Hospital industry seminars advise administrators how to evade RN ratios

pickledpepperRN · Nov 26, 2003

Selected sections from this DHS "Final Statement of Reasons"

http://www.applications.dhs.ca.gov/regulations/search.asp?REGID=R-37-01&advanced=yes&c2=@filewrite&o2=%3E&q1=&EMERGENCY=&submit1=Begin+Search

In October of 2002 Linda Aiken, PhD, RN et. al. published a study in the Journal of the American Medical Association entitled "Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction". The study was designed to determine the association, if any, between nurse-to-patient ratios and risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, as well as nurse-reported job dissatisfaction and job-related burnout (Exhibit V-2). ("Failure-to-rescue" refers to the licensed nurse's failure to respond quickly and intervene effectively when patients (in this study, post-surgical patients) begin to develop signs and symptoms of serious complications. Failure to rescue, then, results in increased patient mortality.) The likelihood of failure-to-rescue was expressed as odds ratios (ORs), after patient and hospital characteristics were controlled for. The study concluded that the OR of failure-to-rescue was sizeable and significant, indicating that the odds of patient mortality increased by 7% for every additional patient in an average nurse's workload and that the difference from 4 to 6 and from 4 to 8 patients per nurse would be accompanied by 14% and 31% increases in patient mortality, respectively. The study concluded, "If the staffing ratio in all hospitals was 8 patients per nurse rather than 6 patients per nurse, we would expect 2.6 additional deaths per 1000 patients and 9.5 additional deaths per 1000 patients with complications....Our results do not directly indicate how many nurses are needed to care for patients or whether there is some maximum ratio of patients per nurse above which hospitals should not venture. Our major point is that there are detectable differences in risk-adjusted mortality and failure-to-rescue rates across hospitals with different registered nurse staffing ratios." The study also showed that nurses who worked in hospitals with the highest nurse-to-patient ratios were more than twice as likely as nurses who worked at lower ratios to report burnout and job dissatisfaction, and four times as likely to report that they intended to leave their current jobs within one year. If that increase in stated intentions truly resulted in resignations, given the high (and steadily increasing) cost of replacing nursing staff, then improving staffing may not only prevent patient deaths but may also improve staff retention and decrease hospital costs.

The positive impact of changes in workload on the nursing workforce was recently demonstrated in the state of Victoria, Australia. After intense lobbying and political pressure from the Australian Nurses Association, the Victorian Ministry for Health, which is responsible for the operation of acute care hospitals there, adopted the union-backed nurse-to-patient ratios effective December 1, 2000. For medical/surgical units, those ratios varied from 1:4 to 1:6, with more patients permitted on the night shift; for emergency departments the ratio was 1:3 at all times, and the triage and charge nurses were not counted in the ratios. The Victorian government also committed to--and funded--re-entry and refresher programs for nurses who wished to return to the workforce, as well as a vigorous advertising recruitment campaign. In addition, Victoria mandated a 12.5% pay increase over three years, paid study leave, and financial rewards based on education. The results were impressive. In 1999, Victoria's hospitals had approximately 20,000 full-time equivalent nursing positions, with 1300 of those positions vacant. By October, 2001, there were an additional 2650 full-time equivalent nurses employed in Victoria's hospitals--half filling the vacancies and the other half to staff up to meet the ratios (Exhibits J, K, and L).

jnette, ASN, EMT-I · Nov 26, 2003

:eek:

This is OUTRAGEUOS !!!

I'm in SHOCK.

OMG, please don't make me have to rip someone's face off... right now.. so close to the Holidays...... :(

sjoe · Nov 27, 2003

Surprise!!!

(You might know that Tenet would be intimately involved in all this, as well.)

caroladybelle, BSN, RN · Nov 27, 2003

I'm not surprised.

nrsfriend · Dec 5, 2003

I hope that the hospital nurses out there use their fine minds and do not fall prey to the propagandizing approach of CNA , or CHA for that matter. I attended one of these seminars and can attest that it was not in any way an attempt to instruct on ways to avoid the regulations! The regs were presented in total (not "selected" exerpts) and methods of meeting them (not avoiding them) were discussed. The PR departments will be crucial in quelling the likely responses of uninformed public and health care consumers, which will be necessary to keep hospitals in a positive light. Hospitals in California are closing folks, for many reasons so what does that do for the state of California Health? Is anyone concerned about where they will work if their hospital closes? NO!! That is because the nursing shortage is REAL and we can always find a job! The average age of the California nurse is 48 - so who will be taking care of us when we finally succumb to the ravages of old age? The information about all of the nurses "flocking to California" is simply ridiculous! There are not enough nurses in California to meet our needs now - and that is without mandated and ill thought out staffing ratios! :angryfire

Gomer · Dec 5, 2003

Totally agree with you nrsfriend. I too have attended a meeting on the subject. The theme was not how to avoid the ratios but how can we possibly meet them. You are correct, there aren't enough working bedside nurses in Calif. to comply with this law. The former governor kissed up to the unions and we are now left with this and other pro-union rulings. Maybe the new "governator" will not be so inclined.

pickledpepperRN · Dec 5, 2003

Originally posted by Gomer
Totally agree with you nrsfriend. I too have attended a meeting on the subject. The theme was not how to avoid the ratios but how can we possibly meet them. You are correct, there aren't enough working bedside nurses in Calif. to comply with this law. The former governor kissed up to the unions and we are now left with this and other pro-union rulings. Maybe the new "governator" will not be so inclined.

