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]

58 minutes ago, TriciaJ said:

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

Question, not snark: Did the ANA attempt to gain enforcement, or thwart enforcement?

I can see getting legislation passed, and then thinking we can gather enforcement tools later.

Personally, I don't think it is a good strategy, but perhaps that was thinking at the time.

How long have hospital committees been in place in Oregon?

I don't know anything about your state's law.

[guest52816]

1 hour ago, TriciaJ said:

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

The ANA rep and I discuss this, as it is logical that committees would be hijacked, if hospitals face no ramifications.

[herring_RN, ASN, BSN]

19 hours ago, klone said:

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.

I am just guessing that the OB nurses at your hospital were united and assertively insisting the management follow the law.

Perhaps the entire nursing staff was too. I think most likely it was, and I hope is, that the law is enforced by the nursing staff. Maybe management knows the nurses would report to the media, or in another was inform the public of their management were they to violate the law, thus risking the very lives of their patients.

In California the worst hospitals assign the maximum number of patients to each nurse and ignore acuity. They often have no break relief RN. One hospital unit manager claimed on the staffing sheet that she relieved her nurses for meal breaks. She was down the hall in her office, never got report or did anything for a patient. Too bad they didn't speak up. They still have a dishonest criminal nurse manager.

[TriciaJ, RN]

47 minutes ago, Lil Nel said:

Question, not snark: Did the ANA attempt to gain enforcement, or thwart enforcement?

I can see getting legislation passed, and then thinking we can gather enforcement tools later.

Personally, I don't think it is a good strategy, but perhaps that was thinking at the time.

How long have hospital committees been in place in Oregon?

I don't know anything about your state's law.

I was on a staffing committee back in the early 2000s. It was a joke. I left bedside nursing in 2008, so maybe the laws have changed. I don't stay in regular-enough touch with my previous bedside cronies to know if anything is new.

I paid dues to ONA (and by extension, ANA) for a lot of years even though I was no longer covered by any of their collective bargaining agreements. I just thought being a professional meant you support your professional organization. I stopped doing this a few years ago. Now, reading ANA positions on certain things, I'm just as glad I no longer support them.

[TriciaJ, RN]

50 minutes ago, Lil Nel said:

The ANA rep and I discuss this, as it is logical that committees would be hijacked, if hospitals face no ramifications.

I was the lone voice at the staff meetings. My coworkers would approach me after the meetings to tell me they were glad I spoke up. But no one ever backed me at the time. When I was relief charge nurse, I had a low threshhold to complete the Staffing Request and Documentation forms. I was the only one who did so. At one of our staffing committee meetings, the manager (who ran the committee) voiced strenuous objection to me doing this. I held firm. They just got busy training other people to do relief charge.

It was nice not having to be in charge so much, but of course they were hoping no one else would speak up. And no one did.

[guest52816]

52 minutes ago, TriciaJ said:

I was the lone voice at the staff meetings. My coworkers would approach me after the meetings to tell me they were glad I spoke up. But no one ever backed me at the time. When I was relief charge nurse, I had a low threshhold to complete the Staffing Request and Documentation forms. I was the only one who did so. At one of our staffing committee meetings, the manager (who ran the committee) voiced strenuous objection to me doing this. I held firm. They just got busy training other people to do relief charge.

It was nice not having to be in charge so much, but of course they were hoping no one else would speak up. And no one did.

Unfortunately, the experience you attest to at the end of your post has been my experience with many fellow nurses.

They will complain to one another about the sleeping tech, but will not complain to management.

They remain silent, but continue to complain amongst themselves.

Myself and ONE other nurse were willing to step forward to our manager regarding the sleeping tech.

It can be hard to organize people unwilling to stand up for themselves.

You didn't need fellow nurses to thank you after the fact, you needed their help in the moment.

[TriciaJ, RN]

8 minutes ago, Lil Nel said:

Unfortunately, the experience you attest to at the end of your post has been my experience with many fellow nurses.

