National Nurses United

NewsBriefs:JanFeb 3 2/28/09 12:56 AM Page 7 Two Flawed Ratio Studies Provide Fodder for Industry Attacks a million dollars from Santa Clara County. CNA/NNOC and the community protested, forcing HCA to withdraw its request. In Loudoun County, Virginia, HCA was pursuing plans to build a new hospital, Broadlands Regional Medical Center, even though the local community does not want it and another hospital already exists just miles down the road from the proposed location. After lobbying by CNA/NNOC nurses, the county board of supervisors on Feb. 3 voted down 5-4 HCA's plans to build on the Broadlands site. RNs view this victory as a first step toward stopping HCA from bulldozing its way over communities and getting its way whenever it wants. CNA/NNOC had been working closely with RNs in many of these communities near HCA to ensure that residents continue to get the access to care that they need. "A company that pioneered the idea of making healthcare a commodity, that was forced to settle the largest medical fraud case in U.S. history, and then went completely private in one of the largest leveraged buyouts ever, is going to continually try and skirt the law to protect its profits, whether it means going against the healing nature and heart of an RN's practice or the best interest of a community," said Lisa Morowitz, who directs CNA/NNOC's work on HCA."And we'll be there to expose that and to hold them accountable." —staff report JANUARY | FEBRUARY 2009 CALIFORNIA alifornia's historic RN-topatient ratio law, sponsored and defended by CNA/NNOC, is marking the fifth anniversary of its implementation in 2009, but that's not stopping the hospital industry and its allies from gearing up for another attack. Two recent studies purport to offer an academic analysis of the impact of the ratios. But both are politically-motivated works, intended as ammunition for the industry campaign. The first study, "California's MinimumNurse-Staffing Legislation and Nurses' Wages," published in Health Affairs, examines what happened to RN wages in metropolitan areas of California compared to non-California metropolitan areas from 2000 through 2006, and attributes higher RN wages in California solely to the requirement for safe staffing ratios in hospitals. California RNs do have the highest wages in the United States because of the dramatic success of CNA/NNOC in winning negotiated improvements to raise standards for RNs as well as passing the ratio law, points deliberately ignored by the study's authors. But the authors' intent seems to be to lay C W W W. C A L N U R S E S . O R G the groundwork for attacks on ratios due to the alleged costs to supposedly impoverished hospitals. In fact, during this same time period cited in the study, metropolitan hospitals in California enjoyed a 13.2 percent increase in their real profits, also ignored in the article. Moreover, the methodology for the report is, at best, sloppy. For example, RNs in California may work more overtime, but the authors dismiss this factor as their data does not allow for a precise measurement. Further, the authors do not account for different changes in cost of living across various metropolitan areas, assuming for example that expenses in Los Angeles were the same as in Topeka, Kansas. The second study, "Assessing the Impact of California's Nurse Staffing Ratios on Hospitals and Patient Care", published by the California HealthCare Foundation, is also littered with methodological errors. The purpose of this study is to attempt to discount any improved patient outcomes resulting from ratios. The authors talked with administrators at 12 hospitals for their thoughts on the ratios. Surprise, the administrators do not like ratios. The authors did not interview RNs or their patients who, presumably, would not fit neatly into the authors' agenda. Regarding quality of care, the authors self-selected five of 27 "nursing-sensitive" measurements, cited by the Agency for Healthcare Research and Quality (AHRQ) as quality indicators. These indicators are actually listed as "patient safety indicators," not nursing sensitive indicators. According to the AHRQ website, the five chosen are "relatively inexpensive to use," meaning they are used because they are cheap to measure. Ironically, even by the authors' own methodology, three of the measures are in the good range, one is on the edge of good, and the last one has been improving. Yet the authors inexplicably allege that quality has not changed. —dan johnston REGISTERED NURSE 7

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