Seachange Bulletin #131April 25, 2004Seachange Bulletin ArchivesEmail the editorSeachange Bulletin #131: Minimum RN-to-Patient Ratios II If You Want Safe Staffing, You Must Be Part Of This Crowd Assemble 9:30 AM at State House, Nurses Hall, Boston * Let your legislators know you want safe staffing for Nurses Week * Stand up for your practice and your patients Please let us know if you are planning to attend and also if you would like to have bus transportation provided or not, by emailing Dolores Neves (dneves@mnarn.org). Introducing the MNA "Tuesday Reporter" Massachusetts Nurses Association, February 2004 <http://www.massnurses.org/safe_care/Tuesday_Reporter/index.htm> In an effort to keep legislators, policy makers and other advocates informed about H.1282 and to help convince them to support this vital legislation, the MNA has created the "Tuesday Reporter," a concise easy-to-read flyer that is designed to follow the Massachusetts Hospital Association’s "Monday Report." Each issue contains excerpts from the latest research, key news reports, as well as personal viewpoints from nurses, patients and advocates for the legislation. Media members, policymakers and nurses who have seen and read the "Tuesday Reporter" give it rave reviews and some chairs have already begun leafleting it to their members in their bargaining unit, while others are posting copies on their MNA bulletin boards. We invite you to copy and distribute these as you see fit as part of your efforts to support H.1282. If you want or need additional flyers or information on the campaign, please call Kate Anderson at 781.830.5713 or email her at kanderson@mnarn.org. The hospital industry's opposition to H. 1282 and why it is wrong Julie Pinkham, Executive Director, Massachusetts Nurses Association, February 27, 2004 <http://www.massnurses.org/News/2004/02/H1282IsWrong.htm> As we head into the final months of the legislative session, the Coalition to Protect Massachusetts Patients will be pushing for passage of H.1282-safe staffing legislation that would regulate RN-to-patient ratios in Massachusetts hospitals. Opposing this bill will be two principal groups: the Massachusetts Hospital Association and their subsidiary, the Massachusetts Organization of Nurse Executives (MONE). Their opposition is based on the following arguments: 1) the bill strips nursing leaders of their ability to make "professional" judgments about staffing; 2) H.1282 fails to provide flexibility to account for the changing needs of patients; 3) there are not enough nurses to meet the ratios; and 4) the cost of meeting these ratios is too high, and will result in the decimation of the state's already fragile health care system. My task here is to examine each of these arguments in light of past history, nursing research and common sense. Under such scrutiny, I'll show that none of these arguments against the bill holds any water. ... Nurse ratios harm hospitals Charles E. Cavagnaro 3D, Boston Globe, March 2, 2004 The Massachusetts Nurses Association is attempting to force through the Legislature a potentially harmful and scientifically suspect piece of legislation. The union, which represents less than one quarter of Massachusetts RNs employed in nursing, has been pressuring the Legislature to support its "mandatory nurse staffing ratios" as if it were their patriotic health care duty. Ratios would force every hospital in the state, no matter its size or specialty, to assign a certain number of nurses to a particular number of patients on every shift. Never mind the conditions of the patients - conditions that can change hour by hour, shift by shift. Ignore the choreographed interplay of hospital staffing - how RNs, nurse managers, doctors, administrators, and support staff all weave through wards to keep patients well and alive. Scrap the long-accepted patient safety idea of aligning a nurse's training and experience with the conditions and needs of the patient. The Nurses Association says forget it all in favor of etched-in-stone ratios. Under the proposed law, if the community hospital you rely on breaks the ratio, it would face a daily $25,000 fine and could lose its license to operate. If a nurse manager wants to shift a nurse at 3 am from a relatively quiet maternity ward to a busy ICU, he or she couldn't if the move violates the Nurses Association's maternity ward ratio. ... (Editorial Comment: Thank you, Dr. Cavagnaro. You have demonstrated quite clearly why hospital administrators are the least appropriate people to pass judgment on safe staffing levels.) MNA’s response: Below is a summary of the key points made in the above op-ed, which we have countered with the facts: Claim: The writer claims this is "MNA/Union backed bill being forced on the legislature." Fact: The bill is supported by 82% of Massachusetts voters and is endorsed and being actively promoted by a The Coalition to Protect Massachusetts Patients, a coalition of more than 65 of the state’s leading health care and consumer advocacy organizations, including the The American Heart Association, American Cancer Society, Health Care for All, Mass. Association of Older Americans, Mass Senior Action Council, Mass. League of Women Voters, just to name a few). The bill was written to comply with recommendations made by a special legislative commission, which spent months studying the problems in hospitals and characterized nursing in Massachusetts as in a "state of crisis." To date, 102 out of 200 legislators have signed on as sponsors of the bill and the Joint Committee on Health Care has unanimously approved the bill. Lastly, a survey of Massachusetts nurses, with more than 70% having no affiliation with the MNA, found that nearly 9 in 10 nurses in this state support H. 1282. Claim: The bill lacks flexibility and doesn’t account for changing needs of patients by forcing hospitals to adopt "etched in stone" ratios. Fact: The MHA and this writer’s claims about the lack of flexibility provided by H.1282 is the most blatant misrepresentation of all. It is clear that this writer either hasn’t read the bill. Ratios would vary for each unit and specialty area and ratios would constitute a staffing ‘floor.’ A standardized patient ‘acuity’ system would provide hospitals the flexibility they need to increase staff to meet patient needs. This bill puts into effect the flexibility that fails to exist in today’s hospitals. It codifies the clinical judgment of registered nurses long ignored by the hospitals to the detriment of the patients. Claim: There is not evidence to support the use of ratios to improve care. Fact: According to the most prestigious medical journals, the most important question a patient can ask when entering a hospital today is "how many other patients is my nurse caring for?" The answer could have life or death consequences. The Journal of the American Medical Association published a landmark study that showed that any time a medical/surgical nurses is assigned more than four patients, the risk of death increases by 7% for each additional patient. If a nurse has 8 patients compared to the 4 patients recommended under H. 1282, the risk of death increases by 31%. The author of this study concluded that mandating RN to patient ratios is "credible" approach to both improving patient care and stemming the floor of nurses leaving the bedside because of poor staffing conditions. The Institute of Medicine, the nation’s most prestigious scientific body spent a year studying the nursing crisis and concluded their was overwhelming evidence that poor staffing harms patients and improvements in staffing will improve patient care. The report stated that regulatory solutions like those proposed under H. 1282 should be part of a multi-faceted response to the problem. The IOM called for mandating ratios in ICUs, and proposed a much more radical approach than H. 1282; which is to give front-line, direct care nurses the right to halt admissions when they feel they have too many patients to provide safe patient care. There is no evidence to support the industry’s attempt to maintain the status quo. In fact, there have been no less than five reports by state and national agencies and organizations criticizing the status quo and calling upon the industry to improve ratios to protect patients. Here in Massachusetts , the DPH issued a report last October that showed a 76% increase in medical errors, patient injuries and complaints with the majority attributable to poor nursing care. According to all the research and all the reports maintaining the status quo is a recipe for increasing complications, injuries to patients, medication errors and mortality. Claim: The industry can’t meet the ratios because there is a shortage of nurses. Fact: Massachusetts has more nurses than any state in the country, per capita. Nurses, burned out with high patient loads, are leaving the bedside. Many nurses are no longer willing to work in situations where they are unable to provide proper care for their patients. The only way to protect patients and to retain skilled nurses in our hospitals is to establish safe staffing standards. In addition, 60% of nurses employed in Massachusetts hospitals work part-time. There are currently enough nurses employed in hospitals to meet the ratios. Again, studies in the most prestigious nursing journals clearly show that it is poor staffing conditions that have and continue to drive nurses away from the hospital bedside. A study in JAMA found that for every patient in addition to 4 assigned to a nurse, the rate of burnout for that nurses increases by 22%, and the rate of job dissatisfaction for that nurses increases by 15%. A study last fall in the Journal of Nursing Administration found that poor staffing is the primary cause of nurses losing satisfaction with their job and with their profession. Conversely, the authors argued that improving ratios was the key to improving patient care and stemming the nursing shortage. A survey of nurses in Massachusetts, 70% of whom had no connection to the MNA, found that more than half have thought or are thinking about leaving bedside nursing because of the current staffing conditions. Of those who have left, 65% said they would be more likely to return should H. 1282 become law. The formula is simple: poor ratios are driving them away; good ratios will bring them back. Claim: Hospitals in California are predicting they will not be able to meet the standard; one California hospital has already closed its doors as a result. The same could occur in Massachusetts. Fact: No hospital in California has closed because they had to provide a safe level of nursing. In fact the two largest hospital chains in California have publicly stated that they are in full compliance with the ratios, and one system, Kaiser Permanente, is advertising they will provide even better ratios "because it will reduce nurse turnover and the costs of complications." No hospital in California has closed because of the new law to regulate ratios. One hospital, which had been in financial trouble for six years, did close, but it had nothing to do with the ratio law. In fact, that hospital is being investigated by authorities in part for its attempt to falsely blame the ratios for its decision to close. In fact, the research shows that hospitals that invest in more nurses will save millions of dollars in reduction in nurse turnover, shortened length of stay and the prevention or reduction of a number of costly complications that have been show to be caused by understaffing of nurses. One study published found that for every $1 invested in hiring nurses to improve ratios resulted in $1.20 in savings due to reductions in nurse turnover. We believe, and the studies show, that an investment in nursing will provide huge dividends to hospitals in improved patient outcomes, higher patient satisfaction and, yes, better financial performance. Nurses need public's support for staffing bill Joyce Hunt-Hosea, RN, Braintree, The Patriot Ledger, March 2, 2004 <http://ledger.southofboston.com/articles/2004/03/02/opinion/opin02.txt> Even though nurses are repeatedly voted as the No. 1 professional regarded by the public for their honesty and ethical standards, what we really need is public support and media coverage to ensure the passing of House Bill 1282 Safe Staffing. Staffing does have an impact on patient outcomes. The media has a responsibility to inform the reader of the repeated results of surveys that show substandard care, complications and even deaths are associated with nurses having too many patients to care for. This is also the reason why many of my colleagues leave the profession. In an eight-hour day, I can be responsible for five to six patients; the ratio is even higher in long term care facilities. Each patient is lucky to receive one hour of care in an eight-hour shift. Make no mistake, medical care is big business, and hospitals will make every effort to sabotage this bill. Improved safety and quality of care patients receive are dependent upon the passage of House Bill 1282. For information on how safe staffing saves lives, or how to contact your representative, visit <http://www.massnurses.org>. We need your support - now. Nurse staffing ratios help patients Suzanne Gordon, Arlington, Boston Globe, March 6, 2004 The argument by Charles E. Cavagnaro III against nurse-to-patient staffing ratios (op ed, March 2) demonstrates exactly why we need them. Over the past decade, hospitals have proved time and again that they cannot be trusted to provide patients with adequate levels of nursing care. Studies have shown that patients have died and suffered more