So I am taking a graduate level research class, and my textbook keeps talking about how there are all of these great care models shown to improve outcomes for patients that aren't being utilized in practice. I just keep thinking about how nurses NEVER have ANY time, and this is probably contributing greatly to the lack of research in practice. It seems like the problem is getting worse and in some cases practice is not only not evidence-based, it's not even safe. Then good nurses stop being nurses because expectations are impossible.
I guess I'm wondering if anyone has any ideas on how to improve staffing ratios? There is evidence out there that the role of the nurse as an educator is as important. How do nurses get the time they need to serve as effective clinicians?
I've read other posts with suggestions like, "cut the CEOs salary", which is a nice idea, but not likely to happen without some sort of catalyst. Does anyone know what the catalyst could be?
Again, I repeat that the purpose for a hospital to exist is ton provide NURSING CARE. ALL other care can be done in an outpatient setting.
Providing sufficient nurses saves money by reducing costly complications and preventable deaths.
With decreased CMS compensation for readmissions within 30 days, ventilator associated pneumonia, bloodstream and other nosocomial infections, and other complications safe staffing ratios save lives and are cost effective:
There are substantial shortfalls in nurse staffing in US neonatal intensive care units (NICUs) relative to national guidelines. These are associated with higher rates of nosocomial infections among infants with very low birth weights.
Improving nurses' work environments and staffing may be effective interventions for preventing readmissions. Each additional patient per nurse was associated with the risk of within 30 days of readmission for heart failure (7%), myocardial infarction (9%), and pneumonia (6%). In all scenarios, the probability of patient readmission was reduced when nurse workloads were lower and nurse work environments were better.â€
Agency for Healthcare Research and Quality, September 26, 2012
The California safe staffing law has increased nurse staffing levels and created more reasonable workloads for nurses in California hospitals, leading to fewer patient deaths and higher levels of job satisfaction than in other states without mandated staffing ratios. Despite initial concerns from opponents, the skill mix of nurses used by California hospitals has not declined since implementation of the mandated ratios.
"Studies involving RN staffing have shown that when the nursing workload is high, nurses' surveillance of patients is impaired, and the risk of adverse events increases." "… We found that the risk of death increased with increasing exposure to shifts in which RN hours were 8 hours or more below target staffing levels or there was high turnover. We estimate that the risk of death increased by 2% for each below-target shift and 4% for each high-turnover shift to which a patient was exposed."
The researchers surveyed 22,336 RNs in California and two comparable states, Pennsylvania and New Jersey, with striking results, including: if they matched California state-mandated ratios in medical and surgical units, New Jersey hospitals would have 13.9 percent fewer patient deaths and Pennsylvania 10.6 percent fewer deaths. Because all hospitalized patients are likely to benefit from improved nurse staffing, not just general surgery patients, the potential number of lives that could be saved by improving nurse staffing in hospitals nationally is likely to be many thousands a year,†according to Linda Aiken, the study's lead author. California RNs report having significantly more time to spend with patients, and their hospitals are far more likely to have enough RNs on staff to provide quality patient care. Fewer California RNs say their workload caused them to miss changes in patient conditions than New Jersey or Pennsylvania RNs
Understaffing of registered nurses in hospital intensive care units increases the risk of serious infections for patients; specifically late-onset ventilator-associated pneumonia, a preventable and potential deadly complication that can add thousands of dollars to the cost of care for hospital patients. Curtailing nurse staffing levels can lead to suboptimal care, which can raise costs far above the expense of employing more nurses
Medical Care,Journal of the American Public Health Association, June 2007
A review of outcomes for more than 15,000 patients in 51 U.S. hospital ICUs showed that those with higher nurse staffing levels had a lower incidence of infections, such as central line associated bloodstream infections, a common cause of death in intensive care settings. The study found that patients cared for in hospitals with higher staffing levels were 68 percent less likely to acquire an infection. Other measures such as ventilator-associated pneumonia and skin ulcers were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units.
Evidence Report/Technology Assessment for Agency for Healthcare Research and Quality, May 2007
A comprehensive analysis of all the scientific evidence linking RN staffing to patient care outcomes found consistent evidence that an increase in RN-to-patient ratios was associated with a reduction in hospital-related mortality, failure to rescue, and other nurse sensitive outcomes, as well as reduced length of stay.
A national study of the quality of care for patients hospitalized for heart attacks, congestive heart failure and pneumonia found that patients are more likely to receive high quality care in hospitals with higher registered nurse staffing ratios.
Patients undergoing common types of cancer surgery are safer in hospitals with higher RN-to-patient ratios. High RN-to-patient ratios were found to reduce the mortality rate by greater than 50% and smaller community hospitals that implement high RN ratios can provide a level of safety and quality of care for cancer patients on a par with much larger urban medical centers that specialize in performing similar types of surger
I love this thread. I'm an ANM on a SPCU floor and I just had this conversation with one of the nurses that work with me. They asked the question about ratios and acuity.
A good example is the patient being charged $25 for one aspirin. It's not the aspirin being charge for. It's the ordering, the verification, the delivery the dispensing and administration of that aspirin.
Until acuity is considered in assignments and nursing hours are billed for and not budgeted for we it will be difficult to change.
herring_RN, ASN, BSN
3,651 Posts
Tenet Healthcare CEO Trevor Fetter CEO's 2014 salary was $13,337,325.00
TENET HEALTHCARE CORP Executive Salaries & Other Compensation | Salary.com
R. Milton Johnson CEO of HCA was paid $10,859,304.00
HCA HOLDINGS, INC. Executive Salaries & Other Compensation | Salary.com
Wayne T. Smith CEO of Community Health Syatems salary in 2014 was $24,442,583.00
COMMUNITY HEALTH SYSTEMS INC Executive Salaries & Other Compensation | Salary.com
Here are 2011 and 2012 salaries for non profit hospitals. Most are more than a million dollars, some many times that.
Chart: Hospital CEO Pay And Incentives | Kaiser Health News
Again, I repeat that the purpose for a hospital to exist is ton provide NURSING CARE. ALL other care can be done in an outpatient setting.
Providing sufficient nurses saves money by reducing costly complications and preventable deaths.
With decreased CMS compensation for readmissions within 30 days, ventilator associated pneumonia, bloodstream and other nosocomial infections, and other complications safe staffing ratios save lives and are cost effective: