The ANA supports physician funding over safe patient ratios!

California implemented Safe Staffing ratios while still maintaining some of the higher pay in the country.

This is the actual ANA position and explanation for that position. Sounds kind of reasonable to me but I am not from MA.

http://c.ymcdn.com/sites/www.anamass.org/resource/resmgr/bod/Comprehensive_Update_on_Staf.pdf

COMMONLY ASKED QUESTIONS

WHAT IS THE ANA MASS SAFE STAFFING POSITION AND WHY ARE WE OPPOSING THE

MNA BALLOT INITIATIVE?

The nurses who are members of MNA, like all nurses in the Commonwealth, provide

compassionate, patient centered and evidence based care to the residents of

Massachusetts. They are our colleagues. We do not however support the strict staffing

ratio ballot initiative.

WHAT IS THE ANA MASS SAFE STAFFING POSITION?

ANA Supports optimal staffing as essential to providing excellent nursing care with

optimal patient outcomes. Staffing models that consider the number of nurses and/or the

nurse-to-patient ratios and can be adjusted to account for unit and shift level factors.

Factors that influence nurse staffing needs include: patient complexity, acuity, or stability;

number of admissions, discharges, and transfers; professional nursing and other staff skill

level and expertise; physical space and layout of the nursing unit; and availability of or

proximity to technological support or other resources.

Nurse staffing is clearly more than numbers. We favor a plan with enough flexibility

to allow the nurse at the bedside to decide how they provide care after careful

consideration of the acuity of the patient, the experience level of the nurse, and the

resources available on the unit. We also support staffing committees made up of more than

55% clinical nurses to guide organizations in assignment making. We believe organizations

need to be held accountable when staffing is not appropriate.

HOW IS THIS DIFFERENT FROM THE MNA STAFFING BALLOT INITIATIVE?

The impact of the ballot initiative would remove clinical input while staffing

hospitals day in and day out. Assignments are made on the basis of patient needs on any

given day and require professional input. Putting strict ratios into law, makes the

government, who are not nursing professionals, decide each day what patients will need.

Although this measure sounds good on the surface, and recognizing that some nurses have

supported this measure with the perception that it will provide more nurses, in actuality, it

can create more disparate nursing coverage for patient care. Moving staffing decisions

away from the professional nurses in an organization on a daily basis ultimately increases

rigidity, and could actually limit needed coverage on a particular unit, because nurses

would be assigned by law, not by patient need.

Flatline,

While the ANA's position may sound reasonable, flexible and professional (and it is in a perfect world), its not real world workable.

Why?

1. Assigning ratios based on patient acuity would mean first creating a score based algorithm for all possible dx, and any behavioral modifiers the patient might be exhibiting. Then consistently updating the patient's assigned score should their dx or condition improve or deteriorate.

2. Then deciding on what the ideal score is per nurse, ie how many points can they handle.

3. Then hiring a staff member to track scores and pt assignments, and collate information. Potentially in a high stakes environment like an ED.

I dont really see any way to "dynamically" massage staffing ratios in real time. So while it sounds GREAT on paper the ANA's position is ultimately completely unrealistic and unworkable.

I'm no fan of the ANA either, but the link in the OP isn't actually to the ANA position, the ANA position (which I don't agree with either) is here: http://c.ymcdn.com/sites/www.anamass.org/resource/resmgr/ANA_MA_Talking_Points2.pdf

While in theory staffing by acuity workload is far superior to ratios, the ANA's proposed way of doing that still leaves the decision completely up to hospital management, with no proposed enforceable standards they can be held to.

If the huge state of California can implement change, I'm pretty sure that Massachusettes/Minnesota (whatever state) can handle it too. Institutions should allow for a phasing in process, if there is concern for meeting expectations. Rome wasn't built in a day.

Personally, reading the report ignited feelings of anger. Although some of us would like to believe we were ordained RNs on our birthday, no one was born a nurse. The nurses that are hired with less experience will eventually gain experience. I'd rather have some help than no help at all.

The article suggest that quality of care is best when experienced & higher educated nurses are stretched thin rather than having a mix of competency levels with better staffing. This proves that they'd rather individual nurses hold the brunt of responsibility and increased stress when it comes to his/her own practice regarding maintaining a high standard of care. The problem with this thought process is that all of us are human and make mistakes. Let's be prudent and reduce the potential for mistakes. It is the responsibility of these governing boards to maintain the safety of the public.

There needs to be a class action lawsuit. Holding our lively hood and license over our head, should not be the only goal of these boards, especially when they refuse to hold these fortunate companies responsible for providing an optimally safe environment to practice.