Can Politics Effect the Nursing Shortage and the Impact on Patient Safety?

A shortage of nurses in combination with increased workloads has the potential to threaten patient safety. Research indicates that nurse staffing levels has a definite and measurable impact on patient outcomes, medical errors and nurse turnover (Curtin,2003).


Can Politics Effect the Nursing Shortage and the Impact on Patient Safety?

A shortage of nurses in combination with increased workloads has the potential to threaten patient safety. Research indicates that nurse staffing levels has a definite and measurable impact on patient outcomes, medical errors and nurse turnover (Curtin,2003). The Joint Commission on Accreditation of Healthcare Organizations reported twenty-four percent of all unexpected problems in hospitals happened because of insufficient number of nurses on duty (JCAHO, 2002). The purpose of this paper is to examine how politicians can impact the nursing shortage and patient safety allowing patients to receive the best practice of care possible.
Patient safety is defined as freedom from accidental injury, or freedom from harm from the healthcare system that is intended to help. Patient safety is evaluated using a term, adverse event. Adverse event is defined as an unexpected undesirable incident resulting in injury or death that are directly associated with the process of providing healthcare to a client.
The professional nursing term” best practice” is the process by which nurses make clinical decisions, using the best available research to apply to their practice. How best practices will work within the limitations of staffing shortages and the effects upon the patients are concerns for all of us as potential patients.
The shortage of registered nurses, causing staffing concerns that are one of the
health care industry’s biggest challenges. The demand for registered nurses and lack of qualified nurses are at a critical point for the nursing profession. There are many reasons for this shortage. One reason is, that nursing schools are turning away students, due to lack of qualified instructors. The reasons also include insufficient nurse staffing causing burn-out, as well as unsafe and dissatisfying work (Ballard, 2003). This looming shortage is becoming clear to health care professionals, policy makers and the public.
The sad truth about the nursing shortage and its effects on patient safety are only beginning to make an impact with the public and our government. During the first six months of 2007, four legislative bills dealing with patient safety and the nursing shortage have been introduced to congress.
Rep. John Conyers Jr. of Michigan has introduced the Nurse and Patient Safety Protection Act of 2007 (H.R.378). The bill is to establish a safe patient handling standard to reduce injuries to patients as well as the healthcare providers (US Fed News Service, 2007). In the “Nurse and Patient Safety & Protection Act of 2007,” Congress finds the following: (1) Direct-care registered nurses rank 10th among all occupations for musculoskeletal disorders. The leading causes of these injuries in health care are the result of patient lifting, transferring and repositioning of patients. (2) The physical demands of the nursing profession are leading many nurses to leave the profession, Fifty-two percent of nurses complain of chronic back pain and thirty-eight percent of those nurses suffer enough pain that they leave the profession. (3) Patients are not at optimum levels of safety while being lifted, transferred or repositioned manually (USFNS,2007).These findings are only a few reasons why nurses are leaving the profession.
Representative Jan Schakowsky, from Illinois, recently introduced The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 (H.R. 2123). She stated, “Nurses are leaving the profession at an alarming rate because they are overworked and hospitals are understaffed. In our hospitals today, there are too few nurses caring for too many patients; a dangerous prescription with disastrous side effects. That’s why I have introduced this bill to improve the quality of patient care by providing a national solution to address the crisis of overworked nurses and nurse-flight" (USFNS,2007). This bill coincided with the release of The Safe Nursing and Patient Care Act of 2007 (H.R.) introduced by Representative Pete Stark of California. According to Congresswomen Schakowsky, “These bills are common sense solutions that would improve patient care and address the nursing shortage. Safe staffing levels save lives" (USFNS, 2007).
No matter how many bills are introduced to protect nurses and their patients, someone will have to step up and do the hard work. This person will have to talk about the money needed and where this money will come from. Earlier this year, Senators Hillary Rodham Clinton of New York and Gordon Smith of Oregon reintroduced legislation to deal with the nursing shortage. The Nursing Education and Quality of Health Care Act (HEQHC) increases the workforce while expanding nursing school faculty (USFNS,2007). The NEQHC Act of 2007 will provide funds through grants and scholarships, to encourage recruitment and retention of nursing students, and nursing faculty. This bill was first introduced by Senator Clinton in 2003, it was voted down.
The United States Department of Health and Human Services reviewed a study done by the Agency for Healthcare Research and Quality. The final report shows scientific data in support of the politicians trying to take action in preventing harm to the public. This report found significant associations between lower levels of nurse staffing and higher rates of pressure ulcers, pneumonia, upper gastrointestinal bleeding, shock/cardiac arrest urinary tract infections, failure to rescue and longer hospital stays (Ballard, 2003). While inadequate staffing levels place a burden on the nursing staff, and adverse events can be painful to the patients, those errors have a financial cost to consider. One example of financial burdens put on our health care system is pressure ulcers, while in hospitals they add an estimated $8.5 billion per year to the cost of health care in the United States (Agency for Healthcare Research and Quality, 2003). Above and beyond the saving in health care dollars, higher staff levels improve the quality of life for patients.
Nurses are choosing to become politically active and lobby for change. Nurses must become active in helping to decrease the potential risks of adverse events that can occur because of the nursing shortage. Nurses need to remain patient advocates as well as nursing advocates. Politicians can help nurses and patients by putting mandates on health care facilities. But it’s the nursing profession itself that needs to find solutions, while influencing the future of health care in America.

