The Arizona Hospital
Patient Protection Act
by Catherine J. Rourke
Published October 24, 2007
Studies show that hospital profits warrant the hiring of sufficient nursing staffs to ensure proper patient care
Cally Caine checks off her list of medications as she makes her rounds at Verde Valley Medical Center. During the course of her 12-hour shift, the night-shift nurse will dispense medications to more than 10 patients under her watch.
Cally claims she has a hard time answering all the patient call buttons throughout the night and keeping up with all the requests. The rookie nurse, a recent grad of NAU Nursing School, says she's still learning the ropes and has a hard time staying awake during the graveyard shift generally reserved for young newbies like herself.
Still, even when amped with plenty of caffeine, Cally says worries about the safety of her patients. While 10 sounds like a general number, for nurses like Cally it's an overwhelming responsibility. In fact, most hospitals around the nation aim for a nurse-to-patient ratio of no more than five patients for every nurse on duty.
However, some nurses at VVMC like Cally report that they are responsible for 10 to 12 patients on a single shift. Yet the hospital continues to operate with a severe shortage of nurses, despite the overwhelming number of applicants and unemployed nurses in the valley.
According to Modern Healthcare (November 7, 2005), aggregate hospital profits in 2004 nationally climbed to an all-time record of $26.3 billion, with net profit margins at a six-year high.
Nurse-to-patient ratios have been demonstrated to produce significant long-term savings for hospitals by reducing patient care costs. By improving staffing conditions, ratios also help hospitals cut RN turnover and reliance on nurse registries. Data also shows that most hospitals can afford to employ sufficient numbers of nurses to provide "safe ratios."
The January/February 2006 issue of Health Affairs states that raising the proportion of nurses by increasing RN staffing to match the top 25 best-staffed hospitals would produce net short-term cost savings of $242 million. It also states that more than 6,700 in-hospital patient deaths and 60,000 adverse outcomes could be avoided.
The Institute of Medicine of the National Academy of Sciences reports that "nurse staffing levels affect patient outcomes and safety.” Insufficient monitoring of patients, caused by poor working conditions and the assignment of too few nurses, increases the likelihood of patient deaths and injuries. The study concludes: “How well we are cared for by nurses affects our health and sometimes can be a matter of life or death.”
According to JCAHO, the Joint Commission on Accreditation of Hospital Organizations, inadequate staffing precipitated one-fourth of all sentinel events — unexpected occurrences that led to patient deaths, injuries, or permanent loss of function, from 1997 to 2002.
The Journal of the American Medical Association reports: “Up to 20,000 patient deaths each year can be linked to preventable patient deaths. For each additional patient assigned to an nurse, the likelihood of death within 30 days increased by seven percent. Four additional patients increased the risk of death by 31 percent.
In Arizona, a new bill introduced to the legislature is designed to establish safe proper nurse-to-patient staffing ratios.
Introduction of the bill was hailed by nurses across the state who have voiced increasing alarm about the erosion of care conditions in Arizona hospitals that they say put patients at risk and fan the nursing shortage since many nurses will no longer work in unsafe hospitals.
The legislation would make Arizona hospitals safer by guaranteeing safe nurse-to-patient ratios, protecting the right of nurses to act as whistle blowers against unsafe conditions, and offer legal recognition of the professional and moral obligations of nurses to act as patient advocates, solely in the interests of their patients.
Nurses like Cally enthusiastically support legislation on behalf of hospital patient safety. "It's not about the money," she declares. "It's about the welfare of our patients."
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Catherine Rourke is the Observer's Health Sentinel and medical reporter.
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