Wide Variation Across Hospitals in Nurse Staffing Is Threat to Public’s Health

[NRSKarenRN, BSN, RN]

Kudos to all the nurses staying on the frontlines during this pandemic especially those in COVID ICU's  Karen

August 2020  Univ, of PENN Center for Health Outcomes and Policy Research

Wide Variation Across Hospitals in Nurse Staffing Is Threat to Public’s Health

Quote

According to the CHOPR study published in BMJ Quality & Safety, many hospitals in New York and Illinois were understaffed before the first surge of critically ill Covid-19 patients.

The paper titled, “Chronic Hospital Nurse Understaffing Meets Covid-19,” documented staffing ratios that varied from 3 to 10 patients for each nurse on general adult medical and surgical units. ICU nurse staffing was better but also varied significantly across hospitals.

“It is an immense credit to nurses that in such an exhausted and depleted state before the pandemic they were able to reach deep within themselves to stay at the hospital bedside very long hours and save lives during the emergency.”...

,,,“Half of nurses right before the Covid-19 emergency scored in the high burnout range due to high workloads, and one in five nurses said they planned to leave their jobs within a year,” said lead author Karen Lasater, PhD, RN, an assistant professor and researcher at the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing (Penn Nursing).  “It is an immense credit to nurses that in such an exhausted and depleted state before the pandemic they were able to reach deep within themselves to stay at the hospital bedside very long hours and save lives during the emergency,” continued Lasater. 

“It is very important for the public to take note that in this large study of nurses practicing in New York and Illinois hospitals, half of nurses gave their hospitals unfavorable grades on patient safety and two-thirds would not definitely recommend their hospital to family and friends,” said CHOPR Director Linda Aiken, PhD, RN, a senior researcher and professor at the University of Pennsylvania. She noted that nurses have been rated in the Gallup poll as the profession most trusted by the American public for past 18 consecutive years.

The researchers surveyed all registered nurses (RNs) holding active licenses to practice in New York state and Illinois during the period December 16, 2019 to February 24, 2020, immediately prior to the Covid-19 medical emergency. Hospital nurses reported on the number of patients assigned to them to care for at one time. These nurse reports were linked to Medicare patient-reported outcomes for the same hospitals. They studied 254 hospitals throughout New York state and Illinois, including 47 hospitals in the metropolitan New York area (the five NYC boroughs plus Nassau and Westchester counties)....

 

[Rose_Queen, BSN, MSN, RN]

This is not surprising in the least. Nursing, one of the main reasons patient require hospitalization, is viewed as expense by the bean counters. Of course they want to cut us to right at or below the bare minimum. It's the nurses and the patients who suffer because of it.

[TheMoonisMyLantern, ADN, LPN, RN]

Nurses are the backbone of healthcare, we make up the largest portion of all health care workers and yet we are an "expense". Without us the healthcare system would collapse and yet we have the least amount of say when it comes to staffing. There are so many other things the hospitals could cut instead of clinical staff but god forbid an administrator or bean counter get cut. 

[Wuzzie]

If they billed separately for nursing services you can bet our ratios would be 1/3. Right now we’re lumped in with the furniture and frankly, the furniture gets treated better. 

[JBMmom, MSN, NP]

I feel incredibly lucky that throughout this pandemic in my ICU we have had no more than three patients per nurse, and other than wearing a N95 for months at a time, until visibly soiled, we have had adequate PPE. That being said, having three COVID patients at once I know there were nights that I could not provide the level of care that I would like for my patients. Bed rotation had to suffice for a few turns. Concentrating on mouth care to prevent VAPs and as many other critical interventions as we could manage. We have received numerous emails about the "concerning" number of device related injuries sustained in the past six months. I'm sure it's concerning to someone in an office that cannot see that patients with COVID skin have literally had their cheeks peel off with the same ET tube holders we've been using for years. We've been proning patients for years and haven't sustained the pressure injuries we've seen recently. They don't care that our level of commitment to providing optimal care for our patients hasn't changed. But due to the acuity of the patients and the increased workloads, there have been some negative effects. It's never the system that's failed, it's the nurses. That's the frustrating part. 

[TheMoonisMyLantern, ADN, LPN, RN]

10 hours ago, JBMmom said:

I feel incredibly lucky that throughout this pandemic in my ICU we have had no more than three patients per nurse, and other than wearing a N95 for months at a time, until visibly soiled, we have had adequate PPE. That being said, having three COVID patients at once I know there were nights that I could not provide the level of care that I would like for my patients. Bed rotation had to suffice for a few turns. Concentrating on mouth care to prevent VAPs and as many other critical interventions as we could manage. We have received numerous emails about the "concerning" number of device related injuries sustained in the past six months. I'm sure it's concerning to someone in an office that cannot see that patients with COVID skin have literally had their cheeks peel off with the same ET tube holders we've been using for years. We've been proning patients for years and haven't sustained the pressure injuries we've seen recently. They don't care that our level of commitment to providing optimal care for our patients hasn't changed. But due to the acuity of the patients and the increased workloads, there have been some negative effects. It's never the system that's failed, it's the nurses. That's the frustrating part. 

It used to be that tripling in the ICU's was relatively uncommon around here and if it did happen usually the 3rd patient was a PCU/medsurg overflow and required less care. Now I hear that nurses are consistently taking 3 critically ill patients a piece and with the acuity it is simply just too much. Add to that that the ICU's around here have done away with monitor techs and secretaries, the workload is just too much. 

[JBMmom, MSN, NP]

14 hours ago, TheMoonisMyLantern said:

Add to that that the ICU's around here have done away with monitor techs and secretaries, the workload is just too much. 

This is a key point!! Having three ICU patients is daunting enough at times, but in our unit, the unit coordinator and techs are no longer required to be monitor trained. Our monitors can show a second room's monitor screen so if you're in one room for a while you can at least keep tabs on the vitals of your second patient. However, if you've got third someone is left out. And when all the nurses have patients on precautions and we don't have a charge person without a patient assignment, we have narrowly averted disaster on a couple occasions. Like when one patient was able to get out of the wrist restraints and accidentally disconnected her ventilator. I could hear the monitor two doors down but couldn't see it. By the time I doffed my PPE in my room and got to her doors, she was in the 40s for a sat by her O2 sensor. Could have easily coded, but fortunately it turned out okay. I'm sure others places have experienced similar situations and maybe not al turned out okay. The do more with less approach is a risky proposition and I hate to be the family member of the patient for whom the outcome is not favorable.  

[toomuchbaloney]

Patients are hospitalized because they require nursing observation and care. If patients don't require nursing care, all of the medical treatments and procedures are outpatient.  All of the inpatient units are nursing units.  

Since Nixon, health businesses have searched for ways to decrease the cost of nursing care in order to increase profit. 

[DNPStudy, MSN]

I lived through this. Post pandemic, having 3-4 patients in the ICU is unacceptable. I'm glad Oregon has passed their staffing ratio law similar to California. I'm currently doing a research on the topic.