Does Legislation Really Improve Patient Safety?

Intervention 1: Bill to mandate nurse to patient ratio.

Representative Jan Schakowsky, from Illinois introduced The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007 (H.R.2123). If this bill passes congress it will require all hospitals in the United States to meet a specific nurse to patient ratio. Many labor unions and consumer groups praise this bill. A resent survey by the national consumer’s league found that 78 percent of respondents who had been hospitalized support national legislative action to set minimum nurse staffing levels (Benko, 2006). The idea of nurse to patient ratio and patient safety sounds good, but at what cost are consumers and politicians willing to accept to make this bill workable.

Disadvantage I- How the nurse to patient ratio impacts the quality of patient care.

California was the first state to enact a law requiring hospitals to meet minimum nurse to patient ratios designed to reduce nurse’s workload and improve patient safety. According to California Healthcare Association 34 percent of California’s hospitals had to close bed or units, 41 percent had to divert ambulances, and 38 percent blamed longer wait times in ER’s because the hospitals didn’t have enough nurses to meet the required ratio( Benko,2006). What kind of patient safety is it when you’re the patient in an ambulance and your ambulance has been diverted to a hospital further away? These concerns are valid but units closing, long wait times and being diverted are already a reality so lets not add more laws without coming up with solutions to enact the laws.

Disadvantage II- How can we afford the cost associated with a nurse to patient ratio.

Let’s take a look at the monetary cost to California. California hospitals are working hard to meet ratios but have been slowed by a severe nursing shortage and the high cost of recruiting staff. As stated in Laura Benko’s article The California Department of Health Services estimates that the ratio law will
cost California hospitals $422 million this year and more than $950 million per year by the year 2008. I support the need for patient safety but it is irresponsible for Rep. Jan Schakowsky to try to pass laws mandating nurse to patient ratios without passing laws appropriating the needed money to make this bill feasible. If these laws are enacted and hospitals have increased costs will the consumer be able to afford those costs or will the consumer just be a new statistic in the uninsured column.

Intervention 2: The nurse and patient protection act of 2007.

Rep. John Conyers Jr. from Michigan introduced, The nurse and patient safety protection act of 2007. This bill is to protect patient safety by reducing injuries to healthcare providers.

Disadvantages I- Everyone will pay for not passing this bill.

Healthcare workers are hurting their backs by lifting, transferring and positioning patients and the monetary costs are enormous. The average back injury case can cost $ 25,000.00. The average cost to more serious injuries requiring surgery cost $ 85,000.00. On the average costs stated above, nationally, the approximately 67,000 back injuries among healthcare workers could cost $1.7 billion in workers compensation claims. Additionally the indirect costs like lost production, retraining, and sick time can account for as much as four times the cost as the direct cost (Feletto, Graze, 2005). All of these costs will only continue and are disadvantages to the passage of this bill.

Disadvantage II- Back injuries will effect the nursing shortage.

Fifty two percent of nurses complain of chronic back pain and thirty eight percent of those nurses suffer enough pain to leave the profession (USFNS,2007). The longer we talk about after injury costs instead of talking about how we can prevent injuries is wasted time. Injuries to nurses mean less nurses and greater risk to the patient.

References:

Agency for Healthcare Research and Quality. (2003). The effect of health care working conditions on patient safety. Bethesda, Md. AHRQ. Retrieved July 15, 2007 from www.ahrq.gov/clinic/epsums/worksum.htm

Ballard, K. (2003). Patient Safety: A Shared Responsibility. Online Journal of Issues in Nursing, 8(3), 105-118 Retrieved July 19, 2007, from Academic Search Premier database.

Benko, L.B. (2004, June). Ratio fight goes national. Modern Healthcare, 34(24), 23, 30. Retrieved October 1, 2007 from Research Library database

Curtin, L. (2003) “An Integrated Analysis of Nurse Staffing and related variables: Effects on Patient Outcomes.” Online Journal of Issues in Nursing. Retrieved July 15, 2007, Available: www.nursingworld.org

Feletto, Graze (2005) A back injury prevention guide for healthcare providers. CAL/OSHA consultation service education and training unit. Retrieved October 5, 2007 from Yahoo.com

Joint Commission on the Accreditation of Healthcare Organizations. (2002) “Health Care at the Crossroads.” Retrieved July 20.2007 from www.jointcommission.org

US Fed News Service (USFNS) (2007) Rep. Conyers introduces nurse, patient safety, protection act. Retrieved July 13, 2007 from www.proquest.umi.com

US Fed News Service (USFNS) (2007). Rep. Schakowsky introduces bill to improve patient care, curb nursing shortage. Retrieved July 13, 2007 from www.proquest.umi.com

US Fed News Service (USFNS)(2007). Sens. Clinton, Smith reintroduce bill to combat severe nursing shortage facing our nation. Retrieved July 13, 2007 from www.proquest.umi.com