Final Reflection

We e-mailed Kelly Brown to have forward our email to the entire nursing student population. We also contacted all of the legislators and stakeholders, unfortunately, we did not hear back from any of the legislators, but we are hoping that they checked out our blog.

o While this bill aims to improve safety, how will the current shortage of RNs influence the effectiveness if it is implemented?

The problem is that there are not nurses out there, but that the nurses available are not being hired due to the economy. This Bill is shown to be cost effective long term, even though it would be more expensive up front. Therefore, if more nurses were highered there would not only be improved patient care, but also in the long run it would help out the economy.

o Will the nurse patient ratio be decided by all of the nurses on the unit, or will this decision be left to a clinical nurse leader or manager?

All of the RNs on unit will be involved in the decision making of the nurse-patient ratio. The clinical manager would most likely be the one to implement the bill once a decision was made.

o What is your group’s opinion on why there are currently staffing issues?

Research has shown that there is a significantly less adequate level of care when a nurse is overloaded with too many patients. Also, nurses themselves have come forward and complained that they are overworked and believe that they cannot deliver the care they would like to since they simply do not have the time. We have also found feedback from patients who claimed that their nurses were so busy that they didn’t feel as though they were receiving sufficient attention and care. Also a factor in the staffing issues is the economy and the fact that the hospitals are not hiring enough nurses to care for the amount of patients.

o Is this a problem that has been escalating over the past ten years or decades, and if it has, why do you think the problem has gone on for so long?

This problem has been escalating due to many reasons. One is the economy, and the fact that nurse units are understaffed. Another reason is that with technology and medical advances, people are living longer. Often, people who live longer have multiple health issues which require a lot of care. This leads to a patient overload for current nurses.

o Is the percentage of hospital deaths due to human era that we listed truly related to nurses being overworked?

Yes, the percentage of hospital deaths due to human era that we listed is truly related to nurses being overworked. Research has shown that nurses who care for a greater number of patients are not only time restricted when it comes to care, but are also worn out, leading to more mistakes being made. With a smaller number of patients to focus on, one is able to look deeper into assessments, signs and symptoms, and medications, rather than simply following a doctor’s orders.

After doing this blog, we realized that what we have been seeing ourselves in the hospitals as a shortages of nurses is not only a problem in those specific hospitals, but a much greater problem nation wide. We have learned from research that patient care is directly affected by nurse-patient ratio and unfortunately most of the time that ratio is rather high, leading to less adequate care. Clearly getting involved in legislation is important to nurses because they not only experience these issues first hand but also have a role in advocating for the patient. We truly enjoyed working on this blog and learned a lot.

Contacting Political Figures

As a group, we have contacted various key figures in politics who support the RN Safe Staffing Act. We provided them a link to our blog and asked for their feedback.

Daniel K. Inouye of Hawaii is the most senior member of the U.S. Senate. He has many accomplishments in Hawaii regarding health including building community health centers that target services to medically under served people, emergency medical services for children, administration on aging grants, pharmacy and pre-pharmacy programs, and much more. Senator Inouye reintroduced this act in Congress for the 2011-2012 session.

Congresswoman Lois Capps represents California’s 23^rd district. She is a former nurse and she supports the Safe Staffing Act as well as the Affordable Care Act. Unfortunately, we were not able to contact her because due to the large volume of email she receives, she only accepts emails from those within her district.

Karen Daley is the president of ANA. She is also a former nurse, as well as a strong supporter of the Safe Staffing Act. She was elected in 2010 and is known for mandating the use of safer needles in health care settings.

Congressman Steven Latourette from Ohio’s 14^th district is very active in nursing issues and is co-chair of the House Nursing Caucus. Along with his support of the RN Safe Staffing Act he is focused on nursing shortage, mandatory overtime, and increased funding for Nursing Workforce Development. Unfortunately, he only accepts emails from constituents within his district.

Delegate Vivian Watts is a delegate in northern Virginia. She is a member of the Virginia House of Delegates. She is also a former Secretary for Transportation and Public Safety and has worked hard to improve the quality of life in Fairfax County and in the Commonwealth of Virginia

There have been no recent updates to our Bill.

Support of the RN Safe Staffing Act

We support the RN Safe Staffing Act (S. 58/ H.R. 876) because we believe that is important for patient safety, adequate care and work satisfaction. This bill, instead of establishing a set nurse-patient ratio, allows for RNs to make the decision on safe ratio based on patient acuity, patient number, resources available and ancillary support services. As future RNs, we understand that while mandatory ratios are helpful, they are rarely sufficient. We have experienced first hand that only nurses who are actually on the floor of a unit understand the need for more staff and how to accommodate. Also, research has shown that poor staffing causes nurse burn out, job dissatisfaction and turnover, and poor patient outcome. Obviously as future RNs, job satisfaction and providing safe care are important components of a future career. Another huge component of this bill is addressing the concern with patient safety. Studies have shown that the consequences of not having adequate staffing are unsafe with multiple detrimental outcomes and that adding RNs to unit staff eliminates almost 1/5 of hospital deaths. The number one goal of the nurse is to provide safe, therapeutic, adequate care to patients, and current ratios are making this difficult. These are the main reasons that this bill has our full support.

The first step in our political action plan is to get in touch with legislators who support this bill to express our support and receive feedback on the current status of the bill. These legislators including Senator Daniel Inouye, Representative Lois Capps, Representative Steven LaTourette, Karen Daley, president of ANA, and Delegate Vivian Watts. We’re also going to e-mail all of the students in the nursing department with the link to our blog to promote awareness and gain support.