complications from preventable medical errors and injuries because of hospital nursing cutbacks. Hospital administrators want "flexibility" in order to protect patients. But over the past decade we've learned how these administrators define flexibility. Indeed, executives who argue against staffing ratios use ratios of their own in the form of patient acuity systems that dictate how many nursing hours per patient day each patient is allowed. Rather than having government mandates, hospitals have corporate mandates in the form of benchmarks, which compare hospital staffing practices and drive nursing care down to its lowest common denominator. These corporate-imposed staffing ratios are sometimes applied on an hour-to-hour basis, not on a shift-by-shift basis, as the proposed ratios would function. Far from being self-serving, as Cavagnaro claims, support by nurses of staffing ratios serves their patients and the public. Nursing is highly specialized Karen Higgins, RN, President, Massachusetts Nurses Association, Boston Globe, March 8, 2004 In his March 2 op-ed article opposing legislation that would establish safe registered-nurse staffing standards in Massachusetts's hospitals, Wing Memorial Hospital CEO Dr. Charles Cavagnaro argued that such a bill would prevent nursing administrators from transferring a nurse in the maternity ward to care for critically ill patients in a busy intensive care unit ("Nurse ratios harm hospitals"). As a critical care nurse who has worked in ICUs for 27 years, I was appalled by his statement. Nursing, like medicine, is highly specialized. There is no way I would ever want to be transferred to a maternity floor to deliver a baby. By the same token, you absolutely don't want your 75-year-old grandmother with congestive heart failure on a respirator, several medicine pumps, and a heart monitor cared for by a nurse from maternity. Any nurse administrator who would ask this of you doesn't deserve to have a license. If your grandmother came to my ICU and was assigned to a maternity nurse, I would urge you to transfer your grandmother to another hospital. Unfortunately, these staffing practices are the norm for many hospitals in our state. This CEO's reason for opposing the bill is the very reason it needs to be passed. It is also the reason 65 of the leading health care and consumer advocacy organizations in the state have banded together in support of legislation to regulate RN-to-patient ratios based on patients' needs. Patient-nurse ratios Sage Skog, RN, Jamaica Plain, Boston Globe, March 8, 2004 I am one of many registered nurses in Massachusetts who are concerned about the quality of patient care in our hospitals. Most hospitalized patients have experienced the frustration of waiting 15 to 20 minutes or longer for a nurse to bring a pain medicine or administer treatment. No nurse wants his or her patients to suffer needlessly. Due to the increasing ratio of patients to nurses in our market-driven health care system, nurses are required to care for too many patients and must delegate more nursing tasks to unlicensed professionals. A sick patient does not want to be cared for by a nurse who does not have time to comfort them. Nurses are forced to prioritize care to patients deemed more acutely ill while other patients may wait hours to ask a nurse a simple question. Research has shown that more medication errors occur with nurses caring for too many patients. Your own life could depend on poor hospital administration policies that put profits before patients. Medicaid cutbacks, rising health care costs, and a nationwide nursing shortage contribute to hospitals' attempts to control costs by increasing the ratio of patients to nurses. The only real solution to this growing health care crisis is the enactment of legislation that would require hospitals to set standards for safe ratios of patients to nurses. A bill must be passed to ensure quality patient care and safety in hospitals. And the next time you or a loved one are hospitalized, ask your nurse how many patients she or he is caring for. Woman Learns to be a Better Doctor After Becoming a Patient Rebecca Deusser, Sentinel & Enterprise, March 14, 2004 <http://www.sentinelandenterprise.com/Stories/0,1413,106%257E4992%257E2017868, 00.html> Fitchburg - Iris Sullivan thought she was going to die just two weeks into her cancer treatment. Sullivan, a family doctor in Fitchburg , began to experience severe abdominal pain, fever and dizziness late one January 2003 evening. "I asked a nurse to help me to the bathroom, and that's the last thing I remember," Sullivan said. Sullivan had gone into septic shock caused by an intestinal infection. She later woke up to a room full of people. "It was a bad night. I felt an excruciating pain I had never had before," said Sullivan. She endured the incident without pain killers, because her blood pressure was too low to take them. "That made it very clear to me the importance of pain control in patients," Sullivan said. "I was begging for morphine." Hospital staff moved Sullivan to the intensive care unit and called her husband. "I thought, 'That's it, I'm not going to make it.' I thought I was going to die," Sullivan said. Though Sullivan survived, she said the experience made her feel weak and vulnerable. After 14 months of battling leukemia and recovering from a bone marrow transplant, Sullivan will resume her practice at the Park Hill Family Clinic in May. She'll return to work with a new perspective on medicine, and the high costs of health care. ... Sullivan saw her first patient, and then another. But by mid-morning, Fluet persuaded her to drive to the Dana-Farber Cancer Clinic in Boston. ... "They are already booking patients for me," she said. But Sullivan said her illness has changed some of her views on medicine. "I have a much higher regard for nurses, the patient-to-nurse ratio is very important," she said. "You see physicians once a day, but nurses are there for the aches and the worries." Sullivan said while she had a positive experience at Brigham and Women's Hospital in Boston, she said nurses at local HealthAlliance Hospital did not have the numbers and the time to provide the same type of care. "It is a real eye-opener," Sullivan said. ... Don’t Leave Patient Safety to the Luck of the Irish Massachusetts Nurses Association, Tuesday Reporter #5, March 2004 <http://www.massnurses.org/safe_care/Tuesday_Reporter/tr5.pdf> Imagine you are out in the city of Boston when you suffer a serious injury that results in your being placed in an ambulance. Depending on where you are in the city, the ambulance driver can choose between a variety of hospitals. Because you happened to be closer, you end up at New England Medical Center where the ratio on a medical surgical floor is one nurse to four patients. Research shows