Research by such institutions as the
Institute of Medicine (IOM) of the National Academies and the
Joint Commission confirms what every working nurse already knows. There are too few nurses caring for too many patients in hospitals around the country. Of course, too few nurses means medical errors causing preventable patient deaths and injuries are more likely to occur. Indeed,
researchers from the University of Pennsylvania have found that when a hospital decreases a registered nurse’s patient load from eight patients to four, the risk that a surgical patient will die within a 30-day period drops by 31 percent!
To make matters worse, as nurses confront the daily reality of chronic understaffing and unmanageable workloads, more and more nurses leave the nursing profession in frustration. A
study in
JAMA, The Journal of the American Medical Association noted each additional patient per nurse (above four) is associated with a 23 percent increase in the odds of nurse burnout and a 15 percent increase in the odds of job dissatisfaction.
While hospital executives and some associations continue to promote simplistic notions that each workplace can work things out, there is simply no reason to think this is a real solution—if hospital executives were willing or able to resolve the staffing crisis, wouldn’t they already have done so?
RNs Working Together, a coalition of 10 AFL-CIO unions representing more than 200,000 registered nurses, thinks it is time for real reform that directly confronts the nursing staffing crisis and increases patient safety. That is why RNs Working Together, as the largest organization of working nurses, has endorsed the
Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 (H.R. 2123)
, introduced by Rep. Jan Schakowsky (D-Ill.). This legislation would mandate minimum nurse-to-patient ratios in the following manner:
- Require federally funded hospitals to meet minimum safe direct-care registered nurse-to-patient ratios in each unit, during each shift:
- One patient in an operating room and trauma emergency unit.
- Two patients in all critical care units, intensive care, labor and delivery and post-anesthesia units.
- Three patients in antepartum, emergency, pediatrics, step-down and telemetry units.
- Four patients in intermediate care nursery, medical/surgical and acute care psychiatric care units.
- Five patients in rehabilitation units.
- Six patients in postpartum (three couplets) and well-baby nursery units.
- Require staffing plans to be developed with the involvement of registered nurses or their representatives.
- Require use of an acuity system to determine staffing levels above the established minimum.
- Require a study that would establish staffing requirements for licensed practical or vocational nurses (LPN/LVN).
- Establish whistle-blower protections, including the right for a nurse to refuse an assignment if it violates the act.
- Require hospitals to post the established ratios for each unit.
- Include corrective action, including civil monetary penalties and loss of federal funds, for hospitals that fail to meet requirements of this act.
- Provide for additional Medicare reimbursement related to costs in meeting new nurse staffing levels.
Enacting comprehensive health care reform is at the top of America's political agenda. Passing the Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 is an important step to solving the "quality of care" portion of the health care reform equation.
Click here to download a pdf of H.R. 2123.
