As many of you know, I write about, support, and sincerely believe staffing is the key to good care. Enough staff is required to follow the nursing standard of care as we have been trained, educated, and must abide by it based on our license.
It is refreshing to see this article where the CEO of Penn Medicine urges state legislators to pass a bill that would require hospitals to follow minimum nurse-to-patient ratios. This Patient Safety Act limits the number of patients a nurse can be assigned in different units.
Let me give you an example …
In this case, in Pennsylvania (PA), it is in the intensive care hospital unit, where the nurses would be assigned no more than two patients at a time. You ask yourself, what about other units of facilities and types of patients?
This change in legislation is a challenge for us who do bedside nursing because situations change, patients’ conditions change quickly, and it is difficult to put exact numbers on all situations. However, this is a step forward for the safety and health of patients and the nursing staff.
We must start somewhere …
This PA legislation is to help strengthen the nurse workforce and reduce nurse burnout and turnover. We all went into nursing to help others and be good nurses.
Not having limits and standards on how many patients a nurse can care for at one time sets nurses up to fail before they even get to work.
Folks who are administrators and sit behind desks have yet to learn how long care needs can take, and sadly, they will probably never get it.
We need to support nursing ratio standards and work towards improving the healthcare system.
Nurses are the foundation and the backbone of a facility. As this Penn Medicine CEO stated, “We had simply had enough with a for-profit, external ranking that really was not advancing our core mission.”
It must be patients over profits and high CEO salaries. We need to solidify the healthcare system we have built and not allow it always to be a “Let’s see how much money we can make out of healthcare.”
There must be accountability!
Nurse staffing and other support staffing must be recognized as the foundation and the basis of good care. When you do not have enough nursing staff and other support staff, it becomes delayed care at best, and delayed care is missed care.
In long-term care, nursing homes, and rehabilitation facilities, as I have stated before, the regulations stipulate, according to Federal Regulations 42 CFR 483.35 – Nursing Services, … that ”the facility must have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services…… to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident…” Sufficient can mean many definitions to many folks.
This Federal Regulation for long-term care is not enough, very subjective, and often sets nurses up to fail because there aren’t enough time and “hands” to provide the nursing care the residents/patients need. This is often the basis of failure, deviations, abuse, and neglect I find in many of the cases I review.
Management knows better. It has set up a culture that “they are doing their best,” not trying to hire and train more nurses and other staff or even asking nurses to stay and work double shifts when they are already exhausted. Yet management is NOT providing the hands of care and does not often understand the need for more staff or simply do not care.
Numbers and Dollars
Management, at times, only sees numbers and dollars. Sadly, I see it all the time in the cases and when I work on the floor.
In one case, an aide was scheduled for 24 hours, not once, but twice and finally, the aide threatened to quit from exhaustion, not to mention breaking the labor laws with this type of schedule. Nothing would have changed had she not spoken up.
As nurses, we need to push continuously, and it may be a “fight” for more staff, better salaries to support a living wage, and, bottom line, provide the nursing standard of care as we have been trained and must provide per our licenses.
What can you do? Reach out and work with your state and federal legislators.
Remember, it is often the “squeaky wheel that gets greased,” but if they don’t hear from you, they may think, “All is OK.”
It is not Ok – another saying is…… “see something, say something.”. Nurses, we can no longer remain silent.