MASSACHUSETTS NURSE NEWSLETTER :: October 2006

Survey says that hospitals put patients last

As the Massachusetts Hospital Association prepared to launch a two-day conference in September in order to trumpet its “Patients First” public relations campaign, the MNA released the preliminary results of the only real-time survey of actual hospital staffing performance—and it found that hospitals regularly violate their own published staffing plans.
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 remained 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 MNA. “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 MNA, 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 these preliminary survey results were part of a larger study on RN staffing in Massachusetts hospitals and the cost of implementing safer staffing standards. Andover Economics intends to release in October.