing laws. In Illinois it’s very weak. Hospitals here do not comply. No penalties therefore... The ANA White Paper from 2015 explains their view. It’s misguided. The premise is the CNO, CFO, CEO and COO will actually allow bedside nurses to determine adequate staffing levels. They are directly responsible for standing on the sidelines allowing the current staffing woes across the country. Why? Look at their affiliates. The American Organization of Nursing Executives AONE, was formed by—the American Hospital Association. The state chapters are the Organization of Nurse Leaders, ONL. These nurse “leaders” have abandoned bedside nurses. The ANA, AONE and state orgs of both are management and have aligned themselves with the American Hospital Association. Many state ANA orgs have split into an ANA state org and a separate union. Due to the nurse executives in the ANA having a fundamental disconnect with the union. How can a Nurses union and Nursing management belong under the auspices of one organization? In Illinois we split in 2012. The Illinois Nurses Association is the Nurses Union. ANA-IL remains the ANA State organization.

https://info.nursingworld.org/staffingwp/

[Doris Carroll, BSN]

11 hours ago, Lil Nel said:

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.

I stopped paying dues to ANA last year. They do not represent bedside nurses. The education they provide is necessary. But they cannot state they are the voice of nursing. They are the voice of Hospital administrators. They support legislation to allow staffing committees make staffing decisions. Except that it’s the top administrators who do. At least in Illinois. For 10 yrs now. The ANA has attempted to pass federal legislation for staffing by committee. Please do not support it. 7 states only have this legislation. And it’s rarely working.

[Doris Carroll, BSN]

8 hours 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

No no no. The ANA-IL is part of the ANA. The Illinois Nurses Association is the Nurses Union. 2 separate organizations. HB2604 was written by the INA, in collaboration with NNU, another nurse union. Here is the INA’s website. http://www.illinoisnurses.com/

[Doris Carroll, BSN]

6 hours ago, 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).

No. It is not the best approach. The best is ratios and acuity. Since Illinois has the Acuity Staffing committee law in place x 10 yrs, this ratio law would be utilized in conjunction. However since this law has no penalties, for the past 10 yrs many hospitals here are not complying. How do I know? Nurses call me from central and southern Illinois with 1-4 ICU ratios. Dangerous. An Oregon nurse stated earlier on this article that their law doesn’t work either. Talk to nurses in OH, CT, TX, NV, WA, OR and IL. They’ll tell you the truth. If you think bedside nurses are the driving force of a hospital hiring more nurses, you are sadly mistaken. We must demand transparency and penalties in any staffing law. Because hospital administrators will manipulate the #s if they can.

[Doris Carroll, BSN]

On 4/10/2019 at 8:22 PM, herring_RN said:

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.

The ANA does agree staffing is an issue. However, they are anti-ratio and Pro staffing committees- where bedside nurses are still ignored.

[Doris Carroll, BSN]

On 4/10/2019 at 8:22 PM, herring_RN said:

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.

From 2015. The ANA does not support ratios. https://info.nursingworld.org/staffingwp/