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09.26.2006
New Survey Says:
Hospitals Put Patients Last
Only real-time survey of actual nurse staffing levels
shows there has been no improvement in Massachusetts hospital RN
staffing in the last two years
Nearly 40 percent of units fail to meet the accepted standard
of two patients per nurse limit in ICUs
CANTON, MA—As the Massachusetts Hospital
Association (MHA) prepares to launch a two-day conference this week
trumpeting their “Patients First” public relations campaign
and Web site on hospital staffing, the Massachusetts Nurses Association
(MNA) is releasing today the preliminary results of the only real-time
survey of actual hospital staffing performance, which found that
hospitals regularly violate their own published staffing plans,
placing patients at a significantly increased risk of injury.
The survey, which is a follow up to a similar analysis completed
in 2004, found that staffing levels in the state’s acute care
hospitals remain unchanged over the last two years, despite the
hospital industry’s claims to be improving the quality and
safety of nursing care.
Survey highlights include:
- There was no statistically significant difference in hospital
staffing levels on medical/surgical units between the 2004 and
2006 surveys.
- Extreme ranges in the number of patients assigned to registered
nurses.
- More than half of the hospitals reported regularly assigning
more than five patients per nurse on the medical/surgical floor,
in excess of the current limit set by regulations in California.
- Every hospital reported an assignment of more than four patients
per nurse on the medical/surgical floor. A study in the Journal
of the American Medical Association finds that for each patient
over four assigned to an RN there is a 7 percent increase in risk
of injury, harm and death to patients.
- In a shocking 36 percent of observations hospitals failed to
meet the accepted minimum standard of no more than two patients
per nurse in the intensive care unit, a standard recommended by
the Institute of Medicine.
- Most alarming of all, more than 45 percent of hospitals had,
on occasion, assigned eight patients or more to their nurses,
a staffing level that according to research published in Journal
of the American Medical Association, placed those patients at
a 31 percent increased risk of death.
“This survey, which is the only study to track what really
is actually happening with nurse staffing in our hospitals, shows
once and for all that the hospital’s ‘Patients First’
initiative is a farce, providing patients with a false promise of
patient safety, and that the hospital’s actual staffing practices
are oftentimes patently dangerous and irresponsible,” said
Beth Piknick, RN, president of the Massachusetts Nurses Association.
“The fact that there is so much variation in hospital staffing
levels and the fact that they are incapable of adhering to their
own self-created plans is the best argument for legislation creating
enforceable safe limits on the number of patients assigned to an
RN.”
Piknick noted, “The MHA Web site is not based on any research
or standard of care; it’s the hospitals self-imposed plan
and ironically one they don't even follow".
The staffing survey was conducted by the Massachusetts Nurses Association,
in conjunction with Andover Economics, a leading health care economics
research firm. The survey was conducted April 4 – 21, 2006,
and employed a random sample of 65 medical/surgical floors and 52
intensive care units in 35 of the state’s 67 acute care hospitals.
The survey, which included random sampling of all shifts and all
days of the week, tracked the actual RN-to-patient ratios, with
nearly 1,000 individual shifts observed. It is the only real-time
survey of hospital staffing and actual RN patient assignments ever
conducted.
The MNA is concerned that the hospital association and others in
the nursing field are treating the Patients First staffing numbers
as if they represent the actual staffing patterns in Massachusetts
hospitals. In fact, the MHA is promoting a research study published
in the September issue of the Journal of Nursing Administration,
which purported to present a scientific analysis of staffing in
Massachusetts hospitals based on the staffing patterns promised
on the Patients First Web site.
A random sampling of hospitals by the MNA analyzing the actual
RN staffing levels and census data with the Patients First Web site
for those hospital units, found the patient census matched only
6 percent of the time while the actual RN staffing matched only
15 percent of the time. This again reaffirms that the Web site has
little relationship to the reality that patients face when they
are admitted to the hospital.
“We will not allow the MHA and its surrogates to use false
data and misinformation to cloud an issue of such great importance
to the safety of patients in our hospitals,” Piknick said.
“The only conclusion that can be reached from any honest look
at the staffing patterns in our hospitals is that, left unregulated,
they vary from facility to facility and there is no guarantee of
any expected level of safety for any patient under current conditions.
Clearly, continued self policing has generated a public relations
campaign and a Web site, but no substantive change for patients
or the front-line nurses who care for them. The only way we can
make that happen is through legislation to actually hold hospitals
accountable.”
The release of the preliminary results of the survey are part of
a larger study on RN staffing in Massachusetts hospitals and the
cost of implementing safer staffing standards, which Andover Economics
intends to release in October.
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