They will complain to one another about the sleeping tech, but will not complain to management.

They remain silent, but continue to complain amongst themselves.

Myself and ONE other nurse were willing to step forward to our manager regarding the sleeping tech.

It can be hard to organize people unwilling to stand up for themselves.

You didn't need fellow nurses to thank you after the fact, you needed their help in the moment.

It's hard not to come away thinking "We're our own worst enemies and maybe we deserve this crap."

I dealt with people refusing to join the union "it's not professional"; refusing to request the needed staff and complete the documentation form "I don't want to make them mad", people that came in on their own time, off the clock, to complete "mandatory" training (one nurse showed up on New Year's Eve because the manager had wanted it done by the end of the year).

Other people beat feet to the manager's office to tattle because I complained too vociferously about the crappy staffing that shift. How do you galvanize a crowd like that? Eventually, all you can do is save yourself.

[klone, MSN, RN]

On 4/11/2019 at 3:36 PM, Lil Nel said:

How long have hospital committees been in place in Oregon?

I don't know anything about your state's law.

They've been legally mandated for approximately 2 years. The laws in place that legally require hospitals to follow the staffing plan created by the staffing committee (that is required to have equal representation by staff nurses and managers) have also been in place for about 2 years.

[guest52816]

14 minutes ago, klone said:

They've been legally mandated for approximately 2 years. The laws in place that legally require hospitals to follow the staffing plan created by the staffing committee (that is required to have equal representation by staff nurses and managers) have also been in place for about 2 years.

Do you know why no provisions were made in the law, to punish hospitals who don't comply?

[guest52816]

3 hours ago, TriciaJ said:

It's hard not to come away thinking "We're our own worst enemies and maybe we deserve this crap."

I dealt with people refusing to join the union "it's not professional"; refusing to request the needed staff and complete the documentation form "I don't want to make them mad", people that came in on their own time, off the clock, to complete "mandatory" training (one nurse showed up on New Year's Eve because the manager had wanted it done by the end of the year).

Other people beat feet to the manager's office to tattle because I complained too vociferously about the crappy staffing that shift. How do you galvanize a crowd like that? Eventually, all you can do is save yourself.

You are right. It is hard not to feel that way.

But I don't want to spend 36.5 hours a week feeling stressed out and unsafe.

And I don't want my co-workers feeling that way either.

As the population continues to age, and more nurses say 'hell no,' to bedside care, something will have to change.

Chin up!

[klone, MSN, RN]

16 minutes ago, Lil Nel said:

Do you know why no provisions were made in the law, to punish hospitals who don't comply?

There are.

[Doris Carroll, BSN]

3 hours ago, TriciaJ said:

It's hard not to come away thinking "We're our own worst enemies and maybe we deserve this crap."

I dealt with people refusing to join the union "it's not professional"; refusing to request the needed staff and complete the documentation form "I don't want to make them mad", people that came in on their own time, off the clock, to complete "mandatory" training (one nurse showed up on New Year's Eve because the manager had wanted it done by the end of the year).

Other people beat feet to the manager's office to tattle because I complained too vociferously about the crappy staffing that shift. How do you galvanize a crowd like that? Eventually, all you can do is save yourself.

I feel such frustration reading your comments. Yes. Like Cher in Moonstruck I want to slap them and say “ Snap out of it!” Because those who stand back, leave you hanging, kowtow to admin and/or complain are people who feel powerless. I’m told we need to educate—give them the tools to realize the power they have as long as we are unified. I then do continue to educate. Rarely do I see others step up. Those who believe unions are not professional— right. Go ahead and keep beating that dead horse. But I’ve found the brain drain, the emotional drain is taxing. I’ve rarely been the follower. And I have a big mouth. So I’m easily rattled by apathy. This is our time. I won’t want to hear 30 yrs from now that staffing remains the same. ??