your nursing care and chances of recovery will be very good. However, should your ambulance end up at St. Elizabeth’s Medical Center, your nurse-to-patient ratio may be as high as one to seven, placing you at a 21% greater risk of suffering a serious complication or even dying. You had no real choice in this decision. Your insurance card was the same, but the standard of care and your potential outcome are vastly different. Linda Aiken, the nation’s leading researcher on nurse staffing and patient outcomes recently wrote that "most Americans don’t realize that the quality of hospital care varies so widely that one hospital may be more likely than another, even within one community, to save the life of a patient. Until recently, few people understood that the availability of nurses is a major determinant as to why outcomes differ among hospitalized patients. ..." For more information on this issue, visit <http://www.protectmasspatients.org> or <http://www.massnurses.org>. Testimony before the House of Representatives Fiscal Year 2005 Budget Task Force on Hospitals Julie Pinkham, RN, Massachusetts Nurses Association, March 15, 2004 <http://www.massnurses.org/News/2004/03/testimony.htm> My name is Julie Pinkham, executive director of the Massachusetts Nurses Association. On behalf of the 22,000 registered nurses and health care professionals of the MNA, I commend you for holding this most important hearing. Candidly, something of its sort is long overdue. The MNA represents registered nurses on the front-line of today’s health care delivery system in all settings, with the largest portion of our membership working in our acute care hospitals. In fact, MNA has members who are front-line nurses working in every hospital in the state, and through our collective bargaining program, we represent nurses working in 60% of the state’s acute care hospitals. My remarks today depict the frustration that front-line registered nurses feel each and every day they arrive in a hospital floor or unit. From the perspective of nurses who work on the front-lines and spend more time with patients and their families than any other provider group, the Massachusetts health care and hospital system needs an overhaul and real reform: it deprives access to those who need services and delivers inadequate to unsafe care to those who manage to obtain access. While structured with the goal of being economically efficient, our health care system is one of the most costly in the nation. Unless dramatic changes are made, it is a system with no prospect of emerging from its current crisis state. ... Staffing law has nurses California dreaming Jennifer Heldt Powell, Boston Herald, March 29, 2004 <http://business.bostonherald.com/businessNews/view.bg?articleid=2121> Patricia Healey, an intensive-care nurse at a major downtown teaching hospital, is envious of her colleagues in California, and not just because the weather is warmer there. A California law that went into effect in January mandates minimum staffing levels, ensuring that there are enough nurses per patient, advocates say. That's a dream Bay State nurses hope to one day realize, Healey said. It's frustrating and stressful to have to leave a patient in need to admit another patient or run to another part of the hospital to help with an emergency, she said. "It makes me feel like I'm a bad nurse because I can't keep up," she said. "You start blaming yourself." Many nurses don't want to work in hospitals, citing pressure, and that contributes to a growing nursing shortage, nurses say. "They know they'll have to race around trying to get everything done," Healey said. "It's incredible pressure to know that you've played a role in not helping patients get better." ... Ratios no nursing solution Boston Herald Editorial, March 31, 2004 <http://news.bostonherald.com/opinion/view.bg?articleid=460> Just because California projects a health-conscious image, its buff new governor the very embodiment of a chopped salad, in-line skating, abs-firming lifestyle, is no reason Massachusetts ought to follow in its health-care policy footsteps. Keeping in mind the Golden State is where Taco Bell and Bob's Big Boy got started, there's another side to mandatory nurse-staffing measures, too. It took from 1999 until January 2004 for state regulators to figure out how to implement California's nurse-to-patient ratio law. And even now, nine out of 10 California hospitals surveyed aren't meeting the new requirements. Why? Governmental demand doesn't necessarily translate to private market supply. There just aren't enough nurses entering the field to meet the new strict staffing rules. It makes no sense to enforce rigid staffing rules across the board at all hospitals, when those institutions' needs - and those of their patients - vary greatly. And who can better determine those needs - a hospital administrator walking the halls of his facility or a lawmaker walking the halls of the State House? ... Editorial Comment: The experts on bedside nursing care have determined the needs of acutely ill patients. The Board of Directors of the Massachusetts Nurses Association, the professional organization of registered nurses in Massachusetts, in consultation with thousands of other bedside nurses in every aspect of acute care, guided as well be the mushrooming research on this question, and in concert with sixty-four other patient-advocacy organizations, have set the numbers and are demanding that the legislators do the right thing. Senator Richard Moore, cochair of the legislature’s Joint Committee on Health Care, was shamed into abstaining last November when the rest of the committee voted to support H.1282. But that has not stopped him from continuing his campaign of advocacy on behalf of the industry by filing parallel legislation that merely institutionalizes the inadequate and dangerous status quo and by writing op-ed pieces to confuse the issue. Moore’s Bill Misses The Mark On Patient Safety Protects The Industry At The Expense Of Patients Massachusetts Nurses Association, April 1, 2004 <http://www.massnurses.org/safe_care/Tuesday_Reporter/tr6.pdf> Legislation by Senator Richard Moore that purports to address the current nursing crisis in Massachusetts, while well intentioned (sic), fails to provide any provisions that will protect hospital patients from the current dangerous RN staffing practices. Numerous prestigious studies shows that understaffing of RNs is causing injury, harm and even death to thousands of patients every year. While the bill includes important initiatives to increase nursing faculty and recruitment efforts, his approach to the staffing crisis endorses the status quo and allows hospital administrators to continue to endanger patients by forcing registered nurses to care for too many patients at a time. ... Time to heal