BLOG: Safe Nurse-to-Patient Staffing Saves Lives and Money

This session, I’m authoring the Standards of Care Act which would guide safe nurse staffing in Minnesota hospitals. Below you’ll find an op-ed that Senator Jeff Hayden and I sent to the Pioneer Press responding to an editorial they had in the paper last weekend.

As always, on this or any other legislative issue, please do not hesitate to contact me. You can leave a comment below, give me a call at the Capitol at 296-4192 or email me at rep.joe.atkins@house.mn. Thank you!

Safe Nurse-to-Patient Staffing Saves Lives and Money

The issue of nurse staffing in Minnesota hospitals has been contentious and controversial, and in the news for a number of years now. While we respect the Pioneer Press Editorial Board’s opinion, their recent editorial (“Nurse ratios are for hospitals, not legislators, to decide”) overlooks key evidence.

After a number of years of strained relationships and difficult contract negotiations, we have a chance this year for nurses, hospitals, and yes legislators, to find a solution that works not just for the nurses or hospitals, but most importantly, for patients as well. To this end, we have chief authored the Standards of Care Act to set up a process by which evidence-based, nationally-accepted standards – not legislators or administrators – will guide safe nurse staffing in Minnesota’s hospitals.

The first step in finding solutions is identifying the problem one is trying to solve, and clearly, Minnesota has some problems when it comes to nurse staffing and how that impacts patient safety and costs. The ninth annual report released on January 31, 2013 by the Minnesota Department of Health on Adverse Health Events in Minnesota helps make the case that there is cause for concern. The 314 reported incidents are basically unchanged from last year’s 316. With respect to harm, deaths from the reported events increased from 11 to 14 and serious injuries increased from 83 to 89 from 2011. What’s more troubling is that even after nine years of testing programs and processes, the incident number hasn’t shown significant improvement.

One health study from Health Research and Educational Trust found that if the nurse staffing in New Jersey and Pennsylvania were equivalent to California’s — which increased nursing staff in 2004 — there would have been 13.9 percent fewer deaths in New Jersey (222 fewer deaths) and 10.6 percent fewer deaths in Pennsylvania (264 fewer deaths).

In addition to saving lives, appropriate nurse staffing results in reduced health care costs. A January 2013 study published in Medical Care determined that costly, 30-day re-admissions could be reduced with adequate nurse staffing, noting that each additional patient per nurse in the average nurse’s workload was associated with a 7 percent higher probability of re-admission for heart failure, 6 percent for pneumonia patients and 9 percent for myocardial infarction patients.

Another study in 2011 from Health Services Research found that additional nursing care hours did a better job preparing patients for discharge, resulting in nearly $12 million in savings on staff and decreased overtime costs.

We would agree with the Pioneer Press editorial board that this is an issue for the bargaining table. Unfortunately, the bargaining table isn't getting the job done. Hospitals and nurses have been negotiating for well over a decade on this issue. The Minnesota Nurses Association has attempted to work through contract deliberations to no avail. A separate task force consisting of MNA and Minnesota Hospital Association decision-makers could not come to agreement in 2009 on this same issue. Moreover, patient safety is a statewide issue, and it is something worth discussing at the Capitol.

We also agree with the Pioneer Press editorial board that nurse staffing ratios ought not be set by legislators. That's why our legislation doesn't do that. It calls for staffing to be set in accordance with evidence-based, nationally-accepted standards where such standards exist. Where such standards do not exist, the legislation calls for a group of independent, experienced professionals to set those standards, a group composed of nurses, hospital representatives, but more importantly, those speaking for patients.

The discussions around appropriate nurse staffing ratios aren’t all that different from other areas where evidence-based, nationally-accepted standards guide staffing: pupil-to-teacher ratios that are consistently shown to have a direct impact on student achievement, daycare provider ratios that directly impact child safety, and staffing ratios for those who care for other vulnerable populations. 

Likewise, it makes sense to establish guidelines for safe nurse-to-patient staffing, where lives are at stake and where the recent Department of Health data shows we are continuing to experience an unacceptable level of unnecessary injuries and deaths.

We look forward to having a conversation about appropriate nurse staffing in Minnesota’s hospitals. Our hope is to find common-ground solutions that will work for everyone: hospitals, nurses, and most importantly, the patients they serve.