The ANA supports safe staffing....

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http://www.healthleadersmedia.com/content/NRS-304933/ANA-Backs-Federal-Nurse-Staffing-Bil

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Legislative Policy & Regulatory News

Senate bill would require reporting of nurse staffing plans
A bill sponsored by Sen. Jeff Merkley, D-Ore., would require public reporting of unit-by-unit nurse staffing plans. The measure would require hospital committees that include nurses to set unit-by-unit staffing ratios. "What works in a rural hospital in my hometown [in North Dakota] may not be the same thing in an urban trauma center. It allows flexibility and it also allows buy-in," said Jerome Mayer, ANA's associate director of government affairs. HealthLeaders Media (5/27)

Here's a sample:

A Senate bill calls for unit-by-unit staffing plans and publicly reporting those staffing plans, but stops short of dictating mandated nurse-patient ratios.

Federal requirements for unit-by-unit staffing plans and publicly reporting those staffing plans are at the heart of the newly introduced Registered Nurse Safe Staffing Act of 2014 (S. 2353), which stops short of dictating across-the-board, mandated, nurse-patient ratios.

Crafted with input from the ANA, the legislation is sponsored by Sen. Jeff Merkley (D-OR) and is companion legislation to a House bill introduced a year ago, the Registered Nurse Safe Staffing Act of 2013 (H.R. 1821).

WHAT Nursing Can Mean

These are only a few of the pressing issues that need to be improved and examined to waylay the oncoming shortage and the danger this presents to the increasingly sick population coming into facilities around the country. Staffing is an issue unto itself and needs extreme measures and policies implemented to ensure patient safety, satisfaction and the care they deserve. Tied to this is nursing satisfaction. Patient safety and satisfaction decrease with decreased nursing satisfaction. Research has noted that patient mortality and morbidity, that is their deaths, increases with nurses unhappy in their situation. Safe staffing ratios can be found throughout nursing studies; many have shown that a nurse with more than two patients in a critical care area compromises patient safety and care, and the nurses on the floor should have no more than four patients to care for and ensure their safety. Some states have even mandated that hospital units advertise their staffing ratios so patients and families know what they are walking into.

Attitudes are changing; hospitals across the nation are adopting more nurturing and less punitive reactions. Nevertheless, they seem to have missed the realization that as the nursing shortage continues; the value of a skilled and professional nursing staff that feels appreciated is paramount to the stability of any facility. The attitudes unfotunately are still Like it or leave. And Big Clue Here...Guess what is happening?? NURSES will continues to leave this wonderful profession for the same reasons that they have left for the last many decades. NEW NURSES will LEAVE for the same reasons because the issues are not being repaired; the problems with this profession are not being fixed. These newly educated nurses are walking into seriously compromised staffing situations and viewed with many of this younger generation’s work ethic, they will not stay as long as the nurses currently in place. THE DEATH OF THE BEDSIDE NURSE IS WHAT IS HAPPENING... For any who care...

Respond....follow and comment please...

Re-Post with additions

Lots of ideas...Need a new computer...Need ideas from my friends and colleagues...

What are your ideas??? (1)

What exactly is short staffing? Is it the new MTO (Oh and suck it up-like it or not)/not necessarily when needed) staffing?

A) Like when JCAHO or OSHA or AHCA visit? (Like does safe staffing really matter any other time)

B) Like when the budget says so? (But hey lets not look for ways to actually encourage money-making ideas for the workplace) Just cut the staff short instead.

C) NURSING SATISFACTION STAFFING???? OH my those are the wrong words to use, because nurse satisfaction is so often the first consideration.... (I can dream)

D) Study after study shows that safe staffing improves not only nursing satisfaction, longevity, security, etc., but actually promotes patient and family satisfaction, promotes better patient outcomes, patient safety and less sentinel events, and reduces medication errors. OH so many ANDS for nurses and patients...and SO many buts fro those that really should care but too often

consider the bottom line and NOT the bottoms of their nurses and patients....

