Support Barbara Boxer National Nursing Shortage Reform and Patient Advocacy Act (S.1031),

[Horse with no Name]

This affects all of us.
I can guarantee every hospital corporation in the country is filling the coffers of their pet Congresscritters to keep this from becoming law.
>>>>>>snip
We cannot guarantee high-quality health care to every American without a high-quality workforce of nurses to provide it. That is why I recently introduced legislation to help address our nationwide shortage of nurses. By investing in nurses and in their training, we can help improve the quality of care in our nation’s hospitals and save the lives of countless patients.

My bill, the National Nursing Shortage Reform and Patient Advocacy Act (S.1031), is designed to set minimum nurse-to-patient ratios in hospitals, invest in training nurses to address the current nationwide nursing shortage, and protect the rights of nurses to advocate on behalf of their patients.

The legislation builds on the success of California’s historic law that set registered nurse-to-patient ratios. The bill would extend the minimum standards already in place in California hospitals to all general and long term care hospitals. Specifically, the bill would:

Establish specific nurse-to-patient ratios that will not only save lives and improve the quality of care but also encourage more nurses to enter and stay in the workforce, which could help ease the nursing shortage.
Provide whistleblower protections to protect the right of nurses to advocate for the safety of patients and report violations of minimum standards of care.
Create a standard for helping nurses to lift patients to prevent on-the-job injuries and promote better quality patient care.
The bill also creates a Registered Nurse Workforce Initiative within the Health Resources and Services Administration that invests in the education of nurses and nursing faculty. The initiative provides grants for:

Nursing educational assistance and living stipends for nursing students who agree to work for at least three years for a safety-net health care provider.
Graduate educational assistance for registered nurses who commit to serve as nurse educators for at least five years at an accredited nursing program.
Training and mentorship demonstration projects.
Good health care depends on a trained workforce of professionals. My bill is aimed at training more professional nurses and giving them the tools to better help their patients.

Sincerely,


Barbara Boxer
United States Senator

[imdjh]

1. Would need to know much more about it- but kick anyway

I'm not a hospital admin person, but I have been a surgical patient many times. I'm not sure that I would be too quick to force hospitals to have certain personnel requirements. Yes, it's a pain when you have to wait for a nurse to come help you, but when that happens it's often because they are doing something more important. Yes, I know that when you are the patient, you can be pretty selfish and you are entitled to be, but if you spend a month in a hospital like I have in the past, then you start to see how things work and the challenges they deal with. Some are administrative, and some are just facts of life stuff.

When I was in the hospital for something serious, I got a lot of care.

vitals, often
a bather
a bed change
two or three nurses getting me up to walk, one nurse staying with me during the walk
IV nurse checking my central line
someone to change the pee bag
someone doing bed pan and clean up
food coming and going
meds
surgeon visiting and changing bandages with a nurse
a crisis here and there
me freaking out over a catheter problem
things needing to be replace
alarms going off
IV's going bad (before the central line was put in)

I dont' work for a hospital, and I'm not saying that they are perfect. But they do have to do this on a budget and I fear that nailing them down isn't going to produce the desired result.

[Horse with no Name]

2. I am a nurse

there is a definite correlation between patient safety, medication errors and understaffing. It has been proven across the country in many studies beyond a shadow of a doubt.

[imdjh]

3. Well that's why I would want to know more about it.

Are we talking about a straight an inflexible formula? Like, one RN and one CNA for every four patients regardless of condition? Or would the staffing specialist be able to allocate more nurses when there are high maintenance patients and fewer when there are low maintenance patients?

I've seen some pretty impressive changes in how things are done over the years. Having someone who does nothing but IV's is a GODSEND to patients, because it's one of those things that some can and some can't. When you are out of veins, it's torture to have someone learning on you. The meds only nurse seems like a good idea, but I wouldn't want that job.

Over the years, the complaint I have heard most often (from nurses) wasn't of a general lack of staff, but of the paperwork requirements which take the nurses away from the patients.

