Nursing Notes

July 8, 2011

Rep. Schakowsky Introduces Bill to Improve Patient Care & Curtail Nurse Shortage

Filed under: Nursing — Shirley @ 3:39 pm
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Here is an article from FierceHealthCare that I found about the government’s attempt to get nurses some protection and encourage nurses back into the profession.  On the one hand, I applaud the actual attempt to set some minimal staffing ratios for hospitals and nursing homes.

Nurses across the board are overworked and overwhelmed.  Nurses are leaving this profession in large numbers due to burnout, stress, fear of  being sued, fear of making a critical mistake and causing harm.  Nurses want to be able to help patients heal.  Period.

On the other hand, this article doesn’t really state what the actual bill would identify as a minimal staffing ratio.  Asking the administration of said hospitals to meet with staff nurses to determine minimum staffing is a joke.  That’s like telling the fox to guard the hen house.

Hospitals have to make a profit to stay in business, whether they are for-profit or not.  Nurse staffing is the singe largest expense that any hospital has after equipment.  There is no way that the hospital administrators will staff according to the nurses working for them.

Anyway, read this article and then let me know what you think, won’t you?


WASHINGTON, DC (June 15, 2011) – Representative Jan Schakowsky (D-IL) today introduced legislation to address increasing hospital mortality rates and preventable medical errors caused by nurse understaffing. The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 would establish a federal minimum standard in all hospitals for direct care registered nurse-to-patient staffing ratios.   The bill would greatly improve patient care while helping to restrict the nursing shortage that has left hospitals across the country dangerously understaffed.

“Nurses are overworked and hospitals are understaffed, leading to disastrous results for patients everywhere,” said Representative Jan Schakowsky.  “By creating a workplace in which nurses are asked to do the impossible, we drive nurses away and jeopardize the quality of patient care. The bill is a common-sense solution to improve the quality of patient care and address the nursing crisis in our hospitals.”

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 would require that hospitals work with their direct care nurses to develop safe staffing plans that meet but can exceed  minimum nurse-to-patient staffing ratios.  The legislation would provide whistleblower protection and give nurses the ability to speak out for enforcement of safe staffing standards.

The bill would also require the Department of Health and Human Services to consider staffing requirements for licensed practical nurses and the Medicare Payment Advisory Commission to recommend any changes in additional reimbursement needed due to the requirements of the bill.

A recent study reported in the New England Journal of Medicine (March 17, 2011), found that  “when the nursing workload is high, nurses’ surveillance of patients is impaired, and the risk of adverse events increases.”  Other studies found that understaffing was a factor in one out of every four unexpected hospital deaths or injuries caused by errors and result in higher incidences of cardiac arrest, pneumonia, urinary tract infections and complications

The legislation is endorsed by the AFL-CIO, the Service Employees International Union, the American Federation of State, Country and Municipal Employees (AFSCME), the National Nurses United, the American Federation of Government Employees, the United Steelworkers, and the American Federation of Teachers.

Read more: Rep. Schakowsky Introduces Bill to Improve Patient Care & Curtail Nurse Shortage – FierceHealthcare


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December 16, 2010

Medical Care in Pennsylvania: Nurse to Patient Ratios

The Great Seal of the State of New Jersey.
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This is a short article I found on the Pennsylvania Law Monitor published by Stark and Stark Attorneys at Law.  I read it, twice.  I find that a 10 to 13% reduction in mortality rates is not something to be ignored.

Today, I watched the news about the side-drop baby crib problem where it was stated that the design of these beds had led to several (less than 100) deaths and now these beds are forbidden to be sold.  But a reduction of 10-13% mortality in hospitals is not okay?  Where is the sense of this?  Where is the public outcry. I understand that my example may be weak–after all we are talking about baby safety–but what about all the senseless deaths that are occurring daily because nurses cannot do the jobs they were trained to do.

When did it become okay for nurses to be the janitors, the transporters, the phlebotimists, the nurse’s aide, and the legal department?  Most nurses just want to be able to nurse patients.

Let me know what you think, won’t you?  This article was found here.


Pennsylvania Law Monitor

Posted at 8:06 AM on December 10, 2010 by Mary M. Labaree

In The Works
In Pennsylvania, House Bill 147 was introduced in January 2009 and remains “in committee.”  A similar version was sponsored in the PA Senate.  Among other provisions, they establish RN – to -patient ratios in the Commonwealth. Specifically, the legislation would establish the following minimums:

  • 1 nurse:1 patient – PR and trauma emergency units;
  • 1 nurse: 2 patients – Critical care, including emergency critical care and all ICUs, labor and delivery units, and post-anethesia units;
  • 1 nurse: 3 patients – Ante partum, emergency room, pediatrics, step-down and telemetry;
  • 1 nurse: 4 patients – intermediate care nursery and medical/surgical and acute care psychiatric units;
  • 1 nurse: 5 patients – rehab units;
  • 1 nurse: 6 patients – postpartum and well-baby nursing units

Why Should You Care?
Nurse-patient ratios can have a significant impact on patient outcome. A research study published in 2010 in the journal Heath Services Research, entitled “Implications of the California Staffing Mandate for Other States” by Linda Aiken, and others, compared 2006 data from three states, including Pennsylvania, New Jersey and California in terms of patient mortality and failure-to-rescue based on the nurse:patient variable.  California has long required a minimum ratio of nurses to patients. Pennsylvania’s bill  is still “in the works”.

The research found that nurses in California were assigned, on average, about one fewer patient each when compared to Pennsylvania and New Jersey.  This may not appear significant on the surface but, in fact, the ratio of nurses to patients correlated negatively with patient mortality.  In other words, the higher the ratio of nurses to patients, the lower patient mortality.  Even more disturbingly, in the med-surg areas, the difference in number of patients cared for was even greater for both Pennsylvania and New Jersey.

