National Nurses United

Nursing turnover is very costly both in terms of quality of care and the bottom line of hospitals According to PriceWaterhouseCoopers (2007) the average hospital is estimated to lose about $300,000 per year for each percentage increase in annual nurse turnover. Given, as reported in the Sacramento Business Journal (2008), that after the introduction of the ratios, California���s major hospital chains��� RN vacancy rates fell below 5 percent, it would appear that the hospital industry in California had cause for celebration. Compare this 5 percent rate in California with Texas, a state with no mandated ratios, where the turnover rate hovers around the 20 percent mark. The national average ranges from about 15 to 25 percent. We built it and they did come As direct-care RNs predicted, the ratios brought their colleagues back to the workplace, improved quality of care and nurses��� morale. Far from bankrupting hospitals, ratios actually improved their bottom lines. Everybody gained, especially the patients who are RNs��� ���rst concern. From the Bedside to the Statehouse and Beyond National ratios legislation, the National Nursing Shortage Reform and Patient Protection Act of 2011, SB 992 (Boxer), builds on the success of the California experience after implementation of landmark ���rst-in-the-nation nurse-to-patient ratio law that has successfully addressed the shortage of direct-care RNs by improving working conditions, making them safer for patients and nurses. Among the many provisions included in the legislation are uniform, national, professional standards that include minimum, speci���c, and numerical direct-care RN-to-patient staf���ng ratios for each clinical unit in acute-care hospitals. For the full text, visit the NNU website at www.nationalnursesunited.org/issues/entry/ratios and scroll down for the link to SB 992. Legislative Purpose: ��� To address the nationwide shortage of hospital direct-care registered nurses; provide minimum safe patient protection standards���such as safe staf���ng ratios���for short-term and long-term acute-care hospitals in the United States; protect direct-care registered nurse as patient advocate; create registered nurse education grants and living stipends to recruit and retain direct-care registered nurses. National Proposed RN-to-Patient Ratios Intensive/critical care 1:2 Neonatal intensive care 1:2 Operating room 1:1 Post-anesthesia recovery 1:2 Labor and delivery 1:2 Ante partum 1:3 Well baby nursery 1:6 Postpartum couplets 1:3 Pediatrics 1:3 NOVEMBER 2012 ��� To create a hospital nursing service environment that will immediately attract new RNs and provide the foundation for ultimate restoration of the hospital direct-RN workforce; and ��� To establish clearly de���ned, legally protected, and enforceable duties and rights to direct-care registered nurses as advocates exclusively for the interests of patients. ��� Whistle-blower protections that encourage patients, RNs, and other healthcare workers to notify government and private accreditation entities of suspected unsafe patient conditions that will greatly enhance the health, welfare, and safety of patients. ��� The essential principles of staf���ng in the acute-care hospital settings must be based on patient���s individual acuity and needs; severity of conditions; services needed; and complexity surrounding those services. The Nurse Staf���ng Standards for Patient Safety and Quality Care Act of 2011, HR 2187 (Shakowsky), is the companion legislation on the House of Representatives side. It establishes new federal staf���ng standards for hospitals that will improve the safety and quality of care. The bill establishes minimum direct-care registered nurse-topatient staf���ng ratios with a mechanism to account for the increased needs of patients based upon acuity of care. It would be enforced through the Public Health Service Act and improve the quality of care in all hospitals receiving federal funding, such as MedicareMedicaid participating hospitals and hospitals under the Department of Veterans Affairs, Department of Defense, and the Indian Health Service. For the full text, visit the NNU website at www.nationalnursesunited.org/issues/entry/ratios and scroll down for the link to HR 2187. Setting the Stage for National Professional Standards Use of a reliable and valid patient classi���cation system (PCS) for staf���ng by acuity has received widespread attention in the literature. Staf���ng plans can vary widely from hospital to hospital, often lacking in speci���city, accountability, and transparency. Many nurses suspect that their hospital���s staf���ng plans serve as a kind of internal public relations program to justify inadequate staf���ng based on budget constraints or pro���t-margin incentives. In any event, it is clear that if the state or federal government is to use acuity as a basis for setting staf���ng ratios, it must utilize a consistent system of determining acuity across all acute-care facilities. And RNs must have the explicit right to advocate in the exclusive interests of the patients entrusted to their care, without fear of retaliation from their Emergency room 1:3 ICU patients in the ER 1:2 Trauma patients in the ER 1:1 Step-down & telemetry 1:3 Medical/surgical 1:4 Other specialty care 1:4 Psychiatric 1:4 Rehabilitation unit & skilled nursing facilities 1:5 Acute respiratory units 1:2 Burn units 1:2 Intermediate care nursery 1:4 Combined labor and delivery, and postpartum 1:3 W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 29

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