I should also note that in my family we have a policy of not leaving anyone alone in a hospital. It's not only a comfort to have a family member there with you, they do a lot for you that a person alone would need to call the nurse for. Most nurses don't seem to mind having help. So perhaps my perceptions of care are a bit warped by having a personal helper.

[Horse with no Name]

4. The bill referred to what is known as a national standard of care

Almost every unit in the hospital has a "suggested standard of care" ratio. However, it isn't standardized from state to state--it is more of a "suggestion" for staffing, according to the hospital corporations. For example...when taking care of general pediatric patients, the standard of care is a ratio of 4 patients to 1 nurse. This assures for good care, the extra time needed for treatments, extra time in calculating pediatric drug doses, time spent comforting family and in general, more bedside care for our youngest patients as well as documentation time.
Given to their own resources, many of the hospital corporations will change the numbers. I have taken care of 6 pediatric patients at a time. That is unsafe. It is not the standard of care.
In the facility that I work, they have 40 beds on one particular specialty unit. However, they routinely staff for a maximum of 24 of those beds, yet don't shut down admissions when they reach 24. They don't utilize agency nurses. If there are no float nurses available, the staff that is there for 24 patients are still given the 40 patients. In Texas, they have what is called Safe Harbor.
What Safe Harbor does is to protect the license of the nurse that initiates it in case someone is harmed during periods of unsafe staffing. However, Texas is a right to work state. The nurses that initiate Safe Harbor are generally targeted for retaliatory firing, but sometimes, there isn't any recourse. It doesn't protect the patient, it protects the nurse--ALTHOUGH these reports are sent to the state and if they see any particular facility getting an abundance of Safe Harbor filings, I am (hoping) that they attempt to remedy the situation with the facility.
As opposed to past times, hospitalized patients nowadays tend to be extremely ill...and are often sent home while they are still ill.
In the past, the ratio was peppered with "social admits", however, that is rarely the case nowadays. Acuities are high on almost all patients.

Here are some excellent articles to research:
http://www.ahrq.gov/research/nursestaffing/nursestaff.htm
>>>snip
Pneumonia Rates Are Especially Sensitive to Staffing Levels

Three AHRQ-funded studies found a significant correlation between lower nurse staffing levels and higher rates of pneumonia.

* The first study found that adding half an hour of RN staffing per patient day could reduce pneumonia in surgical patients by over 4 percent.12 This study covered 589 hospitals in 10 States during 1993.
* A second study by the same researchers also found that fewer RN hours per patient day were significantly correlated with a higher incidence of pneumonia.13 The study examined administrative data on post-surgical patients in 11 States during 1990-96.
* A study of nurse staffing levels and adverse outcomes in California found that an increase of 1 hour worked by RNs per patient day was associated with an 8.9-percent decrease in the odds of a surgical patient's contracting pneumonia.8
* This study also found that a 10-percent increase in RN proportion was associated with a 9.5-percent decrease in the odds of pneumonia.

The researchers in the California study believe that the strong relationship between RN staffing and pneumonia can be attributed to the heavy responsibility RNs have for respiratory care in surgical patients. This study examined the effects of nurse staffing on adverse outcomes in 232 acute care hospitals from 1996 to 1999.F Unlike many earlier studies, the California study included only adverse outcomes that were not present at admission.7

>>>>snip
Nurse Workload and Job Dissatisfaction

The studies discussed have documented the connection between lower levels of nurse staffing and higher rates of adverse events. Complementing those studies are a number of other studies addressing the growing nurse workload and rising rates of burnout and job dissatisfaction. One study, jointly funded by AHRQ and the National Science Foundation, examined the relationship between nurse staffing and hospital patient acuity (the average severity of illness of the inpatient population) in Pennsylvania hospitals.11 Acuity determines how much care a patient needs: the higher the acuity, the more care is required. This study found:

