It is 10 PM. The room is dark. You are feeling short of breath. You have heaviness in your chest. You are feeling anxious. You hear alarms and bells ringing down the hall. You hear nurses running away from you. You press the call button. No one comes. You wait a few moments. Still, no one comes. You call out, “nurse”, but your voice is weak. You close your eyes.

The health care system has its eyes closed regarding safe staffing and the need to limit nurse-patient ratios in the acute environment and long term care facilities. Bill A00921 requires “acute care facilities and nursing homes to implement certain direct-care nurse-to-patient ratios in all nursing units and to maintain staffing records during all shifts” (New York State Assembly, 2011). This bill will reduce the length of hospital stays and hospital acquired infections such as pneumonia and urinary tract infections and improves nurse satisfaction in the workplace. Research shows that nurse staffing shortages are responsible in one out of four unexpected hospital deaths or injuries caused by medical errors (Joint Commission on Accreditation of Healthcare Organizations, 2004).

Opponents fear the bill will create an increase in health care costs. Safe staffing is cost effective. Effective staffing reduces the occurrence of adverse patient outcomes. When nurse staffing practices are inadequate and poorly monitored, the provision of quality health care services is jeopardized. Dangerous and costly medical errors can result as well as higher turnover of nursing staff (New York State Nurses Association, 2008). Hospital acquired infections cause an increase cost by 84% to hospitals and the length of hospital stay increases 5.1 to 5.4 days. Death rates increased from 4.67 % to 5.5% (Stanton, 2009).

Turnover of nursing staff will decrease with the passing of the “Safe Staffing for Quality Care Act”. Studies show that insufficient staffing causes nurse burnout, job dissatisfaction, higher turnover rate, and a decrease in patient satisfaction (American Nurses Association, 2011). As a result, there is a decreased interest to pursue a career in nursing. California implemented the Quality Care Act in 2004 and has shown an increase in activity in licensed registered nurses by more than 11,000 (Aiken, Sloane, Cimiotti, Clarke, Flynn, Seago, & Smith, 2010).

With the passing of Bill A00921, medical expenses will be decreased from fewer hospital acquired infections and shorter hospital stays. I hope that someday there will be adequate nurses available to provide the highest quality of care and have the time to answer our “bell”.

References/ Bibliographies

Aiken, L. H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J., & Smith, H.L. (2010). Implications

of the California Nurse Staffing Mandate for Other States. Health Services Research, 45(4),

904-921. Doi:10.1111/j.1475-6773.2010.01114.x

A survey of 80,000 nurses in California, Pennsylvania, and New Jersey indicated “California nurses cared for one less patient on average and two fewer patients on medical and surgical units” (Aiken,et al, 2010). When nurses patient care ration was similar to the passed legislation already implemented in the state of California- job satisfaction improved and nurses’ “burnout” decreased. The study concluded that “hospital nurse staffing ratios mandated in California are associated with lower mortality rate and nurse retention within the state was at a premium” (Aiken, et al, 2010).

American Nurse Association. (2008). Safe Staffing Saves Lives retrieved March 20, 2011 from

http://www.safestaffingsaveslives.org/WhatisANADoing/LegalAction.aspx

Patients report that improved staffing increased their satisfaction rating. There is documentation of reduced hospital acquired infections and length of stay as a result of better staffing.

Joint Commission on Accreditation of Healthcare Organizations. (2004). Shared visions-new pathways:

Essentials for Healthcare. Oakbrook Terrace, Il: Author.

Research demonstrating too few nurses are caring for too many patients- creating an increase in preventable medical errors and patient deaths. Patients at hospitals with staffing levels greater than 4:1 suffered cardiac arrest or shock 9.4 % more than patients at hospitals with a lower nurse to patient ratio. Other disturbing findings were with 9% increase in urinary tract infections, 5% gastrointestinal discomfort, and 6.5 % more cases of hospital acquired pneumonia. The risk of death increases 7 % in hospitals with an increase in nurse to patient ration. In hospitals where nurses care for 8 patients- the risk of dying increases 31 %.

