New bill for safe nursing standards

[Bjo]

Has anyone seen this new bill summary? I think we need to all write to our representatives and support it. If anyone is interested, I have a sample letter that I would be glad to forward on to you to send. We need to fight for the safer ratios in hospitals and long term care facilities. We have a voice in what we are subjected to. I just thought this was a great start.

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2004 (H.R. 4316)

Introduced by Rep. Jan Schakowsky (D-IL)

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2004 establishes minimum registered nurse-to-patient staffing ratios to improve patient safety and quality of care and to address the nursing shortage that has left our nation's hospitals critically understaffed.

Bill Summary

By January 2007--two years later for rural hospitals--hospitals will be expected to develop and implement nurse staffing plans that meet newly-established minimum direct care registered nurse-to-patient ratios, adjust staffing levels based on acuity of patients and other factors, and ensure quality care and patient safety.

Minimum direct care registered nurse-to-patient ratios: A hospital would be required during each shift, except during a declared emergency, to assign a direct care registered nurse to no more than the following number of patients in designated units:

• 1 patient in an operating room and trauma emergency unit
  
• 2 patients in all critical care units, intensive care, labor and delivery and postanesthesia units
  
• 3 patients in antepartum, emergency, pediatrics, step-down and telemetry units
  
• 4 patients in intermediate care nursery, medical/surgical and acute care psychiatric care units
  
• 5 patients in rehabilitation units
  
• 6 patients in postpartum (3 couplets) and well baby nursery units
  

Based on the outcome of a required study, staffing requirements will be established for licensed practical nurses and will be required to be implemented in all hospitals by January 2007.

Staffing Plans Developed Together with Direct Care Nurses: Hospitals will be required to develop staffing plans no later than January 1, 2006 and must involve direct care nurses and other health care workers or their representatives in the development and the annual re-evaluation of those plans.

The plans must identify and employ an approved acuity system that will establish guidelines by which the hospital must increase staffing above the required minimums based on patient need. The plans must also factor in an appropriate skill mix of other health care workers to ensure that staffing levels account for patient care needs that do not require a direct care registered nurse.

Beginning in 2007, plans must at least comply with minimum ratio standards, but may need to meet higher standards based on hospital specifics.

Enforcement: Uniform notices stating the requirements of this bill including the actual direct care nurse-to-patient ratios for each unit must be posted in a visible, conspicuous and accessible location for both patients and direct care staff.

Hospitals that fail to comply with the nurse staffing plan requirements could face a range of corrective actions, including civil monetary penalties and loss of funds.

Whistleblower Protection: This bill would provide whistleblower protection for nurses by securing a nurse's right and obligation to refuse assignment if doing so threatens the safety and health of a patient by violating the minimum ratios as set forth in this bill or if a nurse is not professionally prepared to fulfill an assignment. The bill also provides protections to any hospital employee who reports a violation of this Act.

Reimbursement: The bill allows for hospitals to receive additional Medicare reimbursement related to costs incurred related to compliance with this bill. Such reimbursement will be based on recommendations by Medicare Payment Advisory Commission (MedPAC).

[BrightonRN]

Please send me the sample letter. I am interested in following up with this

[Boston-RN, RN]

Although this is a great start...what about LTC facilities? I don't see any mention in this bill about safe staffing for those patients.

[Lanceman]

Here is a link to the entire bill. Looks like no action was taken last year when it was introduced other than referring it to a couple of committees that contain Health sub-committees. Unfortunatley this type of legislation is almost always introduced by Democrats and in a Republican controlled house (I am a registered republican but I can see them being against this one from the start) the chances of passage wouldn't exactly be good, unless of course they all actually decide to do something that would benefit the citizens of this country besides catering to their monetary donors (i.e insurance companies and hospitals corporations). Of course maybe the pharmaceutical companies will get behind this one since the longer you can keep people alive the more drugs you can sell them

http://www.theorator.com/bills108/hr4316.html

[Bjo]

Please send me the sample letter. I am interested in following up with this

I sent the letter via private message. You can also check out other political actions at the following site:

www.seiu.org

[MryRose]

Since I am a pre-nursing student at the moment, I may not fully understand why the nursing population doesn't unite together and demand this type of bill. As a 45 year old citizen, i've seen the power of numbers work in government numerous times. A good example is that of AARP.... which by the way, seems like a perfect party to get behind a bill like this. They are the group who would benefit the greates and quickest.

I guess I want to know what prevents a large number of citizens, nurses, from demanding the country give the patients the best of care with safe nursing ratios. It seems crazy that anyone would oppose this.

Before I started the process of becoming a nurse, I truly didn't understand the dire straits that many of the facilities are in when it comes to ratios. Most lay people do not understand it. The facilities hide the actual numbers by dressing everyone alike so the "public" really doesn't know.

I'd definitely support this bill... send me the sample letter for sure.

[Lanceman]

Here is a good website for monitoring the progress of bills introduced to congress, gives all kinds of good information like co-sponsors and lastest action etc.

http://thomas.loc.gov/cgi-bin/bdquery/z?d108:HR04316:@@@L&summ2=m&

[akcarmean, LPN]

Please send me a copy.

