On May 13, 2009, a bill was submitted to the Senate in hopes of modifying the Public Health Service act in regards to the topic of nurse to patient staffing ratio and for other purposes. Section 3101, Minimum Nurse Staffing Requirements, discusses 5 topics: staffing plan, minimum direct care registered nurse-to-patient ratios, development and reevaluation of staffing plan, acuity tool, and submission of plan to secretary.
In regard to nurse-to-patient ratios, the bill entails that each unit has its own requirements as to the number of nurses for each shift. If you are a nurse in the trauma unit or the OR, you should only have 1 patient. If you a nurse in the CCU (including NICU, labor and delivery, coronary care units, acute respiratory care units, burn units, and postanesthesia units), you should only have 2 patients. If you are an emergency room nurse or work in stepdown units, pediatric units, telemetry units, or on a combined labor, delivery, and postpartum units, you should have 3 patients. In antepartum units, intermediate care nursery units, psychiatric units, or other specialty care units, the nurse should have 4 patients. If you work on a medical/surgical floor, rehabilitation unit, or a skilled nursing unit, you should have 5 patients. Lastly, if you worked in a well-baby nursery or postpartum unit, you should have 8 patients. One important note of the staffing bill is to help ensure the annual and continual evaluation of hospital staffing plans in regard to their nurse-to-patient staffing ratio. During the evaluation of the hospital staffing plans each year, input from the registered nurses is required in order to revise the content.
Section 3102 Posting, Records, and Audits discusses how the previously noted nurse-to-patient ratios should be accessible to staff, patients, and the public, a record of the ratios for each shift for the last 2 years, and how the secretory should conduct periodic audits.
Section 3103 Minimum Direct Care Licensed Practical Nurse Staffing Requirements discusses many topics, such as the establishment of the hospital's staffing plan and how a study no later than 1 year after the date of enactment of the plan should be performed to review the effects of patient care in hospitals. Additionally, the application of registered nurse provisions to licensed practical nurse staffing requirements aims to bridge the gap between RNs and LPNs and how the requirements of this section should take effect as soon as possible (which is determined by the secretary) is no later than 2 years.
Section 3104 Federal Assistance for the Purchase of Safe Patient Handling Equipment discusses how it is necessary for this secretary to establish a grant program that entails providing financial assistance to help cover all the costs of purchasing federal/state rewuired equipment. For the year 2010, one example of a grant award was $50,000,000.
Section 3105 Whistleblower and Patient Protections discusses the following topics: recognition of duty and right of nurses to advocate in the exclusive interest of the patient, refusal of assignment, retaliation for refusal of assignment barred, cause of action, complaint to secretary, toll-free telephone number, protection of reporting, prohibition on interference with rights, notice, and effective dates. This part allows the nurse to refuse any assignment without means of retaliation, discrimination, or means of discharge. A nurse, patient, or other individual may file a complaint to the secretary (by means of a toll-free number) against any hospital for violating these policies. In order to help staff and public awareness, a notice with guidelines about patient, nurse, and public rights should be made visible.
Section 3106 Enforcement discusses how it is the duty of the secretary to investigate any complaint, encourage a reestablishment corrective action plan in regard to a facility's violation, and the penalties that the facility may face. Most penalties are financial.
Section 3107 Definitions is responsible for defining acuity system, direct care licensed practical nurse, nurse, direct care registered nurse, employment, staffing plan, and declared state of emergency. Acuity system describes the level of care needed by each patient, the number of nurses to care for these patients, whether the care is performed by a registered nurse or other personnel, and requires this information to be expressed in plain, easy to understand language. Direct care LPN is a nurse who has been licenced for more than 1 state and who provided bedside care for 1 or more patients. The nurse means any RN or LPN regardless of employment. Direct care RN who has been licenced by more than 1 state and provides bedside care for 1 or more patients. Employment is a contract (or otherwise arranged) provision of service. A declared state of emergency is an unavoidable occurrence at an unscheduled interval that relates to healthcare delivery and necessitates immediate attention declared by the federal government.
Section 3108 Rule of Construction discusses the importance of maintaining patient record confidentiality and a report to congress with recommendations regarding sufficient number of nurses no later than 1 year after the bill enactment.
Section 860 Registered Nurse Workforce Initiative (RNWI) was established as a 5 year program to help resolve the nursing shortage issue. One way they intend to do this is to establish many educational system foundations and institutional involvement to allow sufficient number of employable nurses, which is necessary to guarantee a safe and competent hospital nursing staff and care.