New York State Assembly. (2011). Bill Number A00921. Safe Staffing For Quality Care Act. Retrieved

March 19, 2011 from

http://www.assembly.state.ny.us/leg/?default_fld=&bn=A00921%09%09&Summary=Y&Actions=Y&Votes=Y&Memo=Y

Legislation sponsored by Assemblyman Gottfried which is currently before the Health Committee in the State Assembly. The Bill was previously A11015 and presented 2009-2010. The Bill states the following: “JUSTIFICATION : Licensed nurses constitute the highest percentage of direct health care staff in acute care facilities and have a central role in health care delivery. Inadequate and poorly monitored nurse staffing practices jeopardize the quality health care services, resulting in dangerous and costly medical errors, patient infections, and a higher turnover of nursing staff”(NYSA,2011).

The Bill makes reference to legislation already passed in the state of California by expressing: “Six years ago, California became the first state to mandate nurse staffing ratios in hospitals. New statistical analysis reveals that the California mandates are significantly associated with fewer negative outcomes for patients and staff. The study, published in Health Services Research and conducted by the Center for Health Outcomes and Policy Research, University of Pennsylvania, concluded that “Improved nurse staffing, however it is achieved, is associated

with better outcomes for nurses and patients.”(NYSA,2011).

“Establishing staffing standards for nursing and unlicensed direct care staff in acute care facilities and nursing homes will help ensure that these facilities operate in a manner that guarantees the public safety and the delivery of quality health care services”.(NYSA, 2011).

New York State Nurses Association, (2008). Position Statement: RN Staffing Effectiveness and Nursing

Shortage. Retrieved on March 6, 2011 from

http://www.nysna.org/practice/positions/position13_a.htm.

The NYSNA believes it is important that professional and regulatory bodies “uphold existing and professional standards” and seek ways to retain nurses. The NYSNA also recommends that efforts occur to promote the role of the RN while supporting legislature that “establishes a maximum number of patients and disclosure of staffing to consumers”. The NYSNA is in support of the mandatory nurse-patient ratio and provides numerous facts and statistics.

Stanton, M.W. (2009). Hospital Nurse Staffing and Quality of Care. Retrieved March 20, 2011, from

AHRQ: http://www.ahrq.gov/research/nursestaffing/nursestaff.htm

The studies discussed found significant associations between lower levels of nurse staffing and higher rates of adverse affects. “The findings can have a positive impact if used to educate and inform interested parties on how quality of care is changing and how it is linked to the contributions of nurses”. By doing nothing- a large number of patients will experience adverse outcomes and higher costs then necessary.

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Saturday, March 26, 2011

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A00921 Summary:

BILL NO A00921

SAME AS No same as

SPONSOR Gottfried (MS)

COSPNSR Gunther, Millman, Jacobs, Pheffer, Clark, Destito, Peoples-Stokes,

Magnarelli, Markey, Hoyt, Rosenthal, Jaffee, Colton, Benedetto,

Reilly, Gabryszak, Lancman, Schroeder, Stevenson

MLTSPNSR Arroyo, Barron, Bing, Brennan, Brook-Krasny, Burling, Cahill, Camara,

Cook, Crespo, Cusick, Cymbrowitz, Dinowitz, Englebright, Glick,

Heastie, Hooper, Kellner, Latimer, Lavine, Lifton, Lupardo, Maisel,

Mayersohn, McDonough, McEneny, McKevitt, Meng, Miller J, Montesano,

Ortiz, Paulin, Perry, Pretlow, Rabbitt, Ramos, Rivera J, Rivera P,

Robinson, Russell, Saladino, Scarborough, Schimel, Spano, Sweeney,

Thiele, Titone, Titus, Towns, Weisenberg, Wright

Amd Pub Health L, generally; amd S97-aaaa, St Fin L

Enacts the “safe staffing for quality care act” to require acute care

facilities and nursing homes to implement certain direct-care nurse to patient

ratios in all nursing units; sets minimum staffing requirements; requires every

such facility to submit a documented staffing plan to the department on an

annual basis and upon application for an operating certificate; requires acute

care facilities to maintain staffing records during all shifts; authorizes

nurses to refuse work assignments if the assignment exceeds the nurse’s

abilities or if minimum staffing is not present; requires public access to

documented staffing plans; imposes civil penalties for violations of such

provisions; establishes private right of action for nurses discriminated

against for refusing any illegal work assignment.

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