Registered Nurse Staffing LegislationWhy registered nurse staffing benefits nurses, patients and the health care system

Roberto Rivera-OlmoNU420: Leadership and management in the changing health care environmentBarbara FindleyAugust 17th, 2015

Registered Nurse Staffing Legislation

Topic Description

Impact on Nursing and the Health Care System

Nursing Health Care Systems (HCS)

Research findings show a 23% increase in burnout and 15% increase in job dissatisfaction in nurses per additional patient required to be cared for.9

Research findings show a 7% increase in morbidity and mortality for “each additional patient per nurse”.9

Research by Choi and Boyle demonstrated few patient falls and “better patient outcomes” among RN’s with higher job satisfaction that was contributed by higher staffing.10

HCS stands to save up to 2.5 times the cost of hiring additional RN’s per patients in ICUs and society stands to save as much as $10 billion in productivity benefits in patient potential life saved.8

By reducing staffing, RN’s are able to spend more hours on direct patient care and thus shorten patient length of stay, thus reducing the chances of adverse events during hospitalization.11 To increase patient satisfaction and safety, clinicians must have ample time to engage the patient/family into partaking in planning care.12

Increased nurse staffing improves retention and decreases turnover, which can save HCS as much as 2x the cost of nursing salary which does not include cost of marketing and recruitment spent on attracting nurses apply for employment.13

Implementing legislation either mandatory staffing or staffing committees, along side of removing nurses from room charges can lead to further focus on the imperative work nurses do to the delivery of safe and effective health care.14

HCS that are required to have a minimum nursing ratio would benefit from nursing intensity billing by increasing funding for nursing services rendered on DRG groups that require higher care.14 This can also assist to better measure hospital performance in providing quality care.14

Nursing Leadership

Roberto A. Rivera-Olmo, RN

How are Nursing Leaders Involved

The American Nurses Association has written position statements in supports safe staffing legislation as a way to improves patient outcomes and quality of care.5

Health care system managers must weigh the cost of current staffing to quality of care and profit and the cost/benefit of additional staffing to quality of care and staffing.8

National Nurses United, the nation’s largest nursing union, endorses legislation for safe staffing and point to the current California staffing ratio law as basis for nationwide implementation.6

The American Organization of Nurse Executives supports development of staffing guidelines that are based upon evidenced based research instead of a static ratio similar to the proposed H.R. 2083 and S. 1132 bills.7

The United States House of Representatives and Senate are currently considering bills that would require hospitals to implement either a specified minimum nurse to patient ratios by specialty or a committee of nurses as a safety

standard.1

Who and what is involved? How do these bills impact nursing and the health care system? What changes will

and must occur?

Purpose

Workload Factors for Staffing Assignment

To ensure safe staffing workload tools must factor in treatment complexity, medication administration, infection control, cognitive workload, and anticipated interventions, among others into assignments.15

Changes

Nursing Intensity Billing

Billing for services rendered by nurses for each diagnosis related group instead of grouping nurses in room charges, can allow hospitals to hire more nurses, particularly in units that require higher nursing intensive care.14

National Quality Strategy Implementation by Affordable Care Act

Under this new mandate, HCS must “improve the overall quality of healthcare”, provide safer more reliable care, improve the health of people and communities, and reduce the cost of care.16

HR. 2083Registered Nurse Safe Staffing Act

of 2015

Amendment to Social Security Act to increase patient protection by requiring hospitals to implement a staffing plan developed by a hospital nursing staffing committee composed of nurse managers, specialty unit nurses and a majority of direct clinical nurses.2

S. 1132Registered Nurse Safe Staffing Act

of 2015

H.R. 1602Nurse Staffing Standards for

Patient Safety and Quality Care Act of 2015

Amendment to the Public Health Service Act to implement a staffing plan that requires hospitals to have a minimal number of nurse to patient ratio determined in the law by unit type.3 1:1 in trauma emergency & OR; 1:2 in CCU; 1:3 in step-down/tele; 1:4 in med-surg; 1:5 in Rehab/SNF; 1:6 in Postpartum.3

Amendment to Social Security Act to increase patient protection by requiring hospitals to implement a staffing plan developed by a hospital nursing staffing committee composed of nurse managers, specialty unit nurses and a majority of direct clinical nurses.4

H.R. 2083 H.R. 1602 S. 1132

Table data reproduced from Shamliyan, Kane, Mueller, Duval & Wilt, 2009. Cost savings associated with increased RN staffing in acute care hospitals: Simulation exercise (p. 302-314). Nursing economic$. Vol. 27/No. 5

