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AFSCME's Position – Safe Nurse Staffing Practices
AFSCME's Position – Safe Nurse Staffing Practices
Background
In its 2004 report, Keeping Patients Safe: Transforming the Work Environment of Nurses, the Institute of Medicine called attention to strong and growing evidence that substantiates the link between nurse staffing and the quality of care. Yet, unsafe staffing practices, such as insufficient staffing and mandatory overtime, continue to be widespread in health care. Impossible patient workloads have become the norm in virtually all health care settings. In turn, health care facilities often rely on mandatory overtime as a way to compensate for insufficient staffing. The result is that nurses struggle to deliver high quality care to their patients under conditions that make low quality care and even medical errors inevitable. Frustrated with these conditions, many nurses are opting out of the nursing profession, undermining efforts by the nation to increase the supply of nurses.
Summary of legislation
Legislation to establish nurse-to-patient ratios in acute care settings
Substantial research demonstrates that leaner nurse staffing levels in hospitals is associated with negative patient outcomes. For example, researchers at the University of Pennsylvania found that the level of nurse staffing had a significant effect on patient mortality (Aiken et al., 2002). A 2002 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) report concluded that the lack of direct care nurses contributed to nearly a quarter of the unanticipated problems that result in injury or death to hospital patients.
To address the problem of insufficient staffing, Rep. Jan Schakowsky (D-IL) introduced the Nurse Staffing Standards and Patient Safety Quality Care Act (H.R. 1222) in the last Congress. The bill establishes minimum registered nurse-to-patient ratios in acute care settings. Because there is little research regarding licensed practical (vocational) nurses (LPNs), the bill requires a study of LPN staffing standards and their implementation. AFSCME will be working with Rep. Schakowsky to reintroduce the bill.
Legislation to establish staffing ratios in nursing homes
A large, multi-year government study has documented what AFSCME, consumer advocates and geriatric experts have stated for years– that many nursing homes have inadequate numbers of nurses and certified nurse aides (CNAs) to properly care for patients. The study, released by the U.S. Centers on Medicare and Medicaid Services (CMS) in 2002, found that nine in ten nursing homes are inadequately staffed. The study found that in order to avoid quality problems, patients need an average of 1.15 to 1.3 hours of licensed nurse care and .55 to .75 hours of registered nurse care per day, as well as 2.4 to 2.8 hours of care by a CNA. The range in hours depended upon whether the facility was for short or long term nursing care. Despite inadequate levels of nursing care in the vast majority of nursing homes, the Bush Administration opposes the establishment of staff-to-patient ratios in nursing homes.
In the last Congress, Rep. Henry A. Waxman (D-CA) introduced the “Nursing Home Staffing Act” (H.R. 4293) legislation to establish staffing ratios in nursing homes for nurses and CNAs based on the findings of the CMS study. AFSCME will be working with Rep. Waxman on this issue again.
Legislation to restrict mandatory overtime
In the last 15 years, many health care workplaces restructured the delivery of care using fewer nurses to care for greater numbers of patients. Since that time, there has been a growing reliance on the use of mandatory overtime to meet staffing needs. In many workplaces, overtime is no longer an occasional requirement prompted by an emergency or unforeseen event. Rather, it is a routinized alternative to proper staffing with significant consequences for patients. Relying on exhausted nurses to deliver care creates an environment where medical errors and poor quality care are inevitable. The Institute of Medicine study highlighted how the long hours of many nurses "represents one of the most serious threats" to patient safety.
To address the problem of mandatory overtime, Sens. Edward M. Kennedy (D-MA) and John Kerry (D-MA) and Reps. Pete Stark (D-CA) and Steven LaTourette (R-OH) introduced the "Safe Nursing and Patient Care Act" (S. 351/H.R. 791) in the last Congress. This bill limits the ability of hospitals and certain other health care providers to impose mandatory overtime on nurses. We expect this bill to be reintroduced in the next few months.
Department of Legislation
March 2007
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