Sunday, 11 July 2010

RN safe staffing (1 RN to 4 patients) saves money and lives; Untrained staff instead costs money and lives

Safe Staffing

As you read this please keep in mind that here in the UK there are no legal nurse staffing requirements and we are often one RN to 10-35+ patients in hospital. This is getting worse year after year.  Patients are getting older, sicker and much more complicated whist wards are replacing nurses with untrained staff.  MANY MANY TRUSTS HAVE BEEN SLASHING THE NUMBER OF REGISTERED NURSES AT THE BEDSIDE FOR YEARS EITHER REPLACING THEM WHEN UNTRAINED KIDS OR NOT AT ALL. PATIENTS ARE SICKER.  THERE ARE LESS REGISTERED NURSES.  I DON'T CARE WHAT THE GOVERNMENT'S OFFICIAL STATS SAY.  THEY LIE.

Nursing ratios save money and lives

By Suzanne Gordon

July 9, 2008

BEFORE ITS legislative session ends in July, the Massachusetts Senate has an opportunity to protect hospital patients as well as the nurses who care for them by approving the Patient Safety Act that was passed overwhelmingly in the House a month ago.

The ratios bill would require that the Massachusetts Department of Public Health implement enforceable limits on the number of patients a registered nurse can be assigned, thus providing patient protection in all acute care hospitals. As the Senate debates this measure, it should consider the positive effects that legally mandated nurse-patient ratios have had where they've already been enacted - in California and Australia.

In California, since 2005, no nurse on medical surgical floors can be assigned more than five patients at a time. On equivalent units in Victoria - the second largest state in Australia - the minimum required staffing for every 20 patients is five RNs, backed up by a "charge nurse" who has no patient load of her own and is thus free to assist other RNs.

In both California and Victoria, ratios were originally introduced because excessive RN workloads were putting both nurses and patients in jeopardy, while adding to overall healthcare costs. More than 60 studies have documented that hospital understaffing results in more patient deaths, plus more preventable complications like pneumonia, urinary tract and catheter infections, and medication errors. A study done in 2005 by Michael B. Rothberg in the journal Medical Care put a price tag on these problems, concluding that a nurse who had time to prevent a case of pneumonia "saved $22,390 to $28,505, or $4,225 to $5,279 per additional hospital day." When nurses prevent an adverse drug event, they save the patient from an "added 2.2 hospital days at a cost of $3,344." On the other hand, if understaffing leads to complications after surgery, the resulting patient stay can be 8.1 days longer than normal, adding nearly $11,000 to the total expense.

Unmanageable workloads have also created an exodus of nurses into other fields or nonpatient-care jobs. According to a study by L.J. Hayes that appeared in the Journal of International Nursing Studies, hospital nurse turnover in 2006 - outside of California - ranged from 15 to 36 percent per year.

A study by economist Joanne Spetz, just published in the nursing journal Politics, Policy, & Nursing Practice, finds that ratios in California have increased RN job satisfaction and reduced turnover. According to Spetz, nurses are happier at work because they now get to spend more time at the bedside - particularly on patient education - which has a positive impact on nurse turnover and thus on the quality of care.

Researchers at the University of Pennsylvania have compared nurses in California with those in Pennsylvania and New Jersey - states without minimum staffing requirements. California RNs reported greater job satisfaction, leading to less burnout.

Ratio foes claim that ratios will cripple hospital functioning and force ERs to shutter their doors, because not enough RNs are available to meet the new requirements.

The hospital industry in California cited similar dire consequences in its bid to thwart full implementation of ratio legislation. In 2005, however, the state supreme court found no evidence that any hospital or ER there had closed due to new staffing mandates as opposed to the usual reasons for a shutdown (poor management, precarious finances, and consolidation of several nearby facilities).

Easing the nursing workload gives RNs who have dropped out of the active nursing workforce an incentive to return and encourages those already employed to stay. In Victoria, the government lured more than 7,000 inactive nurses back into the workforce. In California, nurses in hospitals that have fully complied with the new standards say ratios have had the same effect and many of those who reported they wanted to leave the profession say they will now stay.

Further legislative inaction on the issue of safe staffing in Massachusetts will only prolong an unacceptable status quo that drives nurses out of their profession, leaving too many hospital patients under-protected. If we want there to be enough nurses to care for the waves of baby boomers who will soon fill our hospitals, the time to act is now.

Suzanne Gordon is co-author of "Safety in Numbers: Nurse-to-Patient Ratios and the Future of Health Care."