Intensive care units

Surgical patients

Medical patients

$0 $200 $400 $600 $800 $1,000 $1,200 $1,400 $1,600 $1,800

Chart Title

Net benefit $ per 1,000 patients Cost of increased one RN FTE/Patient day per 1,000 hospitalized patients

Per thousands

Net Benefit and Benefit/Cost Ratio of Avoided Deaths Corresponding to an Increase in

RN Staffing in Acute Care Hospitals8

References1 Congressional Research Service (2015). Summary: H.R. 2083: 114th Congress 2015-2016. 114th Congress 2015-2016. Retrieved from https://www.congress.gov/bill/114th-congress/house-bill/2083?q=%7B%22search%22%3A%5B%22registered+nurse%22%5D%7D&resultIndex=2 2 Capps, L. (2015). H.R. 2083: Registered nurse safe staffing act of 2015. 114th Congress 2015-2016: House energy and commerce, ways and means committee. Retrieved from https://www.congress.gov/bill/114th-congress/house-bill/2083/text?q=%7B%22search%22%3A%5B%22registered+nurse%22%5D%7D&resultIndex=2 3 Schakowsky, J. (2015). H.R. 1602: Nurse staffing standards for patient safety and quality care act of 2015. 114th Congress 2015-2016: House energy and commerce, ways and means committee. Retrieved from https://www.congress.gov/bill/114th-congress/house-bill/1602/text?q=%7B%22search%22%3A%5B%22%5C%22nursing%5C%22+staffing%22%5D%7D&resultIndex=11 4 Merkley, J. (2015). S. 1132: Registered nurse safe staffing act of 2015. 114th Congress 2015-2016: Senate finance committee. Retrieved from https://www.congress.gov/bill/114th-congress/senate-bill/1132/text?q=%7B%22search%22%3A%5B%22%5C%22nursing%5C%22+staffing%22%5D%7D&resultIndex=10 5 American Nurses Association. Registered nurse safe staffing bill introduced in congress; nurse staffing directly impacts patient safety; direct care nurses to drive staffing plans. Safe staffing saves lives. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NurseStaffing/Registered-Nurse-Safe-Staffing-Bill-Introduced-in-Congress.pdf 6 National Nurses United (2015). National campaign for safe RN-to-patient staffing ratios. Campaigns. Retrieved from http://www.nationalnursesunited.org/issues/entry/ratios.7 American Organization of Nurse Executives (2003). Policy statement on mandated staffing ratios. Mandated staffing ratios. Retrieved from http://www.aone.org/resources/leadership%20tools/staffingratios.shtml 8 Shamliyan, T. A., Kane, R. L., Mueller, C., Duval, S. & Wilt, T. J. (2009). Cost savings associated with increased RN staffing in acute care hospitals: Simulation exercise (p. 302-314). Nursing economic$. Vol. 27/No. 59 Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J., Silber J.H.. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American medical association. 2002;288(16):1987-1993. doi:10.1001/jama.288.16.1987.10 Choi, J. & Boyle, D. K. (2013). RN workgroup job satisfaction and patient falls in acute care hospital units (p. 586-591). Journal of nursing administration. Vol. 43/Num. 11 11 Reeves, K. (2007). New evidence report on nurse staffing and quality of patient care (p. 73 & 78). Medsurg nursing12 Lavoie-Tremblay, M.; O’Connor, P.; Harripaul, A.; Biron, A.; Ritchie, J.; MacGibbon, B.; Cyr, G. (2014). The perceptions of health care team members about engaging patients in care redesign (p. 38-46). American journal of nursing. 13 Jones, C. B. & Gates, M. (2007). The costs and benefits of nurse turnover: A business case for nurse retention. Online journal of issues in nursing. ISSN: 1091-373414 Welton, J. M. (2007). Mandatory hospital nurse to patient staffing ratios: Time to take a different approach (p. 13). Online journal of issues in nursing Vol. 12/Num. 315 Connor, J. A., LaGrasta, C. & Hickey, P. A. (2015). Complexity assessment and monitoring to ensure optimal outcomes tool for measuring pediatric critical care nursing (p. 297-308). American journal of critical care. 16 Brooks, J. A. (2014). Quality counts: The new world of health care quality and measurement (p. 57-59). American journal of nursing. Vol. 114/No. 7