QUESTIONS AND RESPONSE

- Does the Bill take in to consideration the budget cuts most hospitals are experiencing?

- Was there any talk of adding an amendment on to the bill to cover some of the additional costs in order to maintain adequate staffing?

- How is the bill, if it becomes a law, going to be effectively enforced if some hospitals are incapable of paying the nurses required to meet the staffing ratios?

- How will patient acuity level and RN acuity level be measured to determine staffing?

Initially, if this bill becomes a law, hospital costs will be increased because of increased nursing staff. However, costs in the long run will be sufficiently decreased. According to a recent research study, “increasing the number of RN can yield a cost savings of almost $3 billion – the result of more than 4 million avoided extra stay days for adverse patient events such as infection and bleeding occurring in the hospital.” This bill is not establishing a mandated nurse-patient ratio, but instead suggesting that the number itself is set at the unit level with the RN input. Therefore, patient and RN acuity level would be evaluated by the RNs on the floor. This system is even more efficient and effective than a computer system, since the RNs have first hand knowledge and input on the situation.

Potential Impact of Safe Staffing Act on Health Care

As we talked about last week, the Safe Staffing Act will have a huge impact on nurses as well as clients and the health care system. The ANA sees this as a very important issue in health care. The president of ANA, Karen Daley, said "We know that nurses across the country are deeply concerned about unsafe staffing because it puts patients at risk as well as puts nurse’s careers on the line. Nurses observe all the time how insufficient nurse staffing diminishes the quality of care for patients. We wont stop advocating on this issue until federal legislation is enacted to increase protections for patients and ensure fair working conditions for nurses.” Safe staffing is a major concern because it impacts both patient safety as well as job satisfaction for the nurses. Stress related to higher patient ratios is directly related to nurses being unable to provide proficient and quality bedside care. This is one of the major reasons nurses leave the bedside perpetuating a shortage of nurses. In order to keep nurses at the bedside we need to create an optimal working environment. Also understaffing of registered nurses is leading to an increase in unlicensed personnel performing duties for which they are not licensed to do.

Patient safety and outcome is another concern because when nurses have an increased patient load it makes it more difficult to provide safe and therapeutic care. A study conducted in 2002 by Linda Aiken PhD, RN, showed that “each additional patient added to the average workload of staff registered nurses (RNs) increased the risk of death following common medical procedures by 7%, and the risk of death was more than 30% higher in hospitals where nurses' mean workloads were 8 patients or more each shift than in hospitals where nurses cared for 4 or fewer patients.” The Safe Staffing Act not only affects nurses workloads but more importantly it affects patient safety and overall well-being.

The governmental objectives include that the safe staffing bill would require hospitals that participate in Medicare to make nurse staffing plans for each unit accessible to the public. It would limit the practice of floating nurses by making sure that RNs do not work in areas where they lack the education and experience in that specialty. ANA is one of the major groups that has had political influence on this policy. They are promoting this bill and other legislation that holds hospital accountable for developing and implementing unit nurse staffing plans. Based on their principles there are no mandated ratios for nurse staffing plans because they want them to be based on specific needs for each individual unit and the RN’s are directly involved in coordinating the staffing plans. Some of the political figures that support this bill include Representative Lois Capps (D-CA), Representative Steven LaTourette (R-OH), Senator Daniel Inouye (D-HI), and Delegate Vivian Watts (D-VA).

RN Safe Staffing Act for 2011-2012

Our group identified nurse staffing to be a current issue in the healthcare field.  A bill was recently reintroduced in congress addressing many of the issues our group wishes to look into. 

The RN Safe Staffing Act (S. 58/ H.R. 876) focuses on many things, including “acuity of patients, level of experience of nursing staff, layout of the unit, and level of ancillary support.” All of these factors are essential to establishing a “right” nurse-patient ratio. This bill was sponsored by ANA and introduced to congress by Sen. Daniel Inouye (D-HI) and Reps. Lois Capps (D-CA) and Steven LaTourette (R-OH).

The RN Safe Staffing Act was originally introduced in 2003-2004 in order for hospitals to develop their own nurse staffing policies keeping in mind each unit’s unique characteristics. The bill was further refined for the upcoming session with several changes. These changes include holding Medicare-participating hospitals accountable for developing these unit-by-unit staffing policies and that the developing committees would be composed of at least 55% direct care nurses. Specific components of this bill were composed to ensure the staffing plans “are based upon patient numbers and the severity of the patients' health needs (acuity), take into account the level of education, training and experience of the RNs, take into account the availability of support staff, reflect staffing levels recommended by specialty nursing organizations, consider the physical layout of the unit and available technology, do not require RNs to work in units where they are not trained or experienced” (The RN Safe Staffing Act (S. 58/ H.R. 876)).

         We know that safe staffing for nurses is an important issue to address because studies have shown that the consequences of not having adequate staffing are unsafe with multiple detrimental outcomes. One component of this is poor patient outcome. Common problems for patients related to ineffective nurse staffing include but are not limited to UTIs, upper GI bleeds, longer hospital stays, shock, failure to rescue, and mortality within 30 days of admissions. Studies have shown that insufficient nurse staffing is linked to poor patient outcomes and that adding RNs to unit staffing has been shown to eliminate almost 1/5 of hospital deaths. The satisfaction of nurses is also greatly affected by staffing issues. A poll of over ten thousand nurses conducted by the ANA in 2007 revealed that 73% of nurses don’t believe that staffing on their unit or shift is sufficient and 59.8% of the respondents knew of someone who left direct care nursing due to concerns about safe staffing. Poor staffing can cause nurse burn out, job dissatisfaction and turnover and poor patient outcome.

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