The text below is only one small part of the testimony that six RNs with the NNOC presented before the TN Board of Nursing on the morning of September 25, 2008. Issue topics were unsafe floating, short staffing, nurses fired for refusing to sign anti-organizing agreements, and institutional pressures on employees to not join pro-union associations. We received a cordial reception which later turned lukewarm. We were told that the proper way to do it was to file for an "Advisory Ruling". Perhaps we'll do that next...
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BOARD OF NURSING OPEN FORUM
SEPTEMBER 25, 2008
Hello,
My name is Mark. I work as a staff RN at Tennessee hospital. I'm concerned that patient safety is being put at risk because of inadequate staffing levels. Nurses are being put in the position of either refusing a patient assignment and risk losing their jobs, or accepting more patients than they can safely handle. When a nurse has six, seven, or more patients on a medical-surgical floor, it's quite likely that some aspect of patient care will be missed. Charge nurses are frequently assigned a full patient load, rendering them unavailable to be a resource to the nurses under them. A patient has fallen on the floor after a bed alarm was not answered fast enough, another aspirated some food because no one was assisting with feeding, decubitus ulcers got worse when an incontinent patient was not cleaned up often enough, MRSA isolation procedures were incompletely followed in an attempt to save time, and a PCA continuous morphine dose was not turned off before the patient was stuporous. These are only few specific examples. While they may have turned out to be less than sentinel events, they are still very serious.
In addition to direct adverse events to patients, under-staffing has other consequences affecting delivery of safe care. Many experienced nurses have gotten fed up with the workload, and left hospital nursing. New nurses come in to fill vacancies, but many of these don't stay long because of the stressful conditions. We end up with a high percentage of relatively inexperienced nurses doing their best to care for too many patients. It's a recurring situation, one that management is aware of and has said they will address, but so far, nothing much has changed. It's not unique to my hospital; according to reports I've heard, under-staffing may be even worse at other facilities. As a possible solution to the problem, in the interest of patient safety, the retention of experienced professional nurses, and the recruitment of future nurses, would the Board of Nursing be willing support legislation as proposed by the CNA/NNOC for safe nurse to patient ratios?
Thank you for your time and consideration.
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The following was not part of the testimony to TBON:
Below is an excerpt from a discussion board posting, written by the nursing instructor of an RN-BSN course I'm taking, Professional Role Development. It may reflect a typical managerial point of view.
"3) Unions-I am not a union fan in hospitals (note my husband is a union member outside of healthcare). As a CNO, I work every day to provide the best ratios, pay, benefits and work environment for my staff that our facility can afford. I don't see how a union would do any thing in our organization other than complicate things. I have to agree with Jennifer [last name withheld] posting that ultimately if you are not happy with your environment and feel that it is not safe than perhaps it is time to look elsewhere."
So, if conditions aren't safe for patients where I work, I should get a job somewhere else, right? Where should the patients go?
I wish we could get every nurse with a story similar to the ones we presented that day to show up at the next open meeting. Hundreds of nurses would bring the attention that this issues deserves.
ReplyDeleteI plan to complete the advisory form and to be at the next Board meeting to hear their response.
The law that went into affect.. where Medicare and Medicaid will not pay for Hospital Aquired Conditions, went into effect October 1st..
ReplyDeleteOctober 1st - What's New at Your Hospital?
Starting October 1, 2008, Medicare will stop paying hospitals for complications arising from ten preventable Hospital Acquired Conditions (HACs).
HACs Which CMS Will Not Pay For
Pressure ulcers stage III & IV
Severe Falls & Trauma
Vascular Catheter Associated Infection
Poor Glycemic control
Catheter Associated Urinary Tract Infection (UTI)
Deep Vein Thrombosis & Pulmonary Embolism (DVT)
Surgical Site Infection after Ortho and Bariatric
Surgical Site Infection after CABG
Foreign Object Retained after Surgery
Blood Incompatibility
How will CMS decide when not to pay hospitals?
Unless the condition was "Present on Admission (POA)," or, at the time of admission a complete workup was done which neither confirmed nor ruled out the condition, CMS will no longer move patients whose condition worsens while in the hospital to the higher, more lucrative DRG that reflects these complications.
Why is Medicare Changing How it Pays Hospitals?
CMS's goal is to "transform Medicare from a passive payer to an active purchaser of higher quality, more efficient health care." In addition to not paying for HACs, Medicare's other new hospital "Value Based Purchasing" initiatives include
(a) Public Reporting. At HospitalCompare.gov , CMS publishes how hospitals score on 42 quality measurements, including patient satisfaction surveys.
(b) Pay for Performance. Hospitals will be paid extra for high rankings, or for showing improvement; they will be penalized for low scores. CMS has sent Congress a comprehensive Pay-for-Performance plan and is awaiting approval.
(c) Other initiatives. More HACs will be added to Medicare's "do-not-pay" list next year; for example, Ventilator Acquired Pneumonia, with annual costs of $4 billion, is under consideration. Also in CMS's sights: penalizing hospitals for failure to rescue, and for 30-day readmission for heart failure, heart attack and pneumonia.
How will these changes affect nurses and healthcare workers?
In theory, Medicare's paying hospitals based on patient care quality SHOULD be a major incentive for hospital executives to listen to their nurses about how to fix the root causes of poor quality - eliminating problems like short-staffing, abuse of OT, and over-use of temporary nurses and travelers. The entire patient care team matters: If there is not enough EVS staff, there will be cleanliness and infection-control problems; if there are not enough nursing assistants, patients are at risk for falls and bedsores. So also with shortages in respiratory care, imaging, laboratory and pharmacy staff.
In practice, will hospitals instead put their focus solely on charting and documentation - adding even more paperwork burdens that drain even more of nurses' time away from caring for their patients?