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Just Say “NO” to Nurse Staffing Laws

Nurses Article   (8,763 Views | 98 Replies | 1,369 Words)

SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

12 Followers; 54 Articles; 17,873 Profile Views; 340 Posts

What Do Nurses Really Feel about Nurse Staffing Laws?

Mandated nurse-patient ratios may be saving lives, but at what cost? This article presents evidence against the idea of nurse staffing laws. If you feel strongly about the topic, give this a read and weigh in. I’d love to have your opinion on the subject. You are reading page 9 of Just Say “NO” to Nurse Staffing Laws. If you want to start from the beginning Go to First Page.

Safe Staffing Laws

  1. 1. Were you taught about safe staffing laws in nursing school?

    • 63
      Yes
    • 163
      No
  2. 2. Do you work in California?

    • 28
      Yes
    • 198
      No
  3. 3. Have you ever been asked to take on more patients than you thought you could handle safely?

    • 196
      Yes
    • 30
      No
  4. 4. Do you think safe staffing laws are a good idea?

    • 214
      Yes
    • 12
      No

227 members have participated

2 Posts; 83 Profile Views

Some of the article mentioned cost factors. I’m curious if anyone ever did a study on what it ends up costing the employer for overtime, call outs, infection rates, errors, turnovers, patient satisfaction when staffing is not optimum.

Same goes true with supplies & ancillary staff. In the end, if you’re staffed well & have all the things you need, the patients are happy & will recommend. If you’re short staffed or don’t have everything, the patients see & are unhappy.

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82Nurse specializes in ICU.

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This amazes me that you don't think safe nurse patient ratios should be mandatory. Hospitals and CEOs should never be making the decisions on Nurse/Pt ratios! Acuity of the pt is of outmost importance, along with the nurse's experience. There are times even when small community hospitals have less than 6 patients, should only one nurse be left alone to care for the entire floor without back up? I think not!! Emergencies happen!The financial bottom line of the hospital should never be considered when staffing nurses. We are the backbone of a HOSPITAL. Safe Practice!! It just seems when cutting back the nurses are the first to be cut, there are many other places other than the front line that can be cut! CEO salary should be first.

 

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2 Followers; 2 Articles; 25 Posts; 1,241 Profile Views

This was originally written on the Yes article, we feel it warrants to be placed here especially. 

Not one analytical study of staffing committees shows that the method promoted by the ANA is effective at improving patient outcomes or nurse staffing. Which you do note in a paragraph above, thank you, but readers need to really understand the gravity of the inadequacy of that legislation. It looks great on paper and in theory, but the real effect of it greatly lacks. 

There is a notion that with mandated ratios that acuity of patients and a nurses skill set cannot be accounted for, but ironically enough, the national nurses study completed by the data we collected and published by the Illinois Economic & Policy Institute and the Illinois Labor & Employment Relations; shows that CA (with ratios) actually accounts for the acuity of patients more than Illinois, a state that has had the ANA legislation since 2007. That legislation is useless.

"47% of nurses in California report that staffing levels are based on the needs of patients in their units compared to just 32% in Illinois" https://illinoisepi.files.wordpress.com/2019/09/pmcr-with-ilepi-do-nurse-staffing-standards-work.pdf

There are mixed results from California, true enough. This can be attributed to methods of data collection and study design and have been acknowledged as so by Aiken. An aspect for people to know, having read several articles (including anti ratio) that explain how California did not have a significant need for an increase in nurse staffing numbers. It has especially been noted in the Kaiser facilities that most of them were already at the legislated level before the law went into place. Therefore, if you look at before and after, you may not see a significant difference depending on data collection and hospitals used in the studies.

When common sense tells us that improvement should occur on such a fundamental topic such as staffing, and some (not all) research contradicts that, we must ask why did those results that don't make sense occur?

Could it be that by statistically correlating items that did not always have a difference, such as falls and bedsores (again mixed results), in with items that have significant findings, such as failure to rescues, resulting in a decreased overall significant result has skewed significant results? Failure to rescues is statistically significant in almost all, if not every study that I have read, even ones that are anti-ratios. Death of a failure to rescue is significant and warrants not being calculated in with other nursing measurements just to decrease the overall significance.

It is no secret that our professional organization does not support real safe staffing legislation. They only support the fantasy "staffing committee" and the acuity method. And don't get me wrong, having nurses participate in the process is a good thing (if it actually happens and acuity needs to be part of staffing; but there needs to be a cap on the amount of patients nurses can be forced to take at one time. Most hospitals have demonstrated that they will only do this after being forced. 

