Anne Marie Holler NUR 503 Group Project- Safe Staffing for Quality Care Act 11/21/11 Impact of Safe Staffing for Quality Care Act The Safe Staffing for Quality Care Act will have a profound impact on the Advanced Practice Nurse; it will affect the Administrator, Practitioner, and Educator in a variety of ways. Administrative perspective: With the ever-increasing cost restraints facing hospitals, mandatory increases in staffing levels might be difficult for health care Administers to implement. However, studies have shown that cost savings from the prevention of adverse outcomes along with reduced patient length of stay could pay for the staffing reforms (ANA, 2009). Maintaining effective nurse to patient ratios is very important for the improvement of quality of care (ANA, 2009). Hospitals are paid a fixed rate under diagnosis related groups (DRGs) and presently the quality of care provided is not factored into the reimbursed rates. Administrators might argue that they are not in a position financially to assume the increased cost which would burden their facility (U.S. Department of Human Services (AHRQ), 2007). Enacting this legislation would not only improve patient care, it would also help New York State's hospitals achieve improved performance ratings from better health outcomes, which would ultimately have a positive effect on their reimbursement rates. Reimbursement will be effected by quality performance indicators such as patient satisfaction survey, less hospital acquired infections and decubiti, a decrease in patient complications, and length of hospital stay (U.S. Department of Human Services (AHRQ),
2007). This should be an incentive for administrators to maintain staffing levels that will result in safe and quality patient care. Practitioner perspective: Nurses are working longer hours and caring for a larger number of sicker patients. They are concerned about excessive workloads where they cannot provide the sufficient assessment or care resulting in potential issues in compromised patient safety, and mortality. Safe staffing regulations are a necessity both for the nurse and the patient. It will have an impact on decreasing the chance of nurse dissatisfaction, and high turnover rates, as well as increasing the safety for the patient (ANA, 2009). Safe staffing lays the foundation for providing high quality patient care in the healthcare arena. There is significant support from advocacy groups in favor of Safe Staffing for Quality Care Act. But until this legislation becomes law, nurses won't have the ability to influence these unsafe ratios alone. Providing safe staffing standards is often advocated through the assistance of nurse unions and collective bargaining at contract time (Clark & Clark, 2006). Educator Perspective Research on staffing and patient outcomes has relevance for nurse educators, both in the clinical and academic settings. It is essential for nurse educators to produce graduate nurses who are capable of providing safe patient care in the health care setting. They need a strong knowledge base along with good clinical skills. Nursing students need to be aware of the issue of safe staffing and the reality of present staffing practice. Nursing educators help to develop the critical thinking skills that are necessary for these future nurses to be able to identify potential problems or risks that may affect patient safety. The content taught regarding risk factors for
patient safety, proper nursing actions, and behavior, lays the foundation for the provision of safe patient care (Ballard, 2003). Human patient simulation is a fairly new teaching strategy that allows students to apply knowledge and skills in a realistic clinical setting. This is an effective way to practice their skill competencies and decision-making within a safe, supervised setting (AHRQ, 2008, chapter 51, p.1). These learning experiences provide the practice and experience needed to contribute to the safety and quality of patient care. Potential Solutions The idea of the Safe Staffing for Quality Care Act is for the United States Department of Health and Human Services to authorize acute care facilities and nursing homes to comply with regulations to establish standards for appropriate staffing ratios of licensed nursing and unlicensed direct care staff (NYS Assembly, 2011). The high nurse to patient ratios remains a problem for nurses everywhere. This problem also affects the patient because short staffing of nurses is linked with poorer patient outcomes, lengthened hospital stays, increased chance of medication errors, and death (ANA, 2009). American Nurses Association has a national campaign to help solve the nurse staffing crisis. Their idea includes having hospitals set up nurse staffing plans for each unit based on variables such as patient acuity, number of patients, skills and experience of nurses working that shift, and the support staff working (ANA, 2009). The New York State Assembly (2011b) has listed a summary of potential staffing solutions to address the current issue. Formulation of a staffing committee consisting of Registered Nurses, representatives of health care facility, professional nurse association, and collective bargaining representative.
Each acute care facility and nursing home will ensure that it is staffed appropriately with licensed direct care nurses and staff in every department. Facilities need to work with direct care nurses by forming a committee and developing safe staffing plans with a minimum nurse to patient ratio. The committee would advise the New York State Department of Health and Human Services Commissioner on the efficacy of the proposed plan, when requesting approval of it. (New York State Assembly, 2011b). Staffing plan Meet the minimum requirements set forth by the committee to ensure staffing needs are met. Utilize an approved patient acuity system to determine levels of staffing dependent upon patients' conditions on unit and level of care needed. Consider level of skill and experience of direct care providers on unit. Address adjusted staffing levels when fluctuations in patient acuity require additional staffing. Factoring of unit activities which will require additional staffing, including transfers, admissions, discharges, and post-operative patients. Documented orientation /evaluation of nurse prior to providing care to ascertain competence. Yearly assessment of prior years staffing plan. (New York State Assembly, 2011b).
Proposed Staffing Ratios One nurse per patient in the trauma unit, operating room, ICU, maternal/child (second or third stage of labor). One nurse per two patients in the post anesthesia care unit, and maternal/child (first stage of labor). One nurse per three patients in post partum, newborn care, emergency room, pediatrics, step-down units, and telemetry. One nurse per four patients in med/surg, acute psych. One nurse to five patients in rehab unit. One nurse to six patients in well baby nursery. (New York State Assembly, 2011b). Maintaining compliance As a condition for facility operating certificate each facility will maintain daily records of patient census and staffing levels. Staffing levels available for public disclosure. Nurse may refuse work assignment if deems unprepared/unqualified by education and training without retribution by employer. Assessment of civil penalty for violations. (New York State Assembly, 2011b). Nurse staffing is being addressed through state legislation. Not all states will address this act seriously. For the safe staffing for quality care act to become law, Federal legislation might be necessary (Stokowsky, L., 2009).
