ANA Calls On Policymakers To Act On Nurse Staffing Legislation
Association cites new study revealing link between increased RN staffing and improved patient safety and quality of care
Silver Spring, MD - A study published today in the journal Health Affairs provides new evidence that if hospitals invest in appropriate Registered Nurse (RN) staffing, thousands of lives and millions of dollars could be saved each year. Specifically, the study shows that if hospitals increased RN staffing and hours of nursing care per patient, more than 6,700 patient deaths and four million days of care in hospitals could be avoided each year. In addition to the immense societal benefits of adequate nurse staffing, the anticipated financial benefits of savings per avoided patient death or hospitalization may also be significant.
"This new study is important because it highlights the fact that people suffer and die when nursing care is inadequate," said Barbara Blakeney, MS, RN, president of the American Nurses Association (ANA). "It is the latest study in a growing body of evidence that clearly demonstrates that nurses make the critical, cost-effective difference in providing safe, high-quality patient care," she added.
Blakeney pointed to ANA's own report, Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting, released in May 2000. The study looked at hospital and Medicare data in nine states in five categories of adverse outcomes: length of hospital stay, hospital-acquired pneumonia, postoperative infection, bed sores and hospital-acquired urinary tract infections.
All five measures were markedly lower with higher levels of RN involvement in patient care. Three studies published in 2002, one in the New England Journal of Medicine, one by the Joint Commission on the Accreditation of Healthcare Organizations, and another in the Journal of the American Medical Association, also found direct links between nurse staffing levels and better patient outcomes.
"Inappropriate staffing is the number one concern of nurses today," Blakeney said. "Adequate nurse staffing is critical to the delivery of quality patient care because it allows nurses time for appropriate assessment of patients and their needs and initiation of suitable interventions."
"For too long, administrators have viewed nursing as an expense rather than valuing nursing care as a critical investment in quality, cost-effective care. This study demonstrates the economic value of RNs and speaks to the societal benefit of providing better nurse staffing, which ANA believes should be the driver in policy decisions," she said.
"Furthermore, until we as a nation invest in and value nursing care, the nursing shortage will continue because practicing nurses will continue to leave the workplace due to burnout or retirement, and we will fail to attract and educate sufficient numbers of new nurses," said Blakeney.
ANA is calling for additional research using current data to explore more thoroughly the financial implications of nurse staffing.
In addition to the right number and mix of direct-care staff for hands-on care, other resources are necessary to support RNs' ability to deliver the best possible care. Rather than recommending specific numeric ratios, ANA developed the Principles for Nurse Staffing as a tool to better gauge appropriate staffing. The principles not only take into account the number of patients and the mix of staff, but also look at other staffing considerations, such as the experience level of nurses working on the unit, patient acuity, and support services and resources. For details, see http://nursingworld.org/readroom/stffprnc.htm.
Blakeney also encouraged Congress to act on pending federal legislation that would mandate appropriate staffing. The bill, the Quality Nursing Care Act of 2005 (H.R. 1372), was introduced in March 2005 in the U.S. House of Representatives by Reps. Lois Capps (D-CA) and Robert Simmons (R-CT). The bill complements S. 71, which was introduced by Sen. Daniel Inouye (D-HI) last January.
The Quality Nursing Care Act of 2005 will ensure that patients receive safe, quality nursing care in hospitals and other health care institutions. The proposed legislation incorporates ANA's Principles for Nurse Staffing. It mandates the development of staffing systems that require the input of direct-care RNs, and provides whistle-blower protections for RNs who speak out about patient care issues, including inadequate levels of nurse staffing.
Another key provision of the bill requires public reporting of staffing information. Under this mandate, hospitals would be required to post daily the number of licensed and unlicensed staff providing direct patient care on each unit and each shift, while specifically noting the number of RNs.
Similar legislation regarding safe staffing was enacted in Oregon in 2001 and regulations were put into place in Texas in 2002.
Blakeney also called for increased federal funding for nursing workforce and education programs. Funding for such programs for Fiscal Year (FY) 2006 is approximately $150 million, the same level as in FY 2005. More than 30 years ago, during the last serious nursing shortage, Congress appropriated $153 million for nurse education program (FY 1974). In today's dollars that would be worth $609 million, more than four times current spending.
"Nurse Staffing in Hospitals: Is There a Business Case for Quality?" by Jack Needleman, Peter Buerhaus, Maureen Stewart, Katya Zelevinsky and Soeren Mattke, appears in the January/February 2006 issue of Health Affairs.
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The ANA is the only full-service professional organization representing the nation's 2.7 million registered nurses through its 54 constituent member nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.