Again, I really do not place patients after nurses, I just really consider the Patients and families have the WHOLE freakin alphabet advocating for them...Nurses do not even have the ABC's (another day for my BLOG on the one organization that really does care, just a quick hint...FNA)

Re-Post

Re-Post because the situations have not changed in my decades of nursing and It NEEDS Nursing involvement and caring

Political Possibilities

POLITICAL POSSIBILITIES

Everyday in the practice of Nursing, I see RISKS. Nurses across the country work in precarious situations, not only a danger to patient safety, but to their licenses and livelihood. These situations occur due to staffing issues and patient acuity. The population is aging and health is deteriorating for many of these individuals. The responsibilities of nurses are increasing everyday and the higher acuities make it worse and more dangerous for nurses to provide even adequate care.

The nursing shortage is already at dangerous levels and is only going to increase. The changes are not occurring rapidly enough and they are rarely directed in the right paths.

I propose and hope to see in my lifetime these changes and I am HOPING that you will HELP me.

1) A federally funded nursing retirement plan: This could not only improve the influx of people into the profession, but also be a great benefit to nurse retention, especially if it includes past service and years of experience. This could bring nurses back to the bedside; if they were assured of having a dedicated plan for the years of service (Nurses who have left the profession after i.e. 12 years of service come back for eight years and have a full retirement). AARP recently noted that less than 60% of nurses have retirement plans. This federal plan would be portable from job to job. Facilities could enhance retirement benefits or provide other inducements to the profession with the funds currently in use. IF railroad employees, teachers, firefighters, and police officers can have full retirement after 20 years, WHY have nurses been left out? The nurses I have presented this idea to most frequently ask me that question. WHY is this idea not already in practice?

2) Increased political awareness and interest for nurses. Facilities should have a dedicated position related to nursing politics. I have talked to many coworkers and they agree that knowing more about how their local, state, and federal politicians vote on issues regarding nursing would affect not only their voting participation but how and who they voted for. (i.e. IF you believe patients and families have a right to know what SAFE staffing ratios are and how those ratios affect patient safety and care, in addition to how the facility they are currently admitted to staffs their floors, then a politician votes against a bill that promotes these issues, Would you vote for that politician??).

3) An agency that monitors the dangers and RISKS that nurses are often subjected to: to have written protocols and standards of what constitutes patient safety in relation to acuity and ratios. (i.e. What constitutes a 1:1 patient, a 2:1 patient, a 4:1 patient???). One that monitors how often those standards are not met and why. How to make it better to keep nurses at the bedside.

4) National Nursing Licensure

5) Better Health Care Coverage—since we provide so much of it, it should be a reward.

So much more, these are only a few of the issues I would like to see instituted and implemented and truly believe it will affect the future of nursing. So many agencies and groups protect patient safety and there are no real protectors of nurses and their work conditions. Such an agency will only enhance patient safety. The CAN (Center for American Nurses, part of the ANA) is a start, but so far, no one is really affecting change in workforce conditions, thus the NURSING SHORTAGE.

Just because it keeps going on...

Who Cares?

Who cares really?

Do those you work for really care?

I just want you nurses and those that claim to care to really CARE...

Those days that you are working to yet again save the life of your patient, whether they be the loving grandmother of soooo many children or the DOC lifer who may also be a child molester...Who's will is it to beg the difference???? My OH my...who's to decide who deserves better care?

But while you are working so hard to keep this person alive...PLEASE manage to discharge one patient and get to the bathroom another patient... and PLEASE...also get to all of the other computer work and paper work...LOLLLLLLLL. Is there new time on the clock? Has some magical power added a new day?

REALLY???

Make me a promise you can keep OH great administrator.....

Repost

Right in time for Nurses Week

http://www.aacn.org/wd/practice/content/nurse-staffing-ratio.pcms?menu=practice

Nurse-to-Patient Ratios

ANA Applauds Federal Legislation to Mandate Safe Nurse-to-Patient Ratios

Sen. Inouye introduces bill to protect patients, hold hospitals accountable for RN staffing.

Washington, D.C. — The American Nurses Association (ANA) today applauded the introduction of the Registered Nurse Safe Staffing Act of 2003, federal legislation that aims to ensure that patients receive safe, quality nursing care in hospitals and other health care institutions. The legislation mandates the development of staffing systems that require the input of direct-care registered nurses (RNs) and provides whistle-blower protections for RNs who speak out about patient care issues.

The bill, S.991, was introduced by Sen. Daniel Inouye (D-HI) yesterday. Today marks the start of National Nurses Week, which is celebrated May 6-12 each year.

