Published: April 9, 2014
Thousands of reports annually from our members across the state convey a consistent and harsh reality: nurses are caring for too many patients at one time, sometimes in overwhelming numbers. By this count, the vast majority of NYSNA members face this debacle: how to provide safe, quality care when peer-reviewed, academically researched staff-to-patient ratios are routinely exceeded by 50 percent, often more.
Most affected are Med-Surg, Psych and ER units. But staffing shortfalls can be found across the spectrum of hospital departments. At New York Methodist Hospital in Brooklyn, despite a staffing grid written into the contract, every unit came up short. NYSNA is now five months into a class action grievance on staffing shortfalls there.
As you know all too well, understaffing has very real and harmful consequences. Hospitals that routinely staff with 1:8 nurse-to-patient ratios experience five additional deaths per 1,000 patients than those staffing with 1:4 ratios, according to the Journal of the American Medical Association.
Adverse outcomes
Other serious, negative patient outcomes can result from RN understaffing at hospitals. Staffing shortfalls were linked to six categories of adverse patient outcomes in studies in the New England Journal of Medicine. These were length of stay, rates of urinary tract infections, upper gastrointestinal bleeding, hospital-acquired pneumonia, shock or cardiac arrest, and failure to rescue, such as sepsis or deep venous thrombosis. We’ve seen it all.
Bottom-line hospital managers and those doing their bidding look past the science and the poor patient outcomes. They set their sights instead on raising revenue – hospital revenue in New York State totaled $143 billion in 2012.
California’s success
The American Nurses Association embraces what it terms a “flexible” model of staffing tied to acuities and managed within individual hospitals. The ANA has also floated a “market-based incentive to hospitals to optimize nurse staffing levels by unbundling nursing care….” Both concepts move us away from quality patient care.
More than a dozen states have laws to varying degrees covering safe staffing. But only California requires minimum nurse-to-patient ratios be maintained at all times by unit as a matter of law. It’s been a resounding success.
Without ratios in force, patients receive less care. That’s the conclusion of a new study by Nursing Professor Judith Shindul-Rothschild of Boston College in which she compared Massachusetts (like New York), where no ratios are required, to California. She found that Massachusetts patients received three hours less care per day from RNs than in California. Shindul-Rothschild’s research supports the California law, because in her words, with a ratio law there is “no doubt there will be an adequate number of registered nurses to care for [patients] to assure they get safe, quality nursing care.”
That’s our bottom line.
More good news from California: Contrary to industry warnings, not one California hospital closed because of the ratio implementation, which was in 2004. In fact, hospital income rose dramatically there after that date. Another important benefit of the California laws: Safe nurse staffing ratios reduced RN turnover in hospitals, keeping experienced nurses on the job, who then mentor new RNs.
There’s even more: Strong evidence exists that better care achieved with minimum staffing ratios a la California helps the healthcare economy. “[N]egative [patient] outcomes have economic and financial implications for payers, providers, and taxpayers,” concluded Professor Peter Arno, director of health policy research at the University of Massachusetts. Shindul-Rothschild found that “heart failure readmissions were lower when nurse staffing was greater….” Heart failure readmissions were estimated to cost $34 billion in the U.S. in one year alone.
Fighting to win in New York State
Readmissions are now even more costly, as hospitals incur penalties for them under the Affordable Care Act. Ratios can make a difference. “Hospitals with higher nurse staffing levels had 25 percent lower odds of Medicare readmission penalties,” Arno reported.
New York’s Safe Staffing for Quality Care Act would give us minimum nurse-to-patient ratios on a statewide basis as a matter of law. It’s a win-win. Let’s get it passed!
Jill Furillo, RN, BSN, PHN, is the former executive director of the New York State Nurses Association from 2012-2019.
