Proposed federal legislation that would establish a national requirement for hospitals to meet minimum staffing ratios has hospitals on edge about possible government-imposed mandates.
"One staffing ratio does not fit every situation," said William Corley, president of five-hospital Community Health Network, Indianapolis. "Patient care and acuity levels vary considerably. Tell me another industry where the federal government determines the numbers."
Using the celebration of National Nurses Week as a backdrop, Sen. Daniel Inouye (D-Hawaii) introduced the proposal last week that would require hospitals to comply with a minimum nurse-to-patient ratio.
The legislation, backed by the American Nurses Association, does not establish a specific nurse-to-patient ratio but would mandate staffing levels based on several factors at individual hospitals, such as the severity of patients' conditions and the availability of support services and resources. The number of patients and the level and intensity of care that need to be provided would help determine staffing levels, while other factors, such as comment from registered nurses, also would play a role in ratios. Nurses' work experience and their level of preparation would help define ratios too.
Ratios also would take into account the physical layout of the hospital building and available technology. Nurses would be assigned only to units where they have proved they can deliver professional care.
The bill also would require public reporting of staffing information by making hospitals post the number of nurses providing patient care. Whistleblowers who are considering filing a complaint regarding nurse staffing would find protection under the legislation, which would be enforced by HHS through the Centers for Medicare and Medicaid Services.
"Inappropriate nurse staffing is the No. 1 concern of nurses today," said Barbara Blakeney, president of the ANA, which is lobbying for the legislation. "When RN care is insufficient, patient safety is compromised and the risk of death is increased."
Requiring minimum staffing ratios is necessary because of a nursing shortage that is expected to worsen in the future, Blakeney said. According to an HHS study, there was a nationwide shortage of 110,000 nurses, or 6%, in 2000. HHS predicts the shortage will grow to 12% in 2010 and 29% by 2020.
"Nurses are taking care of way too many patients," Blakeney said. "We have got to lessen the burden of nurses taking care of patients. When they have time, they can prevent some significantly bad things from happening."
In a study published in the Oct. 23, 2002, issue of the Journal of the American Medical Association, researchers found that a patient's chances of dying within 30 days of a hospital admission increased when the number of patients under a nurse's care increased.
Each additional patient per nurse over four represented a 7% increase in risk of death within 30 days of admission, according to the study, which was conducted by the University of Pennsylvania School of Nursing (Oct. 28, 2002, p. 14).
The nurses' association is optimistic Congress will approve the legislation, but Blakeney said she knows it will take some effort to see the proposal become law. California is the only state that has passed a nurse-staffing law, which is set to go into effect Jan. 1, 2004.
"We will be doing everything we can to get this issue thoroughly debated," she said. "The nurses need relief."
Thousands of nurses rallied on Capitol Hill last week as part of National Nurses Week, and they said the federal legislation would create safe staffing levels and improve working conditions at all hospitals.
Karen Hankin, a registered nurse at 645-bed Sunrise Hospital and Medical Center, Las Vegas, said Inouye's proposed legislation is a step in the right direction. Under the legislation, Sunrise, which is owned by HCA, Nashville, would have the same staffing standards as other HCA hospitals, she said.
Less than half-about 1.3 million-of the 2.7 million licensed nurses are practicing in hospitals in the U.S., said Martha Baker, a registered nurse at Jackson Memorial Hospital, Miami, who attended the Capitol rally.
"The working conditions are certainly the reason nurses are leaving the profession," Baker said. "If you fix the problem, they will stay."
Some healthcare executives said relief could be on the way at nursing schools. According to a survey released last week by Johnson & Johnson, 84% of nursing schools experienced an increase in applications and enrollment from February to October 2002.
Nurses around the country are lobbying for laws that will lead to fewer patients per nurse. The Wisconsin Federation of Nurses and Health Professionals is backing legislation that state Democratic Sen. Judy Robson plans to introduce this week requiring nurse-to-patient ratios. The union cited a national survey showing medical-surgical nurses care for an average of eight patients per shift.
Of 601 nurses surveyed, 61% said the ratio should be five patients to every nurse. Only 28% of the nurses surveyed said they work within that ratio. In Massachusetts and Nevada, lawmakers are mapping proposals to set minimum nurse-to-patient ratios by unit. Lawmakers in Hawaii, Illinois, Maine, Missouri, Rhode Island and Vermont also are considering nurse-staffing laws.