Staffing should be well enough that one call out does not result in unsafe staffing, contingency plans should be in place for unexpected events within reason. It should not be considered unreasonable to have break/resource nurses on units so that nurses are not watching two assignments when someone goes on break. Most hospitals in California have made it work successfully and hospitals there are making Millions-->Billions. So what if it is less than they would like. When CEOs are making Millions (and they are) along with other shareholders.... why do we care that they would make a little less in return for safe staffing? The fact is, even if CA hospitals are below the rest of the nation, they are still thriving. 

In the article against having mandated ratios, it is discussed how EDs in CA wait time increased. That was found in a hospital that refused to hire staff (because they did not want to spend money, documented in the study). Therefore, they went against the law because they did not want to invest in nursing staff. This is an obvious purposeful outcome from the hospital's manipulation. Yet, there are also studies where hospitals did increase their staffing for the law, and the results show wait times decreased. So basically, we are supposed to concede to what a hospital's responsibility is because they purposely did not staff as they should have? Instead of penalizing them for refusing to abide by the law, safely staff, and provide care in a timely manner we should say no to having a safe patient limit?  

NO.... plain and simple. That should not be the response. We absolutely should hold them accountable. 

If anyone would like to contact their legislators to support real safe staffing legislation, you can do so at https://www-nursestakedc-com.filesusr.com/html/6004d0_2ed35ee2fb8ab9833cd60448c91cb3af.html#/

It is time to implement evidence-based practice into holding hospitals accountable for their responsibility... safely staffing.

To see world-renowned Linda Aiken Ph.D. discuss this as she has researched it for over two decades: 

To the author, thank you again for including our movement, getting nurses to discuss the issue, and allow for the education of what nurses need to be advocating for. 

 

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15 Posts; 401 Profile Views

On 12/30/2019 at 6:29 PM, morelostthanfound said:

Having worked at hospitals that have outsourced nutrition and housekeeping services along with security, I would say the answer to that question is a resounding 'yes'.  If those shortsighted approaches don't appease the MBA numbers crunchers, then there's always the implementation of skeleton staffing, the slashing of employee benefits and wage stagnation to fall back on. 

Hospitals are getting rid of these services with our without safe ratios. It should not be an excuse to say no to safe staffing ratios. 

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15 Posts; 401 Profile Views

On 12/30/2019 at 5:21 PM, adventure_rn said:

It's an interesting concept--I'd never considered the trickle-down effects of staffing ratios...

I do wonder if employers would use mandatory ratios as an excuse to squeeze out other ancillary staff in ways that would screw over both nursing and patients.

For instance, would hospitals lay off half of the housekeeping staff 'in order to make up for the increased nursing cost,' resulting in overflowing garbage bins at 2 am?

Hospitals are doing this in states without mandated ratios. It will happen with our without safe staffing.

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On 12/31/2019 at 8:45 PM, myoglobin said:

Not for profit isn't necessarily much better. For example when we first moved to Florida (about ten years ago) and worked for Florida Hospital in Tavares. Frankly, in many ways they were even worse than HCA even though they were "non for profit". In reality their non for profit scenario seemed more like a "tax avoidance" scheme (since non for profit's don't pay taxes on profits) than representing the religious philosophy upon which they were supposedly built.  Having said that I worked for other hospitals like Saint Francis in Indianapolis, that seemed to adhere much closer to the charitable foundation upon which they were built.  Sometimes things that are done "for profit" result in reasonable outcomes (especially when there is robust regulation like in California with regard to safety issues and also robust competition combined with a culture of excellence).  We will never get consensus (at least not in the near future) on socialization/single payer (these are almost civil war/disturbance level issues in many areas of the country). However, almost all nurses of almost all political leanings (at least 80%) should be able to agree of basic, safe staffing level laws like California.  This is the "universal background checks" of healthcare and the ANA opposing these laws would be a bit like the NRA supporting gun control. How can an organization composed almost entirely of nurses (where probably 80% of their members support staffing laws) consistently come out in opposition to such legislation?  Not to be conspiratorial, but I wonder if HCA (and their dark legions of money) doesn't have a "hidden hand" in the organizational workings of the ANA. 

Amen, the HCA facility that I worked in had the worst reputation for staffing in the area (Florida) and the nurse manager consistently stated: "We pride ourselves for staffing on the guidelines of the American Nurses Association".  Out of the other side of their mouth, they were also telling us ICU nurses that 1 nurse for 3 patients (yes sick patients) was the new normal across the US. That is where I started researching staffing and falling "out of like" of the professional nursing organizations. 

A few years later I became an organizer of a grassroots movement NursesTakeDC comprised of bedside nurses advocating for mandated NTP ratios. #SafePatientLimits www.nursestakedc.com

 

 

 

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15 Posts; 401 Profile Views

17 hours ago, Qqlooney said:

Some of the article mentioned cost factors. I’m curious if anyone ever did a study on what it ends up costing the employer for overtime, call outs, infection rates, errors, turnovers, patient satisfaction when staffing is not optimum.

Same goes true with supplies & ancillary staff. In the end, if you’re staffed well & have all the things you need, the patients are happy & will recommend. If you’re short staffed or don’t have everything, the patients see & are unhappy.

Not exactly cost related to what you have posted, but there are studies that show the cost-benefit of having nurses with fewer patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3207188/pdf/hesr0046-1473.pdf a link to one of many that indeed exist.

"Higher RN nonovertime staffing decreased odds of readmission (OR 5 0.56); higher RN overtime staffing increased odds of ED visit (OR 5 1.70). RN nonovertime staffing reduced ED visits indirectly, via a sequential path through discharge teaching quality and discharge readiness. Cost analysis projected total savings from 1SD increase in RN nonovertime staffing and decrease in RN overtime of U.S.$11.64 million and U.S.$544,000 annually for the 16 study units."

 

Many more safe staffing articles at https://www.nursestakedc.com/research

 

 

 

Edited by catstks

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AnnaFender specializes in ER Trauma.

16 Posts; 92 Profile Views

I think it comes down to good managers and charge nurses. That should be their role to monitor thru out the shift the number of patients, acuity level and the nurses who are working.  Know your employees strengths and adapt or plan for the circumstances at hand.  There is no need for negative interractions between staff and management if all know what is expected and it is consistent and that nurses feel supported by management .  You gotta be proactive and not build resentment by complaining.

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SafetyNurse1968 has 20 years experience as a ADN, BSN, MSN, PhD and specializes in Oncology, Home Health, Patient Safety.

12 Followers; 54 Articles; 340 Posts; 17,873 Profile Views

16 hours ago, NursesTakeDC said:

To the author, thank you again for including our movement, getting nurses to discuss the issue, and allow for the education of what nurses need to be advocating for. 

 

And just like I said in the "YES" article - you are welcome and THANK YOU. We absolutely must stand up for patient and nurse safety. Hospitals have demonstrated their inability to follow guidelines, but they will have to follow laws. I will be calling my legislators and marching.

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AnnaFender specializes in ER Trauma.

16 Posts; 92 Profile Views

There needs to be a nationwide nursing union in my opinion

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Older Male LPN has 17 years experience as a LPN and specializes in Neurology.

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We are such good little boys and girls in this country - we waste our time ***ing on social media and complaining - In Europe they take to the streets march, Strike and Protest - and they get listened to....rather than save up for a vacation we need to save for a strike or walkout.  We know where we and most other workers are at in this economy - might as well face up to it.  This is the new Civil rights struggle.  It's not racial - socioeconomic 

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223 Posts; 5,764 Profile Views

The author referred to the case made by a spokesperson for Illinois Health and Hospital Association. This association advocates for the interests of hospitals, not nurses.

The author says: "...take important staffing decisions out of the hands of nurses."

I would like to know what important staffing decisions do nurses make in a hospital that would end with mandatory staffing ratios. 

The author wrote: "...laws currently proposed also don’t take into account nurse education, skills, knowledge and years of experience."

Neither do nurse managers. They just want warm bodies to take care of the largest number of patients, at the lowest cost.

The author says: "Critics of the bill say that the consequences could be catastrophic, causing shortages of nurses and money."

There is nothing more empowering of nurses than a 'real' nurse shortage, not a fake one created right now by employers who don't care to hire novices and train them, or want to pay for additional employee benefits. Cutting down executive salaries would go a long way in hiring a few more nurses.

The author says: "...Olley (2017) suggests that there is a significant research gap to support claims of increased patient safety in the acute hospital setting with improved ratios."

I agree. But there is zero evidence that hospital ratios don't work. Nurse researchers need to get down to work and fill this gap asap.

Lastly, the author states: "The mortality rate may have decreased, but the finances are problematic."

That tells it all. This article is nothing but an effort to gaslight nurses into believing they don't really know what is best for them, and hospital executives know how to make the best decision for them.

 

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