the nursing issue Senator Richard T. Moore, Boston Globe, April 5, 2004 <http://www.boston.com/dailyglobe2/096/oped/Time_to_heal_the_nursing_issue+.sh tml> For too long our state's health care system has been embroiled in a battle over mandated nurse staffing ratios. The Massachusetts Nurses Association wants the state to determine the maximum number of patients assigned to a registered nurse per shift. The association argues that patient safety is at risk without state mandated staff ratios. Conversely, hospitals and other providers say staffing decisions should continue to reside with their care managers based on each patient's needs, and that "arbitrary" ratios will result in service cutbacks that will, in turn, harm patient safety. This prolonged debate needs to end for the very reason both sides cite - the care and safety of patients. Patients need to know that disagreements will not affect the system on which they rely for professional health care in a safe, caring environment. The Legislature has before it a reasonable and equitable solution to this controversy, "An Act to Support the Nursing Profession and Promote Safe Patient Care." This bill offers a more comprehensive solution to the nurse shortage than staffing ratios alone and includes the steps needed to develop a sufficient supply of nurses. The bill addresses three main issues - bolstering the state's nursing work force, creating an open and "transparent" procedure to hold hospitals accountable for making their nurse staffing plans available to the public, and instituting a series of nurse-sensitive performance measures to allow the state to monitor how hospitals are meeting national standards of care. ... Combating the nursing shortage Jeanette Ives Erickson, Senior Vice President, Massachusetts General Hospital, Boston Globe, April 7, 2004 <http://www.boston.com/dailyglobe2/098/letter/Combating_the_nursing_shortage+. shtml> State senator Richard T. Moore is on target in his efforts to address the emerging shortage of nurses ("Time to heal the nursing issue," op ed, April 5). Moore offers a strategy that focuses on the root causes of the shortage and proposes initiatives that would help ensure an adequate supply of skilled nurses today and into the future. Professional nurses share a common goal: an unwavering dedication to providing quality patient care in a safe environment. Our ability to achieve this goal hinges on having enough nurses who are appropriately educated and trained, supported in their work, and given a strong voice as advocates for patients and their practice. Moore has suggested statewide financial, educational, and professional initiatives for nursing. ... More nurses, better care MetroWest Daily News Editorial, April 11, 2004 <http://www.metrowestdailynews.com/opinion/view.bg?articleid=65450> Bedside nurses are angels of mercy. They provide medication for pain, ice for parched lips, and encouragement when getting out of bed after surgery seems an impossible task. More importantly, they monitor a patient's life signs, and are the first line of defense against death. But the financial crunch that has plagued the state's hospitals for the last decade or more has taken a toll on its nurses as well. For a variety of reasons, hospitals are now facing a nursing shortage, and there is much talk of the need to attract a new generation to this vital profession. The Massachusetts Nurses Association argues that efforts would be better spent bringing back nurses who have left the profession or work in other health venues. They've left, the MNA says, because staffing levels at hospitals are too low, endangering the lives of patients and the job satisfaction so important to nurses. Inadequate staffing levels - as low as one nurse to 10 or more patients on a medical/surgical ward, according to some reports - do more than stress nurses; they compromise care. According to the Joint Commission on Accreditation of Healthcare Organizations, "inadequate (nurse) staffing levels have been a factor in nearly 25 percent of the most serious life-threatening events that have been reported to the Commission in five years." Reducing those errors could save $32 million a year, according to one estimate. Retaining nurses who are already trained could save hospitals money on recruiting and training. An MNA survey of part-time nurses found that 34 percent would extend their hours if staffing was increased to meet the need. ... Nurses: Staffing levels are dangerously low Jon Brodkin, MetroWest Daily News, April 12, 2004 <http://www.metrowestdailynews.com/health/view.bg?articleid=65519> When Cathy Caruso went back to nursing in 2001 after a 10-year hiatus spent raising her kids, it was clear to her things had changed for the worse. As a nurse at MetroWest Medical Center in Natick, Caruso said, she routinely had to care for seven patients at a time, a level many nurses consider unsafe. Caruso resigned within a year to take a lower-paying job as an elementary school health teacher. "If one person had a bad day or a bad turn, and required my attention, that meant six patients weren't getting my attention," she said. "(I was) very concerned for what wasn't being done for the rest of my patients." That's why Caruso and many others want the state to require what they call safe nurse-to-patient ratios. The Massachusetts Nurses Association argues hospitals are understaffed, increasing the risk of patient complications and deaths. Hospitals don't have to publicly report their per-shift staffing levels, but it's no secret there's a nursing shortage. The latest recorded vacancy rate was 8.5 percent statewide, according to the Massachusetts Hospital Association. Two very different pieces of legislation that attempt to solve the problem have set the stage for a battle between nurses and hospital executives. The debate could affect the way hospitals are operated for decades to come. Nurses support a bill, similar to one enacted in California, that would mandate ratios of no more than four patients per registered nurse in medical and surgical areas, and no more than two patients per registered nurse in intensive care units. If ratios were mandated, many former nurses would consider coming back to hospital work, solving the nurse shortage problem, proponents say. Another bill, recently filed by Committee on Health Care Co-Chairman Sen. Richard Moore, D-Uxbridge, aims to increase nursing schools' faculty and help hospitals recruit and retain nurses. The bill would not require specific staff levels, but would force hospitals to report staffing plans to the state. ... Forum favors health care bills Nurse staffing levels at issue Kathleen Shaw, Worcester Telegram & Gazette, April 14, 2004 Worcester - Area legislators, nurses and political activists called on Massachusetts residents yesterday to support