References American Nurses Association. (2009). Safe staffing saves lives: Key findings from research studies on safe nurse staffing. Retrieved from Http://www.safestaffinsaveslives.org Ballard, K., (2003). Patient safety: a shared responsibility. Online Journal of Issues in Nursing. 8(3). Retrieved from http://www.nursingworld.org/mainmenucategories/ ANAMarketplace/ANAPeriodicals/ OJIN/TableofContents/Volume82003/ No3Sept2003/PatientSafety.aspx Clark, P., & Clark, D. (2006). Union strategies for improving patient care: The key to nurse unionism. Labor Studies Journal, 31(1), 51-70. New York State Assembly. (2011). Safe Staffing Bill #A921. Retrieved from http://assembly.state.ny.us/leg/?bn=a00921 New York State Senate. (2011, June 1). Enacts the "Safe Staffing for Quality Care Act". Retrieved from http://m.nysenate.gov/legislation/bill/a921-2011 Stokowski, L., (2009). Nurse Staffing for Safety: Safe staffing legislation. Medscape nurses news. Retrieved from http://www.medscape.com/viewarticle711116 U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2007). Nurse staffing and quality of patient care (AHRQ Publication No. 07-E005). Retrieved from http://www.ahrq.gov/downloads/pub/evidence/ pdf/nursestaff/nursestaff.pdf U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2008). Patient safety & Quality: An evidenced based handbook for nurses (AHRQ Publication No. 08-0043). Retrieved from http://www.ncbi.nlm.gov/books/nbk2651/.
Appendix A: Letter to legislator The Honorable George Maziarz Room 708, Legislative Office Building Albany, N.Y. 12247 September 20, 2011 Dear Senator Maziarz, I am writing to you to express my support for the Safe Staffing for Quality Care Act A00921/A04553/A921-2011. As a Registered Nurse working in acute care I am concerned over the current nurse to patient staffing ratio. It is essential to staff safely based on the specific needs of the unit and factors such as patient acuity. Staffing levels in New York health facilities are inadequate and may impede nurses from practicing safe and effective care. There is a direct correlation between RN staffing and lower rates of patient complications and mortality. Safe staffing ratios would also enhance nurse recruitment and retention efforts, which is so important with our present nursing shortage. I would like to extend an invitation for us to meet to discuss this important bill. I am concerned over the current nurse staffing practice as it negatively affects patient safety, and quality of care. Sincerely, Anne Marie Holler BS RN
Appendix B: Legislation Presentation Safe Staffing for Quality Care Act Bill A00921/A04553 Safe Staffing for Quality Care Act would require each acute care facility to be staffed in a manner that provides sufficient, appropriately qualified direct-care nurses in each department or unit within the facility in order to meet the needs of the patients (New York Senate, June 1, 2011). Nurses are working longer hours and caring for a larger number of sicker patients. They are concerned about excessive workloads where they cannot provide the sufficient assessment or care resulting in potential issues in compromised patient safety, and mortality. A safe staffing regulation is a necessity both for the nurse and the patient. It will have an impact on decreasing the chance of nurse dissatisfaction, and high turnover rates, as well as increasing the safety for the patient (ANA, 2009). Safe staffing lays the foundation for providing high quality patient care in the healthcare arena. An adequate number of Registered Nurses are needed to care for the rising level of patient acuity in healthcare facility today. Inadequate number of Registered Nurses providing direct care places the delivery of quality health care at risk. There is a direct correlation between inadequate number of direct care nurses to patient safety and mortality rates (ANA, 2009). Quality measures need to be improved in order to protect patients and reduce the incidence of medical errors, and adverse patient outcomes.
According to the Joint Commission on Accreditation of Healthcare Organizations (2002), the lack of Registered Nurses contributed to almost 25% of the unanticipated problems that result in injury or death to hospital patients. Requirements for direct care RN staffing ratios will help address the RN shortage by helping recruit new RN's and improve retention of those that are considering leaving the profession due to the demands and risks created by inadequate staffing. RN's are being required to perform patient care in unsafe environments that do not support quality care or a healthful work environment. Establishing adequate minimum direct care nurse to patient ratios that account for patient acuity measures will improve the delivery of health care services and guarantee patient safety. Studies have shown that cost savings from the prevention of adverse outcomes along with reduced patient length of stay could pay for the staffing reforms. Maintaining effective nurse to patient ratios is very important for the improvement of quality of care. Hospitals are paid a fixed rate under diagnosis related groups (DRGs) and presently the quality of care provided is not factored into the reimbursed rates. Administrators might argue that they are not in a position financially to assume the increased cost which would burden their facility. Enacting this legislation would not only improve patient care, it would also help New York State's hospitals achieve improved performance ratings from better health outcomes, which would ultimately have a positive effect on their reimbursement rates. Reimbursement will be effected by quality performance indicators such as patient satisfaction survey, less hospital acquired infections and decubiti, and a decrease in patient complications. This should be an incentive for administrators to maintain staffing levels that will result in safe and quality patient care.
Appendix C: Legislation Presentation Pamphlet Left for Senator Maziarz New York State Nurses Association. (2004). Safe nurse staffing: How does it affect you and your family. Retrieved from http://www.nysna.org/practice/staffing/intro.htm