The lesson of bad grades and understaffing

It came as little surprise to us, but yet with great concern, that grades for acute hospitals in New York were very poor. At the end of April, the annual Leapfrog Hospital Safety Grades were released — a detailed survey of 2,500 hospitals across the United States. New York hospitals received the worst overall scores ever. Our state is one of ten in the nation with hospitals that received “F” grades. These appalling grades should serve as a wake-up call for hospital management in the state and as impetus for everyone concerned with the public’s health to support nurse-patient ratios in the Safe Staffing for Quality Care Act before the Legislature.


RN diligence and professionalism

The Leapfrog surveys review data on safety, quality and resource use, including “nursing standards.” That’s a sore subject.

With diligence and professionalism, we provide hospital management with details of the understaffing on our units and the effects of this profound failure
to guarantee enough RNs to do
the job.

We take our POAs very seriously. And so should management. POAs are filled out at the very time RNs observe conditions that might pose safety and quality issues for patients. These are contemporaneous clinic observations attested to by RNs that have evidentiary value in formal hearings. They are a matter of licensure — a legal obligation — in the advocacy for our patients.


POAs and understaffing

A very large majority of POAs are signed by more than one nurse. In fact, on average, each POA is signed by four RNs. In other words, groups of RNs on the unit share the concerns expressed in the document. And more than 80 percent of problems indicated on POAs relate to understaffing.

At Northwell’s Staten Island University Hospital (SIUH), for example, over the course of the last three years RNs have filed more than 8,000 POAs with thousands of RN attesting signatures on understaffing. SIUH received a “D” grade from Leapfrog. Despite these staffing shortfalls, RNs at the hospital make sure patients receive quality care. Management just makes it harder to get the job done.


Nurses at the bedside

These poor grades should lay to rest management’s position that RN staffing decisions ought to be a matter of their unilateral discretion. Nurses are at the bedside 24/7, caring for our patients with intimate knowledge of care needs and unit conditions. The arrogance of management to impose its judgment in the face of RN experience, backed up by thousands of formal POA filings, does a disservice to not just to us, but to patients across the state — and results in very poor grades.


Listen to the RNs

There is a correlation between poor grades and high revenue, because when staffing is limited the hospital’s bottom line goes up. Making a profit at the expense of the public’s health is a treacherous game. We know from peer-reviewed studies that safe staffing results in lower mortality, infection and readmission rates.

It’s time for hospital management in New York to listen to their RNs. Safe staffing saves lives! And gets good grades, too.

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