Vacancy Rates Say Little about the Actual Safety of Staffing in Hospitals — It’s RN-to-Patient Ratios that Matter
Without a Guarantee of Safe RN-Patient Ratios, Patients Remain at Risk and Nurses Recruited to Fill Vacancies Will Not Stay
Boston, Mass. – The release of a survey today by the Massachusetts Hospital Association and Mass Organization of Nurse Executives showing a drop in the vacancy rate for registered nurses in Massachusetts hospitals fails to provide a true measure of the quality and safety of nurse staffing levels in Commonwealth hospitals. The most important measure of nursing care quality is the ratio of registered nurses to patients, something the hospital industry refuses to provide. Without legislation to establish safe, minimum RN-to-patient ratios, attempts to address the nursing crisis in hospitals will not succeed, placing patients at continued risk, while forcing more nurses to leave hospital nursing.
"Front-line nurses put little stock in hospital reporting of vacancy rates, as they don’t reflect what is really happening on the frontlines for either nurses or patients," said Julie Pinkham, RN, MNA executive director. "A hospital can have no vacancies, yet assigns each of their nurses 6, 7 or 8 patients and the result will be those patients are placed at a 14%, 21% and 30% risk of death respectively, according to research published in the Journal of the American Medical Association."
There is no shortage of nurses in Massachusetts according to Pinkham. “What we have is a shortage of nurses willing to work under the conditions created by the hospital industry. The fact is that our state has more nurses per capita than any state in the nation. The number one problem we face is one of retention.”
The MHA survey does not provide data on the turnover rate of nurses recruited into these positions. The turnover rate refers the rate that nurses, who take positions, leave those positions. "We have received numerous reports from our members of nurses who are recruited into positions and leave those positions within a year because they were unhappy and dissatisfied with the staffing conditions," said Pinkham.
Pinkham cites the same study by the Journal of the American Medical Association, which showed that for every patient beyond four assigned to an RN, the risk of nurse dissatisfaction increased by 15% per patient and the rate of burnout increased by 23%. Numerous studies show that nurse burnout and job dissatisfaction are the key determinants of nurse turnover.
A number of studies, including those done by the hospital industry and nursing administrators, show the cost of such turnover to be enormous. A study published in the scholarly journal, Health Care Management Review on the high cost of RN turnover found the cost for advertising, training and loss in productivity associated with recruiting new nurses to a facility is $37,000 per nurse at minimum and can add as much as 5 percent to a hospital’s annual budget. The study concludes that improving working/staffing conditions is a primary strategy for hospitals that can generate significant cost savings.
The MHA survey, which details strategies to recruit and retain nurses into facilities, fails to list RN-to- patient ratios as one of those strategies. A study of nurses in Massachusetts found that 93 percent report being burnt out by excessive patient loads and understaffing; and fully 87% rank the guarantee of safe RN-to-patient ratios as the most important solution to the nurse staffing crisis.
The MNA, along with 70 leading health care and consumer organizations, last year formed the Coalition to Protect Massachusetts Patients, which has been advocating for the passage of legislation, similar to a measure passed in California, that would establish safe, minimum RN-to-patients ratios for Massachusetts hospitals. The bill passed the Joint Committee on Health Care last year, and compromised version of the bill passed the Senate as part of the budget process. Ultimately, after intense lobbying from the health care industry, the measure failed to be released for a vote by legislators.
"The hospital industry, which has created staffing conditions and working conditions for nurses that have caused the purported nursing shortage in our state, is doing everything it can to thwart efforts to hold them accountable for safe staffing standards," Pinkham explained. "Hiring has increased, but that is in direct response from public pressure to pass legislation to ensure safe staffing," Pinkham said. "The industry’s report of improved vacancy rates is not supported by nurses on the front-lines who remain concerned about patient assignments that prevent them from providing quality patient care. The bottom line is we can no longer trust this industry, which has placed so many patients and nurses at risk, to police itself."
Surveys of the public and nurses show that 8 in 10 voters and 9 in 10 nurses support legislation to regulate RN-to-patient ratios. Last year, 102 out of 200 legislators signed on as sponsors of the bill. The Coalition to Protect Massachusetts Patients and the MNA will reintroduce the measure in the coming session.