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.

[Doris Carroll, BSN]

5 hours ago, LovingLife123 said:

I don’t understand our own nurses that don’t support safe staffing ratios. We pretty much have them in my unit and I still feel like I’m trying to constantly avert disaster every shift.

I get a patient back from surgery the other night. They honestly should have been singled and I think charge thought they were doing me a favor by giving me what they thought was an easy one to match my sick one. My “easy” one was q1 Neuro checks and needed to be gotten up every time she had to pee. She had a few other things as well which made her not difficult, but not easy for the first part of the day. I get my other back from surgery and as I’m trying to clean her up and look pretty for nights, I notice the gown is covered in blood. They are bleeding, but not from the surgical site.

Meanwhile, my other one is having a complete mental breakdown. I wonder, is this neurological, or just being scared. But I don’t have that much time as the residents finally come to bedside of the bleeding one and we start getting orders. Oh, it’s also shift change. There a new admit that’s very sick. Not mine, but they need help.

I could not imagine if I had 3-4 in the icu. Things get missed with that many. I gave the best report I could on the Neuro pt and then got to helping the night shift nurse on the surgical pt with the ton of brand new orders that came in.

Oh yeah, I needed to leave to pick up my child as well. Staying real late was not an option. I would have never of left if I had more than 2.

What do these CEOs think we do? I can not work 24 hours a day. With the amount of “required” charting, I simply cannot do it all.

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.

Good grief.

Good grief is right. They just don’t get it. And I’m tired of them saying “do the best you can” This is not my best! When will they hear us? When you have a union forcing these issues through monthly meetings with management, grievances and legislation.

[traumaRUs, MSN, APRN]

5 hours ago, Doris Carroll said:

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/

I stand corrected.

[Doris Carroll, BSN]

23 minutes ago, traumaRUs said:

I stand corrected.

We could change that. ?

[Hoosier_RN, MSN]

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 think the reason it happens is many hospitals (at least where I am, and many I read comments about on here) only hire RNs (and BSNs at that!).But I also think safe staffing needs to cover rehab and LTCs as well. They really get dumped on ratio-wise! Anyone with common sense knows the value of our LPN sisters!

[guest52816]

7 hours ago, Doris Carroll said:

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.

Yes. I understand it is rarely working.

A poster stated it is working in Oregon.

It can only work IF it is enforced, and IF there is punishment for non-enforcement.

That comes from state legislatures.

That means nurses in those states, need to organize, like they did in CA, and IL, and either demand enforcement or ratios.

No more status quo.

Nurses in other states need to organize.

Personally, I do not work myself to death. I do my best.

I don't pick up extra hours, even though my employer leans heavily on existing staff to fill their constant staffing woes.

Not a single manager at my facility ever works bedside when the units are short.

It is left to staff nurses to deal with the situation.

That shoes how little they care. If they cared about patient safety, staff safety and satisfaction, they would pitch in when necessary.

But they don't.

I did ask the ANA person who called me back about the close ties to hospital associations.

She responded by saying the organization felt those ties were necessary to move anything forward.

Of course, hospitals will fight anything perceived to cost them money.

[guest52816]

23 minutes ago, Hoosier_RN said:

I think the reason it happens is many hospitals (at least where I am, and many I read comments about on here) only hire RNs (and BSNs at that!).But I also think safe staffing needs to cover rehab and LTCs as well. They really get dumped on ratio-wise! Anyone with common sense knows the value of our LPN sisters!

I work physical rehab, which has become a dumping ground for local hospitals.

Our patients are sometimes VERY sick, and it is akin to working a med-surge unit, only with more dressing changes.

We give round the clock IV antibiotics and blood transfusions, and magnesium, without telemetry monitoring.

When I was out on vacation two weeks ago, my coworkers told me they had 9 and 10 patients a piece.

We also have an LPN on our unit (new grad), so RNs must assess and chart on her patients too.

That means, my RN coworkers were responsible for more like 13 patients a piece.

They told me it was horrible.

[Nurse Beth, MSN]

On 4/9/2019 at 7:00 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 was an LVN before becoming an RN and I've worked with many wonderful LVNs. In California, the scope of LVNs is limited.

They work under the supervision of an RN when it comes to assessments and patient teaching. So an RN who has 4 patients on Tele, for example, cannot also be responsible for an LVN's patients as that would violate nurse-patient ratios.

That's why for the most part, LVNs do not work in acute care in California.

[guest52816]

There is KY legislator, who is an RN.

I just emailed her at the State House, to ask if she is willing to meet with nurses, and listen to their concerns regarding safe staffing issues.

I am hoping she may be willing to bring a proposal forward.

Will keep you all updated.

When I joined KNA two years ago, I specifically told the president that my reason for doing so was safe staffing.

Yes, I care about nurses in schools, and other issues, but safe staffing propels me to pay those monthly dues.

But nothing has been proposed.

Time to do something about it.

[RNMgrSarah]

Please let me know. Our state is so behind in many things (including nursing issues). I have been disappointed in the silence of the KNA and would love to help our state advance in several nursing areas (including safe staffing).

[guest52816]

8 minutes ago, RNMgrSarah said:

Please let me know. Our state is so behind in many things (including nursing issues). I have been disappointed in the silence of the KNA and would love to help our state advance in several nursing areas (including safe staffing).

I emailed Mary Lou Marzian.

Even though I don't live in Jefferson County, and that is her area.

Hoping she responds to email. If not, I will call her home.

She lists her home number.

I have noted you, and may private message you for help.

The status quo can't remain.

[TriciaJ, RN]

12 hours ago, Doris Carroll said:

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.

Oregon nurse here. I have first-hand experience with a hijacked staffing committee. I also stopped paying dues to ANA a few years ago.

[Forest2]

On 4/9/2019 at 2:43 PM, Nurse Beth said:

Correct, I will change the language to say "only CA has mandated nurse-patient ratios".

Oregon has Staffing Committees which, when run as intended, allow nurses to have a say in staffing plans. Unfortunately, in the 7 states with Staffing Committees, the committees are typically weak and subject to over ride by members who are managers or admin.

Who is the decision maker in these committees and what do they base their decisions on? Taking a guess here it is management and money.