patient falls and bed sores were criteria studied by nursing coalition
sacramento business journal - by [color=#2c5d8f]kathy robertson staff writer
the first study of the effect of nurse-to-patient ratios on care in california hospitals concludes hospitals have hired more registered nurses, but they've had little effect on two areas of care -- patient falls and bed sores.
there was no statistically significant change in either area between 2002, two years before california's strict nurse-to-patient ratio law took effect, and 2006, according to a study by the california nursing outcomes coalition.
the findings -- strongly disputed by the state's largest nurses union -- were published in the march issue of policy, politics & nursing practice, a peer-reviewed journal that explores the relationship between nursing and health policy. the study was paid for by the association of california nurse leaders and the american nurses association/california, the two groups that established the research coalition.
the study is significant on a national level because california serves as a bellwether on nurse-to-patient ratios. it was the first, and remains the only, state to enact this kind of law. efforts have started in at least seven other states this year.
I've looked at the study claiming increases instead of reductions in patient falls and bed sores since the staffing ratio laws went into effect in California, and have a few comments to make.
1) The authors mention that ancillary staff had also declined.
2) The authors noted that restraint usage had declined
Both of these factors can contribute to falls.
3) It is way too soon to be analyzing data on the effects of staffing ratios in California. I understand many facilities have been incompliance for less than a year.
4) Each one of these authors is a member of CALNOC, the California version of the American Organization of Nurse Executives with only their statistician not citing membership. This organization is a puppet of the American Hospital Association. Consequently, this article must be assumed to be biased until proven otherwise.
CNA/NNOC can anticipate more of these "anti-staffing laws" "research" to come out and needs to be prepared.
Nursing journals need to start printing author affiliations when publishing "research" on controversial issues. We have already seen the issue addressed by medical journals in reference to the drug studies.
I would advise everyone to criitically look at published research and make sure it is coming from credible universities...and even then, check the affiliations of the authors. Many academics also belong to the AONE and its affiliate chapters.
I say again, the AONE is a chapter of the AHA. Both groups have opposed nursing issues related to mandatory staffing ratios.
The AONE opposed the reform to the Kentucky River decision by the NLRB.
They have openly spread false stories about hospital closures due to the staffing law.
The AONE cannot be trusted to support working nurses, and its members cannot be trusted to present unbiased research (again, until proven otherwise).
The UAN also has some good information on its web site, but falls short of calling for fixed staffing ratios. It copies the terminology of the ANA, which is too vague and lets these facilities off the responsibility hook.
With floors as busy as they are in most major facilities, and with the in and out nature of our healthcare system, expecting that patient acuity systems (not that there are any real ones) can deal with this is, well, assinine.
Trouble with the unions is that they deal only with THEIR facilities.
We need to start thinking nationally.
So far, the CNA/NNOC is the only group advocating for bedside nurses using the mechanism of state law.
Too bad the ANA doesn't have the wherewithall to do it this directly on the national level.
Seems they trust nurse executives to make those decisions...jokes on them...or is it us????
For hospital-acquired pressure ulcers, there was approximately a 14% reduction in the total period of study (14.0% on medical-surgical units and 14.5% on step-down units); however, on medical-surgical units the means were essentially the same in 2002 and 2004, with a decrease only occurring in 2006.
Step-down units demonstrated an increase between 2002 and 2004, with a nonsignificant decrease in 2006 for any ulcers as well as any hospital-acquired ulcers.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
I'm not a researcher, nor a statistician.
I thought, though, that the article at least implied that patients were very likely sicker after ratios than before. It also seemed to say that there was less support staff.
You can't just look at numbers of nurses and numbers of patients only. Any nurse who's ever practiced knows that's way too simplistic. I could have a patient assignment of six and spend half my shift sitting around with my feet up; you could have a patient assignment of six and be lucky to get to go to the bathroom. You have to look at the patients' ages, diagnoses, levels of functioning, meds, IVs, tests, your support staff, whether they are private or staff patients, etc etc etc. Lots and lots of variables here.
I guess I'm saying that I don't think this study showed much of anything, really.
Julia RN
111 Posts
Thought this was a pretty comprehensive document
http://www.dpeaflcio.org/programs/factsheets/fs_2007_staffratio.htm