ANA, which worked closely with Sen. Inouye's office on the bill, lobbied for this legislation to protect patients and registered nurses, given the absence of enforceable standards for nurse staffing in hospitals and the widespread practice of healthcare facilities stretching their nursing staff with unsafe patient loads, mandatory overtime, "floating" to specialty units without training and orientation and other practices that undermine the delivery of safe, quality care.

"Inappropriate nurse staffing is the number one concern of nurses today," said ANA President Barbara Blakeney, MS, APRN, BC, ANP. "More than a decade of research has shown that RNs make the quality difference in patient care and that when RN care is insufficient, patient safety is compromised and the risk of death is increased."

"We applaud Sen. Inouye for his leadership on this issue and for his commitment to protecting patients and nurses from practices that are dangerous," said Blakeney. "Furthermore, this legislation is needed to improve the work environment for nurses, to enhance retention of practicing nurses and recruitment into the profession."

In July 2002, the Department of Health and Human Services released data confirming that a nursing shortage already exists in the United States and that it is expected to grow. According to the HHS study, in 2000, there was a shortage of 110,000 nurses (6 percent).

Without changes in the system, the HHS study predicts that shortage will grow to 12 percent by the year 2010, 20 percent by 2015 and 29 percent by 2020.

The RN Safe Staffing Act amends the conditions of participation in the Medicare program and establishes a requirement for minimum staffing ratios. Rather than establishing a specific numeric ratio, the act requires the establishment of a staffing system that "ensures a number of registered nurses on each shift and in each unit of the hospital to ensure appropriate staffing levels for patient care."

Specifically, the staffing system must:

• Be created with input from direct-care RNs.
• Be based on the number of patients and level and intensity of care to be provided, with consideration given to admissions, discharges and transfers that nurses must handle each shift.
• Account for architecture and geography of the environment and available technology.
• Reflect the level of preparation and experience of those providing care.
• Reflect staffing levels recommended by specialty nursing organizations.
• Provide that a RN not be assigned to work in a particular unit without first having established the ability to provide professional care in such a unit.

In addition, the act requires public reporting of staffing information. Hospitals must post daily for each shift the number of licensed and unlicensed staff providing direct patient care, specifically noting the number of RNs.

In addition, the act provides whistle-blower protections for RNs and others who may file a complaint regarding staffing. The RN Safe Staffing Act incorporates ANA's Principles of Nurse Staffing. Rather than recommending specific numeric ratios, ANA developed the principles in 1999 as a tool for nurses to better gauge appropriate staffing.

The principles not only take into account the number of patients, but also look at other important staffing considerations, such as the experience level of nurses on the unit, the severity of patients' conditions and the availability of support services and resources.

"ANA has long been supportive of establishing nurse-to-patient ratios," said Blakeney. "However, ANA has not supported the approach of legislating specific numeric ratios, because that approach fails to take into consideration the multiple variables that affect nurse staffing at the unit level. Staffing systems can only be effective if the direct care nurses who work on a specific unit have input into the system. This legislation provides a comprehensive solution to the complex and urgent problem of insufficient nurse staffing."

Staffing by Acuity makes Ratios SAFE

Just a few proofs that better staffing provides better outcomes:

http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.html

• Lower levels of hospital nurse staffing are associated with more adverse outcomes.


• Patients have higher acuity, yet the skill levels of the nursing staff have declined.
• Higher acuity patients and added responsibilities increase nurse workload.
• Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
• Hiring more RNs does not decrease profits.
• Higher levels of nurse staffing could have positive impact on both quality of care and nurse satisfaction.

Additional Studies and websites:

Saint Joseph’s is part of the Resurrection Health Care system, which assembled committees across the system to develop standards and assign weights to different patient types.

Mary Anne Harper, clinical manager of maternal child services, explains that before launching the program, her department discussed the amount of time nurses spend on the various patient types in maternal-child nursing, e.g., a normal newborn. The weights assigned were reviewed and agreed upon by the entire system.

Once the program was implemented, she says it was fairly easy to roll out to nurses. Two hours before the end of their shift, nurses enter information about their patients into the computer system. They select attributes for patients from lists already entered, such as whether patients are receiving blood transfusions or have total care needs, whether they are in isolation, and so on. The program assigns a weight to each patient that indicates the acuity needs.

