Nurses Take Campaign for Safe Staffing Levels to Capitol Hill

[Julia RN]

nurses take campaign for safe staffing levels to capitol hill

posted by mike hall on july 14, 2008 afl-cio now blog

"the formula too many hospitals use today to establish nurse-to-patient ratios should be called the “whatever-we-can-get-away with” formula, says suzanne gordon, nursing professor and co-author of the new book, safety in numbers: nurse to patient ratios and the future of health care.

gordon, along with representatives from four afl-cio nursing unions, met in a roundtable discussion with dozens of health care experts from the staffs of senate and house members to explain the dangerous and sometimes tragic impact of understaffing on patient care that is also a major factor in driving nurses from the profession and the growing nurses shortage.

the roundtable, sponsored by the [1] rns working together, the coalition of 10 afl-cio unions representing more than 200,000 registered nurses, is one step in the campaign to build support on capitol hill for the first national nurse-to-patient ratio legislation (h.r. 2123) introduced by rep. jan schakowsky (d-ill.).

the bill would establish minimum 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. this legislation would give nurses manageable patient loads, which would allow them to provide better care while also avoiding preventable medical errors. the bill would establish safe staffing standards in all hospitals, including hospitals that serve medicare and medicaid patients and federally operated hospitals.

gordon, whose book traces how hospital cost cutting in the 1990s created huge new workloads for nurses and deteriorating patient care, told the group that more than 60 studies have documented that hospital understaffing results in more patient deaths, plus more preventable complications like pneumonia, urinary tract and catheter infections, and medication errors.

ann converso, a registered nurse and president of united american nurses uan, noted that the need for safer staffing levels and higher patient care standards were the reasons some 700 kentucky and west virginia nurses, members of uan, waged a three-month strike last fall at the appalachian regional hospital system.

the california nurses association/national nurses organizing committee cna/nnoc was among the organizations spearheading the fight that won california’s first-in-the-nation law establishing a minimum nurse-to-patient ratio of one-to-five. deborah burger, an rn and president of cnn/nnoc, said that before the law was enacted, it was not uncommon to find a single nurse in charge of 8, 10, 12 or more patients on a shift.

jan nygaard, an rn who works in a va hospital in minnesota and who is an afge vice president, says nurses are dedicated to providing the best care possible and giving the correct medications and dosages.

what you do is try to do the best you can with what you’ve got.

but the unmanageable workload—mandatory overtime, double shifts, canceled days off—caused by nurse understaffing is the main reason behind the exodus of nurses from the profession and the resulting shortage. some 500,000 rns in the united states are not practicing their profession, according to a 2007 business week article.

safe staffing levels would bring more nurses back into the field, and in california it already has, says burger:

it made a difference almost overnight. from the time the bill was signed into law in 1999 to 2007, more than 80,000 nurses were added to the workforce."

[BookwormRN]

It sure is great to hear that nurses are stepping up and campaigning for safer staffing.

However, I do not agree with mandated ratios. I believe an acuity system is a much better way to staff.

Sure, they could manadate that every nurse have no more than 4 pts. Well, there are nights I can have 5 pts and it is a great night; on the flip side, I could have 3 pts and be pulling my hair out-it's all about how ACUTE these pts are.

We use an acuity system, and it works pretty well most of the time; as will all things, there can be a glitch here and there.

Speak up-what do you all think???

[RN1989]

I do believe that acuity is a better way to staff. Unfortunately, when acuity is used, different people will determine acuity differently. This is how employers get away with understaffing because "someone" sees the acuity levels much differently than the nurses actually caring for the patients.

There just hasn't been a good way to really crack down on this except for the mandated ratios.

[BookwormRN]

At our facility, we use the MESH acuity system and it seems to work out pretty well. Please see below for the link to the website.

http://www.uwhealth.org/aboutuwhealth/managementandeducationservicesforhealthcaremesh/12761

[Julia RN]

This bill, H.R. 2123, has mandated minimum ratios and staffing by acuity.

If adopted, every hospital would have to develop a staffing plan "on the basis of input from direct care registered nurses at the hospital." If the nurses are represented for collective bargaining, their union must have input as well.

The staffing plan has to meet the minimum ratio set in the bill- for each shift, a direct care registered nurse may not be assigned to more than the number of patients specified for that unit.

In addition, the staffing plan must provide for direct care registered nurse-to-patient ratios above the minimum based upon consideration of the following:

(A) The number of patients and acuity level of patients as determined by the application of an acuity system on a shift-by-shift basis.

(B) The anticipated admissions, discharges, and transfers of patients during each shift that impacts direct patient care.

© Specialized experience required of direct care registered nurses on a particular unit.

(D) Staffing levels and services provided by other health care personnel in meeting direct patient care needs not required by a direct care registered nurse.

(E) The level of technology available that affects the delivery of direct patient care.

(F) The level of familiarity with hospital practices, policies, and procedures by temporary agency direct care registered nurses used during a shift.

(G) Obstacles to efficiency in the delivery of patient care presented by physical layout.

The term acuity system is defined in the bill as an established measurement tool that--

(A) predicts nursing care requirements for individual patients based on severity of patient illness, need for specialized equipment and technology, intensity of nursing interventions required, and the complexity of clinical nursing judgment needed to design, implement, and evaluate the patient's nursing care plan;

(B) details the amount of nursing care needed, both in number of nurses and in skill mix of nursing personnel required, on a daily basis, for each patient in a nursing department or unit;

© takes into consideration the patient care services provided not only by registered nurses but also by direct care licensed practical nurses and other health care personnel; and

(D) is stated in terms that can be readily used and understood by nurses.

[RN1989]

Bookworm,

How does MESH work exactly? Do you have to input patient data to get the acuity results? I did that years ago at one place via Meditech - took forever to do. Does MESH give you a staffing grid to follow for the next shift? Do you usually have the required amt of staff even if the acuity fluctuates high?

[RN1989]

Guess we all need to get on the ball and send a message to our representives and tell them that their nurse constituents want them to support this bill.