Thanks,

Angie

[Bjo]

although this is a great start...what about ltc facilities? i don't see any mention in this bill about safe staffing for those patients.

in ohio, the department of health regulates staffing in nursing homes. however, the ratio is very high (1 stna to 15 residents). you figure in an eight hour shift you can give less than 30 minutes to each person on your hall and maybe you'll have time for a 30 minute lunch. there have been several studies done by hcfa about the relationship to quality care and minimum required staff. this has been going on for about 4 or 5 years i think. the reports i've read always say "there wasn't sufficient evidence to make it an issue." staffing in nursing homes needs to be adequate as well. now, with the cuts to medicare being proposed, it is going to make it even harder to give the quality care the residents need.

[Rose56]

Send me the sample letter, please. Thanks.

[kmchugh]

OK, this is sure to paint a target on my back, but I'm not so sure that this bill would be a good thing, at least not as it is presented in the OP. As it is presented, it simply looks at staffing levels, which I think we all agree are a huge problem. However, what it completely fails to account for is the fact that there is already a nursing shortage. Sudden implementation of such a bill would only make what is a big problem for us all into a crisis. There simply are not enough nurses for this bill to be workable.

I can foresee patients being turned away from hospitals. I can foresee more than half the beds in some units, and in some cases, entire units, being closed down for lack of nurses. I can foresee people dying as a result of not getting into hospitals, and the number of wrongful death lawsuits will skyrocket. And you cannot mandate staffing levels and at the same time mandate that hospitals not take actions (i.e. closing beds/units) to meet the staffing level requirements. The results themselves will be bad enough, but there will also be a national backlash against nursing and nurses.

There is no way the hospitals, who are well organized and funded, and who have entire PR departments, will take any part of the blame for the bad outcomes. They will say that they are "just following the law, and that their hands are tied." Along the way, they will be sure to point out that the laws they are following were the result of the actions of nurses. Only it's likely to come out as "lazy, greedy nurses." There won't be any mention of our concern with safe, sane staffing levels. And at that point, the public perception of nurses won't be much better than their perception of physicians.

While I do believe that there must be some laws that govern staffing (I've seen a medical/oncology with 41 patients covered for third shift by two RN's), those laws must be enacted in a manner that won't cause a sudden crisis. (And yes, that's why Arnie's position in California is correct, though his macho posturing gets in the way.) We have to be farsighted enough to see the consequences of such actions, both good and bad. I think that such a law must be enacted in a way that staffing mandates are implemented over a period of time, giving hospitals time to hire appropriate numbers of nurses. Such a bill must also include measures (not just words) that support nursing education, so that we can increase the number of nurses.

Just telling hospitals "tomorrow, these are the required staffing levels," would in the long run harm a lot of patients, as well as nursing as a profession.

Kevin McHugh

[Sheri257]

OK, this is sure to paint a target on my back, but I'm not so sure that this bill would be a good thing, at least not as it is presented in the OP. As it is presented, it simply looks at staffing levels, which I think we all agree are a huge problem. However, what it completely fails to account for is the fact that there is already a nursing shortage. Sudden implementation of such a bill would only make what is a big problem for us all into a crisis. There simply are not enough nurses for this bill to be workable.

I can foresee patients being turned away from hospitals. I can foresee more than half the beds in some units, and in some cases, entire units, being closed down for lack of nurses. I can foresee people dying as a result of not getting into hospitals, and the number of wrongful death lawsuits will skyrocket. And you cannot mandate staffing levels and at the same time mandate that hospitals not take actions (i.e. closing beds/units) to meet the staffing level requirements. The results themselves will be bad enough, but there will also be a national backlash against nursing and nurses.

Interesting you mention this. In California, where we do have ratios, a few (although certainly not all) hospitals have claimed that ratios are shutting down facilities. However, there's one important factor that's really causing the problem: illegal immigrants who, as you know, are draining the system.

When pressed on this issue, the hospitals usually admit that the illegals are really causing the shut downs, although they like to add that staff ratios are also "part" of the problem. Of course, if you had less illegals, you wouldn't have to hire as much staff to meet the ratios.

Yes, there is a shortage. But every RN I know says more nurses have returned to the bedside because of the ratios. Some estimate 30,000 RNs have come back to work in California since the ratios were implemented. And the BORN has been flooded with license applications from RNs wanting to work here after the ratios were enacted.

We have to be farsighted enough to see the consequences of such actions, both good and bad. I think that such a law must be enacted in a way that staffing mandates are implemented over a period of time, giving hospitals time to hire appropriate numbers of nurses. Such a bill must also include measures (not just words) that support nursing education, so that we can increase the number of nurses.

California hospitals had plenty of time to hire more staff ... five years. Kaiser, for example, met the ratios two years before everybody else. They even put ratios in their union contracts. If other hospitals had planned ahead, they could have done the same.

By most accounts, Kaiser also goes further. Instead of six patients per nurse, their ratios are typically down to four. Apparently Kaiser values RNs and that's why they're probably the most popular place to work in California.

Funny how Kaiser has no problem with the ratio law, and actually exceeds the requirements. But other hospitals claim they can't do the same.

BTW, while Schwarzenegger is trying to roll back portions of the ratio law, he's also been cutting school funding. My nursing school had reduce class sizes by 10 positions because of state cutbacks. So, Schwarzenegger is not doing much to alleviate the shortage.