three bills that will affect how health care is provided. The issues involve nurse staffing levels in hospitals, affordable prescription drugs and a single-payer health care system open to all residents. The Massachusetts Senior Action Council, Massachusetts Campaign for Single Payer Health Care, and the Massachusetts Nurses Association drew more than 50 people yesterday to a legislative forum at the Worcester Senior Center. ... The Massachusetts Nurses Association supports House Bill 1282 to set up what it called "safe staffing" levels at hospitals. Recent studies show that more people die when the nurse-to-patients ratio rises beyond a certain level, and fewer patients die when nursing staff in hospitals is at an acceptable level, according to Karen Higgins, a registered nurse and MNA president. Ms. Higgins said detractors such as the Massachusetts Hospital Association try to say this is a bill sponsored by the nurses union to benefit the nurses. The bill will also provide protection for non-union hospitals, she declared."This bill puts in a safety net that has been shredded over the years." Ms. Higgins, a nurse at Boston Medical Center, said many Massachusetts hospitals, while requiring registered nurses to take care of increasing numbers of patients, are turning high profits and are expanding. She stated her employer turned a profit of more than $5 million last year. "No hospital ever closed because of good nursing care," she said. ... Survey Shows That Part-Time RNs Already in Massachusetts Hospitals Would Be Able to Fill Safe Staffing Needs Hospitals Have Claimed Nurses Can’t Be Found. Time Has Come for Safe Staffing, Advocates Say, Will Introduce Budget Amendment. Massachusetts Nurses Association, April 15, 2004 <http://www.massnurses.org/News/2004/04/survey.htm> Boston - A new survey of acute care Registered Nurses working part-time shows that more than a third would work additional hours if the Safe Staffing Bill (H. 1282) became law. By the most conservative estimates, this would translate into at least 1,824 full-time RN positions, more than enough to meet the bill’s staffing requirements without new hires. The Safe Staffing Bill, which was approved by the Legislature’s Health Care Committee and is now before the Ways and Means Committee, sets flexible minimum RN-to-patient ratios in Massachusetts hospitals. The measure will dramatically improve the quality and safety of patient care in Massachusetts hospitals, where current staffing levels have resulted in a 76 percent increase in the rate of injuries, medication errors, and complaints by patients in the last seven years, according to the Massachusetts Department of Public Health (DPH). The statewide survey of part-time hospital RNs conducted in March by the respected Cambridge-based polling firm, Opinion Dynamics Corp. (ODC), found that 33 percent of all RNs working part-time in acute-care settings (hospitals) would consider working more hours if the Safe Staffing Law is passed. Among those who would consider taking more hours, 47 percent would consider an additional 8 hours a week, 23 percent would consider 9 to 24 additional hours a week, 11 percent would consider an additional 24 hours a week, while 17 percent would consider an additional 7 or fewer hours a week. ... Text of H.1282 (and of House Budget Attachment 572) <http://www.massnurses.org/News/safestaff/billtextdec2002.pdf> Survey: No lack of willing nurses Patricia Norris, Springfield Republican, April 16, 2004 <http://www.masslive.com/search/index.ssf?/base/news-6/1082105505222750.xml?nn mw> A new survey of the state's part-time registered nurses shows that more than a third would return to work full-time if a proposed Safe Staffing Bill becomes law. The survey, conducted in March by Opinion Dynamics Corporation, for the Massachusetts Nurses Association - a supporter of the staffing bill - bucks the argument that there are not enough nurses in the state to handle the workload in Massachusetts hospitals. But the Massachusetts Organization of Nurse Executives contends many nurses work part-time because of family obligations, a need that would not change with the passage of the bill. Hospitals have long said a nursing shortage is contributing to the staffing problems in institutions, while the union contends there are plenty of nurses in Massachusetts. Nurses, they say, have left the field or reduced their hours because the patient-to-nurse ratio is too high and unsafe. The proposed bill, which was approved by the Legislature's Health Care Committee and is now before the Ways and Means Committee, would set minimum staffing requirements for all hospital departments. "Now we know that the nurses we need are already working in our hospitals and are more than willing to increase their hours provided they have the guarantee of a safe work environment and the ability to provide proper care for their patients," said Karen Higgins, president of the Massachusetts Nurses Association. ... Nurses want lighter patient loads Jennifer Heldt Powell, Boston Herald, April 16, 2004 <http://business.bostonherald.com/businessNews/view.bg?articleid=2304> Beth Hulett, a part-time nurse at a Boston teaching hospital, wants to work more hours. But she said she won't because of the stress of having to care for too many patients. If the state passes a law limiting the number of patients a nurse can care for at any given time, Hulett and other nurses say they'd work longer hours, which could alleviate the state's nursing shortage, a survey released yesterday found. "It's a struggle every day to care for patients when you don't have enough nurses," said Hulett, who has been a nurse for 14 years. "If there was a set ratio and I could be guaranteed that I could do my job the way I know it should be done, I'd pick up extra shifts." ... National Studies: Needlestick injuries to nurses, in context Clarke SP, Sloane DM, Aiken LH, Center for Health Outcomes and Policy Research School of Nursing, University of Pennsylvania, USA, LDI Issue Brief. 