Burda: Something we havent written a lot about lately is staffing ratios. That was a real big issue in California. We covered the up and down of that in Massachusetts, a couple other states, but that seems to have dropped off the radar lately.
Jenkins: Its a huge issue. You talk to any nurse anywhere in this country and staffing ratios is the first thing they want to talk about. I was here in Chicago in May for a critical-care conference, probably talked to 500 nurses myself. Thats the first word out of their mouth, staffing ratios. They are tired of coming to work, not having the staff they need, having the budget override, having enough people to take care of patients, and it is the No. 1 hot-button issue with nurses whether youre seeing it or not. As a nursing organization, that is the primary issue nurses are concerned about still.
Burda: Is that being welcomed in statehouses across the country, or is it just out of step with other issues?
Jenkins: Its being proposed in many statehouses. The problem is there are people who come around and try to counteract the basic fundamental concept with watered-down plans that dont quite address the issue of what really concerns nurses, which is when I go to work every day, I know theres going to be at least this many patients that Im going to be taking care of, and thats not going to be an issue every day. So you see in Massachusetts, you see in Illinois, you see in Arizona, Texas, places where ratios are being proposed, and I think its still the No. 1 primary issue for nurses in this country. Its really hard to go to work and feel like you can provide safe care when theres not enough staff to do it. And if youre not seeing it, were certainly seeing it at the top of the list of what concerns nurses.
Burda: How does something like that affect your ability to run a hospital, Dave, if youre under mandates like that?
Hefner: Its not a mandate in Illinois yet, but there are different ways of viewing it. Theres a Senate Bill 867 that while its not straight ratios, its beginning to lay the track for: How do you staff and how do you account for it? Im not a nurse. But if I stood in a nurses shoes and I looked at life from that perspective and what I want to do is take care of this patient and their families, thats why Im a nurse, but Im being buffeted by so many different forces that Im not either privy to or understanding of or management hadnt sorted it out for me, that I will probably default to, like everybody else in the institution, give me more people or give me more space or give me more money, as if thats going to solve the problem, rather than fixing the process itself.
And thats something we dont do very good in healthcare because of the fragmentation in silos that we have to break down those walls and work as collaborative teams. I think nurses end up having to suffer from that, and I think its somewhat illusionary or misguided that staffing ratios are the answer. If that were true, then the nursing workforce in California should be the happiest campers in the nation, and theyre not. Nor can we prove that it even impacts outcomes in the direction that we want. But Im not saying its a bad thing. It just ends up taking us, I think, down some blind alleys that really arent solving what we need to.
Jenkins: I would differ with that because there are some significant studies out there that show better staffing improves patient outcomes.
Stickler: And there are other studies that say it doesnt. And let me just say that we have a difference of view here, not on the basis of ratios because youve got 1,300 nurses about three miles from here that just negotiated a contract, ratified last month, and the contract was negotiated in less than a month. And this is a state nurses association in Illinois, and they have a patient-by-acuity model that I would say is better than any ratio that you will see. Now, really, we have guidelines. I mean, lets be honest. In every single hospital in each unit, we staff according to the guidelines, and we flex up or flex down based upon the needs of the moment.
Jenkins: And they get tweaked every which way possible every day all the time, which is why nurses demanded ratios in California. We went to an acuity system. Those systems are proprietary. You buy them from a company. The data that actually formulates the acuities is proprietary, so nobody knows what it is, and they tweak it any way they want.
And, you know, we tried all the incremental things in California. The reality was the ratios are still a minimum not a maximum. You can staff up if you need to based on all those things youre talking about, acuity and the judgment of the charge nurse. All that still happens within the context. All the ratio says is this is the bottom line you cant go below. And I think the reason we went to that in California, it was after years and years and years of trying to implement systems like that, that had that wiggle room in them, and we found they got tweaked all over the place all the time, so you never had a minimum standard you could rely on.