Are you saying that the AHA classes were not how to avoid obeying the law?

They were about how it is impossible to comply?

I remember when our RN staffing was cut in half. We were told to 'trust' the unlicensed personnel.

We were told to embrace change!

Think outside the box!

Why not rise to the challenge?

Do nurses get cancelled for low census days or sent home early?

"If the staffing ratio in all hospitals was 8 patients per nurse rather than 6 patients per nurse, we would expect 2.6 additional deaths per 1000 patients and 9.5 additional deaths per 1000 patients with complications..." From the NEJM article by Dr. Linda Aiken.

Not enough nurses? Come on, be positive. It is a new day in the 21st century! Lets make hospitals safe for patients!

sanakruz, ADN · Dec 5, 2003

[There are not enough nurses in California to meet our needs now - and that is without mandated and ill thought out staffing ratios! :angryfire [/b]

EXCUSE ME?

Rapheal · Dec 5, 2003

I think the public should be informed of this tactic- by their local daily paper. I would send a copy to them- call the editor and ask for the writer who covers medical news. Send it to him or her. These tactics make me sick.

pickledpepperRN · Dec 5, 2003

http://www.presstelegram.com/Stories/0,1413,204%257E21474%257E1807116,00.html

Protesting nurses support ratios

Picketers from union enter L.B. hotel hosting health industry conclave.

By Neda Raouf

Staff writer

LONG BEACH -- Nurses and union organizers rushed into a meeting of the hospital industry Wednesday and accused officials of trying to undermine a state-mandated law for new nurse-to-patient ratios that becomes effective Jan. 1.

About 50 people with the California Nurses Association who had been protesting outside the Hilton Long Beach rushed through the lobby and up an escalator about 9:30 a.m., waving picket signs on their way to the door of the meeting of the California Healthcare Association.

There, they chanted for a couple minutes in a call for ratios to be implemented, then left. Long Beach police arrived at the scene, but the protesters were already quietly exiting the hotel's lobby by then.

At the heart of the protest was a state mandate, effective Jan. 1, requiring hospitals to provide a minimum number of nurses per patient. For example, there must be one nurse for every four patients in an emergency room and one nurse for every two patients in delivery rooms. The ratio varies depending on the unit.

Several nurses marching with CNA and a CNA official said the ratios are an important part of quality care for patients. They said there are nurses available to meet the ratios but that hospitals are trying to find a way to get around the law.

"I think they ought to be arrested for what they're doing today conspiring to break the law,' said Jill Furillo, a registered nurse with CNA who spoke over a small bullhorn to the crowd.

Jan Emerson, with the California Healthcare Association, disputed the union's accusations and said that the meeting was to educate hospital representatives about the new guidelines, which will be expensive for hospitals to implement.

Emerson said that in 2004, it will cost the industry $422 million statewide to meet guidelines, and as more steps are required in 2005, the costs will increase to $652 million. She said the source of her figures was the state Department of Health Services.

Also, a nursing shortage makes it hard to meet the ratios, she said. Many nurses who will be retiring over the next few years also have to be replaced.

Margie Keenan, a registered nurse at Long Beach Memorial Medical Center in the coronary care unit for 30 years, said she participated in the protest because she is concerned about patient care.

"Citizens of Long Beach, citizens of California need to be taken care of the right way,' she said, adding that the expertise of nurses should be taken into account when it comes to patient care.

She added that she disagreed with hospital industry plans to bring in licensed vocational nurses to supplement the ratios because they still need to be supervised by RNs and that the money should go to hiring RNs instead.

Deann McEwen, a nurse at Long Beach Memorial for 29 years, said there are enough nurses graduating to meet the required ratios, even though the industry disputes that.

But according to Joanne Spetz, an assistant professor at UC San Francisco's Center for California Health Work Force Studies, there are some truths coming from both sides.

Spetz said that former Gov. Gray Davis' administration had announced that $60 million would be given to partnerships that included schools and hospitals to graduate more nurses, but only about $34 million to $36 million has been given out.

Spetz, who has been doing policy research on nursing for about a decade, also said there was validity to union comments that more staffing is better for patients. Some studies have indicated that a higher staffing level helps reduce infection and deaths.

The Los Angeles County Board of Supervisors in a meeting this week said it plans to ask Gov. Arnold Schwarzenegger to delay the mandated nurse-to- patient ratios.

Despite four years to prepare, most hospitals do not expect to be in compliance by the first of the year, according to the Hospital Association of Southern California.

Gomer · Dec 5, 2003

Hey Spacenurse...

If you haven't already read it, check out page 5 in the Dec 1st edition of "Nurseweek".