The researchers extrapolated the findings to ascertain whether changes in staffing for the two states, Pennsylvania and New Jersey, would materially impact mortality rates.  They predicted a reduction in mortality rates by 10.6 and 13.9 percent in Pennsylvania and New Jersey respectively.

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September 22, 2010

Nurses Wrestle Schwarzenegger on Staffing

As a nurse who traveled and worked in California, I found this article to be quite entertaining and informative.  I was in California when the Nurse’s Union picketed the state capitol building and when the governor made his now famous statement about “kicking butt”.

It’s strange to me that Arnold Schwarzenegger has chosen nurses and teachers as his enemy.  To me, this indicates just how far out of touch with the real world he is.  He doesn’t worry about getting quality care for his family or for himself and he doesn’t have to worry about his children’s education, thanks to his movie star income and the rich family he married into.  The rest of the world has to worry about such mundane issues.

Please read the article from WeNews and let me know your thoughts, won’t you?  I’ve only posted part of the article here, but I recommend clicking over to read the entire story because it is quite informative.


By Rebecca Vesely

WeNews correspondent

Thursday, March 24, 2005

In their ongoing wrestling match with Schwarzenegger over hospital staffing, California nurses are proving to be tough opponents for the former action-movie star. Last week they pinned him down in court with a ruling the governor is now appealing.

California nurses protest against Schwarzenegger

SAN FRANCISCO (WOMENSENEWS)–California Governor Arnold Schwarzenegger has met a foe to match any from his blockbuster action movies: nurses.

To counter what they regard as Schwarzenegger’s strong-arm legal tactics to hold back staffing hikes, members of the state’s nurses’ union–the majority of whom are women–have maintained a vigorous schedule of well-attended protests, stunts to protest and embarrass the muscular governor and negative advertising campaigns.

On March 14, nurses managed a legal pin-down when a Sacramento Superior Court judge ruled that the governor had improperly invoked an emergency measure to suspend parts of a landmark nurse staffing law.

The judge ordered hospitals to comply with nurse-to-patient ratios immediately, which mandate 1 nurse to every 5 patients on medical and surgical wards, up from the former 1-to-6 ratio that the governor had moved to uphold.

Judge Judy Holzer Hersher also ruled the state could not suspend other provisions of the ratio law, such as allowing emergency rooms to break the ratios during very busy times. She called the governor’s emergency regulation “an end run around the regulatory process.”

The state, along with the California Hospital Association, filed an appeal within days seeking to overturn the ruling. Ken August, spokesperson for the state Department of Health Services, said the appeal will likely be heard in the next several weeks.

In the meantime the state will urge hospitals to comply with the law and has sent a letter to the hospitals to that effect.

State Senate President Pro Tem Don Perata, an Oakland Democrat, will hold a hearing on the nurse staffing ratios on April 4.

At a Sacramento press conference, Perata predicted that the legislature would be “like junkyard dogs,” in their support of the nurses. He said the hearings would focus on whether the administration violated a legislative mandate to implement and enforce the staffing law.

Hospital Association Outcry

The California Hospital Association, an ally of Schwarzenegger in this issue, said hospitals are closing because they can’t meet the ratio requirements amid a severe nursing shortage. The association estimates hospitals will need an additional 4,000 nurses just to meet the new ratios on medical and surgical floors. This is on top of the 14,000 nurse vacancies that already exist at hospitals statewide, according to the […read the rest here…]

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September 7, 2010

Nursing in the news today

Filed under: Nursing — Shirley @ 9:27 pm
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I know how I feel about this topic and I know what I think but I would like to post this video here for you to watch and think about.  Let me know what you are thinking and feeling about this issue.  This seems to be a really touchy topic and is in the news more and more.  Anyway, watch the video and leave me a comment, won’t you?


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September 6, 2010

Texas Considers Minimum Nurse-to-Patient Staffing Ratios

U.S. Army Nurse at the bedside of a young Iraq...
Image via Wikipedia

I found this today and felt I should post it here.  I read the article and I had to laugh when I got to the last part.  I bet that statement came from a hospital administrator who knows that the nurse on the floor has no control on staffing at all.  I will be following this up since I work in the great state of Texas and serve on my hospital’s Staffing Effectiveness Committee.

I will be trying to find some follow-up since this is from 2009 and I am sure there is more about this initiative somewhere out here on the web.


Texas is considering legislation that would mandate specific nurse-to-patient ratios on certain hospital units, reports. The Texas Hospital Patient Protection Act of 2009 would require one nurse for every four patients on med/surg units, in the emergency department (ED), on postpartum women-only units and on psychiatric units. Meanwhile, the legislation stipulates one nurse for every two patients on intensive care units (ICUs), neonatal ICUs, on the post-anesthesia recovery unit and in the newborn nursery. A one-to-one nurse-to-patient ratio would be required for operating rooms, conscious sedation, labor and delivery and for trauma patients in the ED. The proposed legislation would require only one nurse for every five patients on rehabilitation units. Advocates of the legislation assert that the proposed ratios will allow nurses to more personally treat patients and possibly attract nurses back to the profession. According to the California Nurses Association, after California passed nurse-to-patient ratios, the state saw an influx of 80,000 nurses. The Texas law would also protect whistle-blowers and hold hospitals accountable for violating the measures. Opponents to the proposed measures, meanwhile, say a bill is unnecessary and that bedside nurses, not legislators, are best equipped to determine optimal nursing ratios (Wood,, 1/12/09).

This is a great site and you can read this article and others like it here.

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