* A 21-percent increase in hospital patient acuity between 1991 and 1996.
* No net change in the number of employed licensed nurses.
* A total decrease of 14.2 percent in the ratio of licensed nursing staff to acuity-adjusted patient days of care because of the increase in patient acuity.G

In addition, the skill mix of the nursing staff shifted as hospitals increased the number of nurses' aides. As a result, RNs acquired more supervisory responsibilities that took them away from the bedside at a time when their patients needed more bedside nursing care.H

Concerns arising from increased patient acuity and the assumption of additional supervisory responsibilities appear to be directly related to job dissatisfaction expressed by nurses in various opinion surveys. For example, a 1999 AHRQ-funded study surveyed 13,471 nurses in Pennsylvania. Among the principal findings:

* Among those surveyed, 40 percent were dissatisfied with their jobs. This is much higher than the 10-15 percent levels of dissatisfaction registered by other professionals and by workers in general in the United States.
* Only 35.7 percent of the nurses surveyed described the quality of care on their unit as excellent.
* A large proportion of nurses, 44.8 percent, said that there had been deterioration in the quality of care in their hospital during the past year.
* Of the nurses surveyed, 83 percent reported that there had been an increase in the number of patients assigned to them during the previous year.
* Only 34.4 percent of nurses believed that there are enough RNs to provide high-quality care.
* Only 33.4 percent believed that there are enough staff to get the work done.

In addition to increased patient acuity, nurse perceptions of inadequate staffing levels are probably related to their being expected to perform non-nursing tasks such as delivering and retrieving food trays; housekeeping duties; transporting patients; and ordering, coordinating, or performing ancillary services.17,18

[imdjh]

5. I'm with you. And I just thought of something huge that has changed.

Surely you were already aware of this, but as a patient it didn't occur to me until just now that the new practice of sending patients home sooner after surgery (sometimes while still bleeding :) ) means that there are fewer patients on that day or two of low maintenance before going home, and a much higher percentage of patients would be high maintenance. Obviously staffing needs would have to change due to this condition, but we can reasonably assume that hospital corporations have only been trying to raise the patient to staff ratio despite this change.

[Horse with no Name]

6. Exactly the point. The nurse:patient ratios do not reflect the acuity

(nor could they) nor do they reflect the fact that while the ratio has steadily increased, the other dynamic is that hospitals have piled more responsibilities on the RN.
Not only do they do patient and patient-related care, nowadays in many facilities, cost cutting measures in other departments have forced the RN draw the labs, put orders in the computer, answer the phones, deliver and pick up food trays, strip the linens out of the room after the patient is discharged, etc.

[w8liftinglady]

7. exactly-we go through the motions of assessing acuity on all patients-

only to end up with the same number of nurses regardless.

[Horse with no Name]

9. ahhh aint that a hoot?

you are going to get a predetermined number of nurses regardless of how many patients you have.
How the heck are you doing?
I don't see you around here much anymore? Don't know if it is me or you, lol.
Are you still at the same job?:hug:

[northernlights]

8. are you effin' kidding?!?!

Go check out the health care forums and get a glimpse of what nurses' working conditions are before you start spouting bullshit about how budgets should come out of *their* hides. :grr:

You got great care because the nurses are put between a rock and a hard place. They are too compassionate to neglect their patients, so instead they run themselves into the ground to give good care. They don't even have time to go pee. If their shift replacement calls in sick, they're trapped into doing double-shifts.

In them meantime, the administrative leeches suck the life out of the system. If there's a snowstorm, they stay home. The healthcare delivery people stay at work.

[eridani]

10. This would be a good useful career for surplus insurance industry people n/t

[northernlights]

11. what, going from denying care on paper

to delivering it in person?

It would be good for their souls to come face-to-face with the people they would have preferred to leave to die.

And it would be good for their souls to live a nurse's grueling working conditions for a while.

I just wonder what qualities they'd bring to the job. And whether they could hack it.