*Moody's Investors Service said the spread between upgrades and downgrades of hospital bond ratings narrowed during the first quarter. The New York-based rating agency raised nine ratings on $523 million of debt and lowered 12 ratings on $471 million of debt. While the rating actions show "pockets of improvement," Moody's said it expects increased competitive and reimbursement pressures. Several of the downgrades stem from managed-care pricing pressures. Most of the upgrades affected hospitals that have yet to be seriously hurt by such pressures.
*The public doubts it's getting the best quality of care in the nation's hospitals, according to a study sponsored by the American Nurses Association. About half the respondents said reducing the number of bedside nurses lowers quality a lot, and 23% said it lowers quality a little. Four in 10 people said letting unlicensed workers do the tasks nurses used to do will harm quality a lot, and 27% said it will harm quality a little. Those results align closely with the ANA's political goals of defending the position of registered nurses in the healthcare employment matrix. The ANA and other nursing organizations are fighting the tendency of hospitals and other providers to diminish the numbers of nurses on staff or alter their role. Coincident with National Nurses Week, the survey results were released late last week at a news conference on Capitol Hill with four members of Congress, including Rep. Maurice Hinchey (D-N.Y.), who introduced the ANA's Patient Safety Act the previous week. That bill would require hospitals to publish staffing levels, staffing mix and patient outcomes. It also would protect nurses from retaliation if they blow the whistle on unsafe practices. Meanwhile, Revolution magazine, which calls itself "the journal of nurse empowerment," scheduled a rally of 20,000 nurses at the Capitol for late last week. Publisher Laura Gasparis Vonfrolio said: "No one is keeping track of how patients fare in a restructured healthcare environment. Our family members are suffering and dying in these re-engineering experiments, and most don't even know why."