How many nurses should a hospital maternity ward have? How about the intensive care or neonatal units? Should they be the same numbers at rural and inner city hospitals?
The correct answer now depends upon each individual hospital’s best practices. But state legislators want to take the guess work out of staffing.
A pair of Democratic state lawmakers have introduced bills in both the House and Senate that would mandate a minimum number of registered nurses-to-patient ratio at all hospitals in the state. The concept has been embraced by nursing unions but is not being warmly received by hospitals and related organizations.
The companion bills, introduced in the House by state Rep. Phyllis Mundy, of Kingston, and in the Senate by Sen. Leach, of Wayne, call for a ratio that would vary, depending on the nature of the care. For example, under their legislation, there would be one registered nurse for every two neonatal patients, and one registered nurse for every four patients in a pre-surgical unit.
Push for patient safety
Both Mundy and Leach tout patient safety as the driving force behind their bills.
“Studies show that patients in hospitals with higher registered nurse staffing levels are less likely to get an infection during their care, and as a result, health care costs can be reduced by as much as 30 percent,” Mundy said.
“There is compelling statistical evidence that patient safety is improved dramatically, and the costs to hospitals are reduced as malpractice claims fall and unnecessary, uncompensated care is avoided,” said Leach. “Hospitals should make this investment in patient care that will pay dividends in overall savings.”
Kim Klinger, a registered nurse at Geisinger Wyoming Valley and the vice president of the SEIU local that represents more than 400 nurses at the Plains Township hospital, said the union supports the bill “strongly.”
She chided hospital decisions on staffing saying: “There’s no rhyme or reason as to how much staff or staff mix there is. It’s something staff feels every day of every working hour.”
Another strong supporter of the bills is the nursing union that represents about 5,000 nurses statewide, including several hundred at Wilkes-Barre General Hospital.
“Nurses and patients need this protection,” said Patricia Eakin, an emergency room nurse at Temple University Hospital and president of The Pennsylvania Association of Staff Nurses and Allied Professionals. “If we don’t have adequate time to do our work — assessing patients for change in condition, administering medications properly, ensuring that the patient is out of bed and walking so they don’t develop pneumonia or life-threatening blood clots — patients can die.”
The Pennsylvania Association of Staff Nurses and Allied Professionals previously has backed enactment of similar legislation. An almost identical bill was introduced last session by Mundy. It was referred to the House Health Committee and never made it out.
“We will keep fighting,” Klinger said. She noted that for seven years nurses fought for the state to approve a mandatory overtime law. That happened, and Klinger said that nurses will keep fighting for this bill to become law, too.
Wilkes-Barre General Hospital issued a statement on the proposal, pointing out that present best practices work.
The statement reads: “Wilkes-Barre General Hospital is committed to providing safe, quality care and a safe and comfortable hospital environment for our patients. We staff our hospital based on the number of patients in our care and their medical needs and greatly appreciate the many employees who deliver that care day in and day out.”
California’s legislature approved a mandate to address the state’s nursing shortage and patient safety, and Mundy said an evaluation of data since the law took effect shows it’s working.
Since California’s ratio law was signed, the number of registered nurses in California has grown by about 100,000, according to Board of Registered Nursing data. Many of California’s largest hospital systems have seen their turnover and vacancy rates fall below 5 percent, which is far below the national average, Mundy noted.
While that might be what data show, a Geisinger Health System spokesman said patient outcomes are not affected.
“In line with the position of the Hospital Association of Pennsylvania, at Geisinger, we believe mandated nurse staffing ratios have not demonstrated improvement in patient outcomes,” said Matt Van Stone, a spokesman for the health system that operates facilities in Plains Township, South Wilkes-Barre, Scranton and elsewhere.
All hospitals are “required to ensure safe and adequate staffing under their licensure regulations, Joint Commission accreditation standards and Medicare Conditions of Participation,” he said. Geisinger hospitals, Van Stone said, comply with these requirements.
“Nurse staffing levels are influenced by multiple factors, all of which are taken into consideration, reviewed each day and for each shift to ensure appropriate staffing,” Van Stone said. Among those factors are: education of nurses, total years of experience, number of patients assigned to each nurse, number of ancillary and other licensed staff, patient acuity and technology support to the nursing staff.
Association weighs in
Roger Baumgarten, a spokesman for the Hospital Association of Pennsylvania, said “Pennsylvania’s hospitals are opposed to mandatory ratios, and have been for many years. There are too many variables involved with determining staffing levels, and any one-size-fits-all policy/ratio ignores those variables.”
Baumgarten said the association, and its member hospitals, “recognize the importance of nurses in providing high-quality care and know that nurses make a difference in preventing harm and saving lives.” But the results in California have shown only “that California hospitals did experience increased labor costs higher than in other states.”
The House bill has been sent to the Finance Committee. The Senate bill has not yet moved.