“The charge nurse on each shift will review after everyone has entered,” says Harper. “They run a report to determine needs. How many people are level 1 acuity, how many people are level 2, etc. The charge nurse looks at the numbers and determines her staffing needs.”

Harper says the charge nurse may find the unit has a lot of patients with high acuity, which may mean they need more nurses. Sometimes they may have low acuity—for example, if a lot of patients are simply waiting to go home—and may need fewer nurses.

Just another clue that staffing SHOULD be based on patient needs/acuity

Acuity Systems Dialogue and Patient Classification System Essentials
"Aiken and colleagues found that when nurse-to-patient ratios go from 1:6 to 1:4, patient death rates decreased by 2.3 per 1000 patients. Cho et al found lower rates of urinary tract infections, pneumonia, upper gastrointestinal bleeding, and shorter hospital stays"

http://www.ena.org/practice-research/Documents/StaffingGuideline/Harper_2007.pdf

This is just from floor staffing, THINK of how many sentinel events can be averted in an ICU with proper staffing and acuity levels.

The Association of Registered Nurse Staffing Levels and Patient Outcomes

http://www.ona.org.3pdns.korax.net/documents/File/pdf/KaneRNStaffingPatientOutcomesMedCare.pdf

Again...Fight for your rights...To Party or just be respected...

Specialty Nursing Certification--Benefits you if you work in the right place

Organizations and articles show that specialty nursing certification benefits nurses through improved continuing education and benefits patients in this way also. As one of the most trusted professions, certification provides a sense of stability and comfort to patients in the advanced knowledge these nurses attain. Employers also benefit from the respect and security felt by patients who are cared for by certified nurses and can feel secure themselves with highly trained staff.
These sites offer more information:

http://www.aacn.org/wd/certifications/content/benefitstoptempnrs.pcms?menu=certification

http://www.medscape.com/viewarticle/717805

The Medscape article claims that a 2006 survey showed certified nurses made $7300/year more for said specialty certification.

http://www.nursingcertification.org/pdf/white_paper_final_12_12_06.pdf (2006 survey)

This survey shows that close to 2500 surveyed offer NO Incentives. It also cites lack of institutional incentive and support as barriers to certification. May be a CLUE... or do they just need the board game.

Do you know where?

I plan to look, because many places in my state don't seem to offer such incentives. Yet they seem to think the certification which often requires many more CEU's to renew is okay to expect and/or mandate that you do. Incentives and salary differentials seem like a better plan. I suspect one day such certification may be mandatory in some workplaces, as well as higher levels of education, which few facilities reward. This is especially true for experienced nurses who have reached the cap of the payroll limit for their years of service (Yet again, another topic for another day). Here is the CLUE, for all of the places who find incentives beneath them. Make it....WORTHWHILE, it costs time and money, continuously.

These issues are again an ISSUE...

CCRN-CEN??? DO they make it worth it?

NOT just in the monetary sense, that is a topic for another day. BUT, just FYI, there are actual facilities and states that pay $/hour for being certified in your training specialty.

Today, consider the critical patients you care for on a daily basis and how safe or unsafe you feel in your practice. Especially when they are handing you the responsibility of even another patient when you can barely get out of the room of the current TTD (trying-to-die) patient.

DOES the place you work have formal guidelines for what constitutes a 1:1 patient? It is more than just treating a patient with an IABP or running CRRT or ECMO, or initiating a hypothermia, TPA, or sepsis protocol. These are the DUH factor, but how many other patients get paired or more? Every area with any standards should have policies that protect the patient with such guidelines. And safe staffing should be maintained.

Many organizations have statements and standards relating to what constitutes 1:1 care and 1:2 care and so on. They provide guidelines for what protects your practice and constitutes safe care delivery.

As your director or manager encourages you to be certified in your specialty by such entities (i.e. AACN or ENA), think about whether or not they honor the standards recommended by these organizations.

Give thought...should you have time, when the next shift you have the crazy busy night and you know you are just lucky if the patients all survive, much less get the care they deserve and the care you chose this profession to give. The night you are thankful to grab a sip of some refreshing beverage, maybe from the sink in the room (YUCK) if you are allowed, and again very happy to actually make it to the bathroom, some times that day or night. These are the times to just give it a thought. Is the certification worth it, if they cannot even HONOR standards for those TTD's?