If you need anything else to shove up your hospital chiefs ass print the following  links out.  I doubt the fuckers will read any of it because they don't care about patients or saving money. But it's worth a try.  You could always roll the articles up and use them to slap them!  There is a reason I am getting super militant about all this at the moment.  The only new staff we are getting are 16 year old "apprentices" because the hospital can get away with paying them £2.00 an hour.  They are terrible.  This will kill so many people and cost so much money as well. But the trust thinks it needs to save money on "staffing costs" so they replace real nurses with teenagers who cannot do even 1/10 of the job.   The regulation of HCA's won't help us because we have only 2 or 3 HCA's left.  Then we have a few staff nurses, and the rest of the staff is comprised of non nurse non hca apprentices.  Help help help.



Dino-nurse said...

Unfortunately management sees what it wants to see. It knows full well that demographics are changing and not only are people living longer there are fewer youngsters to pay NI so costs are going to rise. Patients cost money so anything that reduces the cost per patient will be a winner. How about getting rid of nurses altogether and insisting that women stay at home and care for the sick? The local wise woman can come and prescribe medicinal herbs (and also act as your midwife), that new fangled breed of doctor can apply leeches and bleed you every so often and the barber surgeon can sort out your gammy hip. Better still, how about adopting the Logans Run Philosophy, or Soylent Green? I have ranted on about safe staffing levels until I am blue in the face. As long as we put up with it, nothing will change. I foresee more and more staff upping sticks to the US, Canada and Oz. Pretty soon nursing students will no longer get bursaries so the old "we paid to train you" brigade will have to shut up face facts. The NHS is a shambles despite all the shiny new PFI buildings ( National Debt paid for these and we will carry on paying for several decades). The rise of the AP will continue and the nursing hierachy will sit back and allow itself (and us) to be shafted. Patients advocate my arse. Its a two tier system and will only get worse.

Anonymous said...

I have to agree.
My partner is currently in hospital- as he is every month for 5 days- and the Poor nurses who are expected to care for so many patients are underpaid, overworked and under a great deal of stress, the HCAs who leave a great deal to be desired, cannot, will not attempt and do not provide the same standard of care, one HCA told me last month on the phone that my partner had died! then said- oh no sorry wrong person. I nearly died on the spot! the just do not give a damn about care and safety of the people in their care- by the way the managers response to my experience was, oh she apologised to you so it doesnt matter really does it?
bring back properly staffed wards with nurses and Proper matrons who do the job and make sure our loved ones get the best possible care

UCL Med Student said...

Ironically Anne, it seems that where we could quite reasonably have high patient:nurse ratios (i.e. lots of patient, few nurses) is where there are lots of otherwise healthy people (e.g. Simple day surgery stuff - a healthy 20 year old having a lumpectomy =/= 70 year old with COPD, cor pulmonale and diabetes) is where we do have good staffing ratios.


capgrass said...

militant medical nurse shut herself away in I.V. fluids cupbourd where she hurridly researched as those excellent evidence based links aka A/E charge nurse used to. Dino has just been told to "shut up and give the oxygen" by a poncy new medical registrar who thinks he is an intensivist and wants normal medical wards to start using Cpap/Ccrap. UCL medical student was hurridly trying to eat his cheese and onion when he got hit on the head by a femoral head which the surgeon had just sawn off an octogenarians hip. capgrass has been told to move a patient out of ICU NOW despite the fact that the patient is covered in bile and shit. poncy medical Reg is now digging around the ward linen room looking for some Sodium Bicarb as he believes everyone should have this as first line drug during cardiac arrest. militant medical nurse is scared incase he opens i.v. cupbourd door next. Nurse Cadet Vicky Pollard is dreaming of Robert Patterson. philapino nurse Jingle is writing a business plan to go get some more collegues from the third world. she hasnt had time to pass urine the whole long day.

uknurse said... Capgrass!

phatboy said...

I have to agree with you.

When my girlfriend had our baby in January she ended up on a ward (after the birth) where there seemed to be just one RN on the whole ward. There were a few assistants or helpers, not sure of exact title but there weren't even many of them.

In the end, after two days of waiting for a post natal check-up she couldn't take the hospital any more so we left at about 10.30pm (visiting ended at 8pm but nobody was about to throw me out so I stayed). When we left there was nobody to tell that we were going despite our best effots so we just took the baby and went.

phatboy said...

I should say that during the birth there were a lot of people about to help and she was looked after really well at the really important bit.

Dino-nurse said...

Yup...Capgrass, ever considered a career in stand-up ? We should get together and write a script for a new BBC3 would be better than that Jo Brand one. You "joke" about CPAP on general medical wards...I have heard this bandied about at inter directorate meetings recently and only the ICU contingent gasped in disbelief. If the medical directorates clinical manager had bothered to turn up I think he would have had a heart attack. The non-clinical director thought it was a good idea however. I will be having a quiet word with him later this week.

Nurse Anne said...

Capgrass rules.

UCL Med Student said...

Capgrass, was that a funny story or actually representation of something that actually happened :|

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