2002 Sep;8(1):1-4 <http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528750&dopt=Abstract> Injuries with used needles and other "sharps" put health care workers at risk for serious bloodborne infections, such as HIV and hepatitis B and C. To some extent, this risk can be lessened through safer techniques (such as not recapping needles) and safer devices (such as needleless and self-sheathing equipment). But these injuries occur within a context (often a hospital unit) with organizational features that may themselves contribute to an increased or decreased risk. This Issue Brief summarizes a series of studies that investigate whether workplace aspects of the hospital (such as staffing levels, and organizational structure and climate) affect the risk of needlestick injuries to nurses. Organizational climate, staffing, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses Sean P. Clarke, RN, Joan L. Rockett, RN, Douglas M. Sloane & Linda H. Aiken, RN American Journal of Infection Control, June 2002 • Volume 30 • Number 4 <http://www2.us.elsevierhealth.com/scripts/om.dll/serve?action=searchDB&search DBfor=art&artType=abs&id=a123392&nav=abs> ... Poor organizational climate and high workloads were associated with 50% to 2-fold increases in the likelihood of needlestick injuries and near-misses to hospital nurses. Capless-valve secondary intravenous set systems and use of any type of protective equipment for IV starts or blood draws were associated with 20% to 30% lowered risks of both event types. ... Nurse staffing and organizational climate are key determinants of needlestick risk and must be considered with the adoption of safety equipment to effectively reduce sharps injuries. (Am J Infect Control 2002;30:207-16.) Editorial Comment: Even though we fought long and hard for safer needles, a far greater threat is posed by unsafe staffing and "out-of-control" work environments. So fight for safe staffing ratios. Remember: the life you save may be your own! Nurse Burnout and Patient Satisfaction Doris C. Vahey, Linda H. Aiken, Douglas M. Sloane, Sean P. Clarke & Delfino Vargas Medical Care: Volume 42(2) Suppl February 2004 pp II-57-II-66 <http://intapp.medscape.com/px/medlineapp/getdoc?pmi=14734943&cid=med> ... The hospital nurse workforce is experiencing greater workloads resulting from shorter hospital stays, rising average patient acuity, fewer support resources, and a national nurse shortage. Higher nurse workloads are associated with burnout and job dissatisfaction, precursors to voluntary turnover that contribute to the understaffing of nurses in hospitals and poorer patient outcomes. Indeed, more than 40% of hospital staff nurses score in the high range for job-related burnout, and more than 1 in 5 hospital staff nurses say they intend to leave their hospital jobs within 1 year. The understaffing of nurses and the overwork of health professionals in hospitals are ranked by consumers as major threats to patient safety, and more patients are bringing their own caregivers to the hospital with them. Research on job-related burnout among human service workers, nurses in particular, suggests that organizational stressors in the work environment are important determinants of burnout and subsequent voluntary turnover. A largely separate research literature on patient satisfaction documents the importance of patients' satisfaction with nursing care in their overall ratings of satisfaction with their hospital care. This article examines the association between nurse burnout and patient satisfaction, and explores whether the factors that account for nurse burnout also account for patient dissatisfaction. The findings are important to understanding how to simultaneously stem the flight of nurses from hospital bedside care and improve patient satisfaction with care. Is More Better?: The Relationship Between Nurse Staffing and the Quality of Nursing Care in Hospitals Julie Sochalski, Medical Care: Volume 42(2) Suppl February 2004 pp II-67-II-73 <http://www.lww-medicalcare.com/pt/re/medcare/abstract.00005650-200402001-0000 9.htm;jsessionid=AGWogpZSYpumqvwKA1RH0Bz0zPDxLs2DK7LgFLY2iLV23hF32oXU!-1164127 213> ... Assessments of the quality of nursing are associated with both structural (workload) and process of care indicators (unfinished clinical care and patient safety problems), with the relationship strongest between process of care and quality. Explicating the interrelationship between structure and process of care is key to understanding the influence of both on quality. Studies that assess the causal influence of these features on quality of care and patient outcomes are warranted. Studies noting variation in hospital patient outcomes, now nearly 3 decades in the making, have fueled the search for the etiology of these differences, and the role of quality of care in producing the differences that have been found in outcomes. The focus on quality has been heightened by landmark reports issued recently from the Institute of Medicine: To Err is Human and Crossing the Quality Chasm. Each report exposed serious gaps in the US healthcare system's efforts to deliver safe, efficient, and high-quality patient care, and sounded the call for systemic initiatives to bridge those gaps. These initiatives include changes in both the structure and the processes of care such as the recommendations from the Leapfrog Group for the use of physician intensivists in intensive-care units and computer physician order entry systems for drug dispensing. Initiatives directed toward nursing have largely focused on assuring adequate staffing levels as the vehicle through which outcomes and quality are improved. Studies attesting to the impact of nurse staffing on patient outcomes date back several decades, and have culminated in the last 5 years in an array of studies affirming that effect. These recent studies responded to the Institute of Medicine's call to develop a more rigorous empiric base on the impact of nurse staffing and the work environment on patient outcomes and quality of care, and in particular the mechanisms by which nursing influenced those outcomes. Although the evidence of the staffing effect on outcomes is clear, the mechanism by which its effect is rendered is much less so. Nonetheless, these studies have motivated nearly half of the states in the United States to explore the adoption of minimum nurse staffing ratios in hospitals. Yet, attempting that in the absence of a clear understanding of how and why different staffing levels affect outcomes could result in ratios that overestimate or underestimate what is really needed to improve patient care. This study endeavors to take a first step in addressing that question by assessing whether nursing workload is associated with nurses' reports on the quality of nursing care in hospitals, and whether workload is related to indicators of the process of nursing care that also are associated with quality care. ... Audio conference: Special Guest Speaker Dana Beth Weinberg, Author of: "Code Green: Money- Driven Hospitals and the Dismantling of Nursing" Joint Commission Resources, March 18, 2004 We are on the verge of the nation's worst nursing shortage in history. Dedicated nurses are leaving hospitals everyday, and there are not enough new recruits to meet the demands. This audio conference will cover Ms. Weinberg's story, and it will show the effects of hospital restructuring on nurses' ability to plan, evaluate and deliver excellent care. Ms. Weinberg will also provide a stinging indictment of standard industry practices that underestimate the contribution nurses make to patient care and hospitals. This session