Section 861 Education Assistance Benefits discusses how the secretary is finding means to ensure progressive nursing educational assistance by establishing a grant program.
Bill information was found from the following webstie:
http://www.govtrack.us/congress/billtext.xpd?bill=s111-1031
The national nursing shortage and reform act is an important bill that is a catalyst in solving the current shortage of nurses in our hospitals. An important component of this bill is section 861 as it addresses the development of a grant assistance program for nursing education. New England Public Policy Center and the Massachusetts Health Policy Forum released an article addressing the current nursing shortage titled Nurse-To-Patient rations: Reality and Research; they address this issue by stating that nurses are not simply standing around in the community waiting to be hired. We must attract more people to the profession and provide adequate education and financial incentives (http://www.bos.frb.org/ economic/neppc/conreports/2005/conreport051.pdf). The bill also establishes that each unit should set standards particular to their patient needs and undergo continual evaluations to keep these standards in check. This is an important element in the achievement of a successful nurse-patient ratio.
ReplyDeleteThis bill is important in helping solve the nursing shortage by providing a plan and set regulations in nursing staffing ratios. Many nurses have left the nursing workforce, or have been turned away from the profession because they were overworked and given too many patients. With regulations in place to limit the amount of patients a nurse would be assigned, the nurse would have more time to dedicate to their selected patients, and there would also be more nurses on the floor to help with both expected and unexpected tasks.
ReplyDeleteIn addition to making the workload more desirable and managable to the nurses, having a set nurse-to-patient ratio would make the hospital environment safer for the patients as well. The nurse having more time to concentrate on the few patients he or she is assigned would allow for more thorough and personalized care. The nurse may be more observant to smaller details with their patient's and would have more one-to-one time with them to get to know them and learn their baselines. This would aid the nurses in being able to more quickly identify problematic changes in their patients. Also, the nurse would be less likely to make mistakes if he or she was not rushing to complete all of their tasks.
Setting new regulations on nurse-to-patient ratios in certain units would greatly improve nursing care as a whole, and would improve the safety and quality of the environment for both the nurses and the patients.
Nursing care can be stressful, especially when the nurse receives a high patient load and inadequate time and resources to provide the effective care to meet their patients’ needs. I think much of the burnout and compassion fatigue many nurses experience today largely stems from the unregulated nurse-to-patient ratio. Addressing this issue will not only improve patient care, but will encourage more professionals to enter the nursing field while preserving the nurses who currently practice. We all recognize the importance of our profession, now we should take the knowledge and power we possess and bring about improvements to advance our national nursing care. When I think of nursing care, my mind is filled with meaningful and life-fulfilling thoughts and I am saddened many nurses today are bitter and hardened to this beautiful service because as a nation we are ignoring this problem.
ReplyDelete"Acuity system describes the level of care needed by each patient, the number of nurses to care for these patients, whether the care is performed by a registered nurse or other personnel, and requires this information to be expressed in plain, easy to understand language."
ReplyDeleteThe acuity system that this bill, if approved, will create would be an invaluable resource for the nursing profession. The rate of burn out would plumet if a nurse could be comforted in the fact that she/he will never again wish they could be in three places at one time due to an overwhelming number of patients. The skill level of the healthcare worker would match the task assigned, which in many instances has not been the case in recent times. The patient could rest assured that their nurse is going to be there for them when needed and is able and qualified to make critical decisions in their care. Setting standards of nurse:patient ratios is a must. However, we need the nurses and qualified personnel to staff units with these ratios in mind. That is the true problem with the ratios in units today. Many nurse managers have been educated on the dangers of high patient to low nurse ratios and the negative outcomes associated with them. They simply just do not have the qualified nurses to put on the units.
It is good to hear to everyone is encouraged by setting patient- nurse ratio regulations. As we enter the workforce it will greatly impact us. We all understand that these regulations will help keep our patients safe and their families mind at ease. It will also improve the quality of the work we do. We can be accurate and astute in our care and assessments. With that in mind, we can all also see how a work place that has regulations is a better place to work. As a nurse the job can be tiring and draining but through the shortage reform the job can be more fulfilling and less chaotic. Eventually the overall goal is to create a more positive nursing career which will encourage people to join nursing and aide in stopping the shortage!
ReplyDelete