Nearly two-thirds of RNs working in Michigan hospitals believe staffing levels are based more on financial factors than on patient acuity.

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1 Memorandum To: From: Michigan Nurses Association Chris Anderson, Lauren Coates Date: March 21, 2016 RE: Survey of Michigan Registered Nurses This memorandum summarizes the key findings from a statewide survey of 401 Michigan Registered Nurses. Interviewing was conducted March 2 14, The margin of error associated with the overall results is +/- 4.9% at a 95% confidence interval. A full methodological description is included at the end of this document. Executive Summary A large majority of Registered Nurses in Michigan believe patient care is suffering due to RNs being required to care for too many patients at once. Understaffing is by far the most frequent obstacle RNs face in doing their jobs, and nearly six-in-ten hospital RNs feel that they do not have enough time to give needed attention to patients. Most nurses are aware of a range of negative patient outcomes from unsafe patient loads, including: infections, injuries, re-admission, longer stays, and even death. Fully 50% of hospital RNs say they are assigned an unsafe patient workload on half or more of their shifts. And when unsafe patient loads are reported to management, half of hospital RNs say loads are rarely or never adjusted. Nearly two-thirds of RNs working in Michigan hospitals believe staffing levels are based more on financial factors than on patient acuity. Michigan RNs are overwhelmingly supportive of legislating safe patient limits, with over eight-in-ten saying doing so would improve the quality of patient care.

2 Summary of Key Findings RNs are more likely to think that the quality of patient care in the state s hospitals has gotten worse than better in the past two years. Among those who think care is worse, staffing issues are cited as the main reason. Quality of hospital care in the past 2 years? Why has care gotten worse? Much Worse 1 Worse 2 Much better 5% Stayed the same 42% Better 15% Understaffing of nurses 2 Too many patients per nurse 20 Lack of support staff 12 Lack of training 11 Lack of time with patients 10 Shortage of nurses 8 Note: Only those 5% and higher shown More than eight-in-ten (86%) RNs believe that the quality of patient care is suffering due to overassignment of patients, and nearly six-in-ten (58%) hospital RNs feel that they do not have enough time to provide patients with the necessary care. Is quality of patient care suffering due to understaffing? Strongly disagree disagree 6% agree 20% 5% Strongly agree 66% Do you have enough time to care for patients? No 58% Yes 38% Page 2 of 5

3 Half (50%) of hospital RNs say they are assigned an unsafe patient load at least half of the time they re working. Among those who do have an unsafe patient load, almost half (49%) say management usually does not adjust patient assignments. How often do you have an unsafe patient load? How often does management adjust unsafe patient loads? 15% Almost every shift 7% 9% 18% Always 12% Rarely 3 Half or more Shifts 4 Rarely 3 Most of the time 29% In addition, nurses are aware of a range of specific negative patient outcomes as a result of inadequate staffing, with more than one-in-five (22%) reporting awareness of a patient s death. Are you aware of any instances when understaffing has led to Nurses lacking time to properly comfort and assist patients and families Nurses lacking time to educate patients and provide adequate discharge planning Yes, Aware 79% 85% Medication errors, such as the wrong medication, wrong dosage, or missed meds Infections or other complications for a patient 57% 6 Re- admission for a patient 5 Injury or harm to a patient 49% Longer hospital stays 45% A patient dying 22% Page 3 of 5

4 Nearly two-thirds (65%) of hospital RNs say that staffing decisions are made based on hospital finances and profit margins rather than patient acuity. Are staffing decision based more on More than half (55%) of hospital RNs have often considered leaving bedside nursing because of short staffing. How often has short staffing caused you to consider leaving bedside nursing? Combination 6% Patient acuity 27% 30% Very often 3 Profit margins 65% Not very Often 1 often 2 Michigan RNs overwhelmingly favor passing a law to establish a limit on the number of patients a nurse is assigned at one time. More than eight-in-ten (8) RNs agree that the proposed law will improve the quality of patient care. Do you favor or oppose a law establishing patient limits? Strongly oppose oppose favor 87% 16% UNAP members 7 non-members Strongly favor 7 Would quality of care improve or get worse if law was established? Get a lot worse Get a little worse Stay the same 1 Improve a little 19% Improve a lot 6

5 Methodology A total of 401 interviews with Michigan Registered Nurses were conducted by trained professionals working from a central, monitored location. Respondents were randomly selected from a list of all registered nurses licensed in Michigan and screened to identify those currently working in hospitals and those working outside of a hospital. Of the 401 respondents, 200 work in a hospital providing direct patient care, 160 work in healthcare outside of a hospital setting, and the remaining work in a hospital but do not provide acute care. Additionally, 48 respondents are members of the Michigan Nurses Association and the remainder are not members. The Michigan Nurses Association was not revealed to respondents as the sponsor of the research until after interviews were complete. Page 5 of 5