will be held on April 15, 2004 , from 12:00 noon CST to 1:00 PM CST. This 60-minute audio conference will consist of 30 minutes of formal presentation and 30 minutes of Q&A. The session format is via telephone. Participants can ask questions during the moderated Q&A session via the telephone. The cost is $199 per connection. Space is limited so register now! (Editorial Comment: Keep reading!) Shortage of nurses can be hazardous to your health, even deadly Linda A. Johnson, Associated Press, March 27, 2004 <http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/2004/03/27/natio nal1218EST0509.DTL> Becky Hartman will tell you how crucial it is for a hospital to have enough nurses. When she rushed her mother to a Wichita, Kan., hospital, an ER doctor quickly sized up the older woman as another pneumonia case. Her breathing was labored and pneumonia patients filled the emergency room. But 61-year-old Shirley Keck didn't have pneumonia. As she lay in a hospital room all but ignored, she was suffering from a common type of heart failure that filled her lungs with fluid. As Keck deteriorated over several hours, Hartman begged Wesley Hospital nurses for help. "It was total chaos. Everybody was tired. Everybody was totally overworked," Hartman recalls. "As the breathing got worse, I'd ring the button. Nobody came." It was Feb. 8, 1998 - a Sunday night, when hospital staffs are leanest. There were just two registered nurses and two nurse aides for 42 patients on Keck's floor, fewer than half the staff the hospital's own guidelines required. "I'm going to die," Shirley Keck told her daughter. She did, but was resuscitated and lingered for four years - depressed, paralyzed except for one arm and unable to talk because a stroke during the ordeal had caused brain damage. Her family sued and won a $2.7 million malpractice settlement from Wesley Hospital in July 2000. Two years later Keck died. The hospital and Keck's attorney, Bradley Prochaska, say it's the first malpractice decision specifically pinned on inadequate nurse staffing. He has filed a similar suit involving a 38-year-old quadriplegic woman. At first, Hartman was furious with the nurses. Now, she's joined their cause, speaking out about the need for more nurses at the bedside. ... Silencing debate on the nursing shortage Scott Allen, Boston Globe, March 30, 2004 <http://www.boston.com/dailyglobe2/090/science/White_Coat_Notes+.shtml> Brandeis University sociologist Dana Beth Weinberg couldn't believe her good luck when the influential group that evaluates the nation's hospitals asked her to lead a conference about the nursing crisis. Weinberg, author of the book, "Code Green: Money-driven Hospitals and the Dismantling of Nursing," would get a chance to make her case about the plight of nurses directly to executives who could reverse the tide. But, within 24 hours of advertising the by-phone conference, the Joint Commission on Accreditation of Healthcare Organizations pulled the plug on her April 15 appearance after hospital officials complained about Weinberg's perceived bias. Commission spokeswoman Charlene Hill said the title of Weinberg's book dismayed some callers because it "cast a kind of disparaging light on hospitals." It probably didn't help that the commission's e-mail promoting the event promised Weinberg would deliver "a stinging indictment" of hospital practices. Nursing advocates say the about-face shows how defensive hospitals are about the growing nursing shortage, which has prompted legislators in Massachusetts to push a bill that would require minimum nursing levels. Weinberg has publicly supported the staffing legislation, but her book, based on research at Beth Israel Deaconess Medical Center, has been well-reviewed for its even-handed approach. "I'm hardly like the flaming activist," Weinberg said. "I'm really disappointed the message is not getting out there." The Shocking Cost of Turnover in Health Care J. Deane Waldman, Frank Kelly, Sanjeev Aurora, Howard L. Smith, Health Care Management Review, Volume 29 Number 1, January/March 2004 <http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=470227> Review of turnover costs at a major medical center helps health care managers gain insights about the magnitude and determinants of this managerial challenge and assess the implications for organizational effectiveness. Here, turnover includes hiring, training, and productivity loss costs. Minimum cost of turnover represented a loss of >5 percent of the total annual operating budget. New Study Shows Huge Cost of RN Turnover Massachusetts Nurses Association, Tuesday Reporter #10, April 2004 <http://www.massnurses.org/safe_care/Tuesday_Reporter/tr10.pdf> A new study published last month in the scholarly journal, Health Care Management Review, is the latest in a series of recent studies to document the enormously high cost of RN turnover for hospitals. It found the cost for advertising, training and loss in productivity associated with recruiting new nurses to a facility is $37,000 per nurse at minimum and can add as much as 5% to a hospital’s annual budget. The cost to one hospital was in excess of $8 million. The study concludes that improving working/staffing conditions is a primary strategy for hospitals that can improve patient care and generate significant cost savings. Safe ratios have been shown to be a key to reducing hospital turnover and improving the bottom line. Web Directory: AARN <http://www.aarn.org> Australian Nursing Federation <http://www.anf.org.au> California Nurses Association <http://www.calnurse.org> Canadian Federation of Nurses Unions <http://www.nursesunions.ca> CCDS <http://www.cc-ds.org> Committee for Health Care for Massachusetts <http://www.healthcareformass.org> Irish Nurses Organisation <http://www.ino.ie> Labor Party <http://www.thelaborparty.org> LabourStart <http://www.labourstart.org> Maine State Nurses Association <http://www.mainenurse.org> Massachusetts Ad Hoc Committee <http://www.MassDefendHealthCare.org> Massachusetts Green-Rainbow Party <http://www.green-rainbow.org> Massachusetts Nurses Association <http://www.massnurses.org> MASS-CARE <http://www.masscare.org> New York Professional Nurses Union <http://www.nypnu.org> New Zealand Nurses Organisation <http://www.nzno.org.nz> PASNAP <http://www.pennanurses.org> PNHP <http://www.pnhp.org> Québec Nurses’ Federation <http://www.fiiq.qc.ca> Revolution Magazine <http://www.revolutionmag.com> Saint Louis Area Nurses Coalition <http://www.slanc.org> Seachange Bulletin <http://www.seachangebulletin.org> Southern Arizona Nurses Coalition <http://SAZNC.homestead.com> Union Web Services <http://www.unionwebservices.com> Women’s Universal Health Initiative <http://www.WUHI.org> FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. 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