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Something’s got to give


There’s a bill before Congress — the Registered Nurse Safe Staffing Act of 2013 — that would set minimum standards for nurse-to-patient ratios at hospitals, at least at hospitals that treat Medicare patients. All the nurses’ organizations seem to be for it, on the grounds that a shortage of RNs, plus hospital-budget pressures, have resulted in “fewer nurses working longer hours and caring for sicker patients.”

Those exact words can be found on the websites of any number of nursing groups, which are all in favor of setting minimum staffing levels. What’s much harder to find is any mention of that bill (H.R. 1821) on the websites of hospital management groups or associations. There’s another bill, though — this one is before the Connecticut General Assembly — that would merely require hospitals to regularly report their staffing ratios. But the Connecticut Hospital Association is against it, on the grounds that numbers alone aren’t indicators of quality care, and that there’s “no scientific evidence” to support such numbers.

If true, that’s a startling hole in our knowledge of such an important — literally, life-and-death — topic, and we can only wonder why neither Congress nor our state legislature has seen fit to learn whether there is such evidence. And there is some work done by Linda H. Aiken a decade ago at the University of Pennsylvania (it was mentioned recently in The New York Times) that seems to show a specific correlation between an increase in nurses’ patient loads and an increase in patient mortality. According to Aiken, 20,000 people die each year because they are in hospitals where the nurses were overworked.

And yet, only California has a rigorous and thorough law setting RN staffing levels for hospitals. Earlier this year H.R. 1821 was referred to a subcommittee, from which it may never recover.

Hospitals certainly have a justified interest in controlling costs, and nurse salaries are a big part of their budgets. But those of us who are neither nurses nor hospital administrators may find it difficult to resolve in our minds the sumptuous salaries that so many top hospital executives receive — even and especially at hospitals that never tire of telling the public that they’re not for profit — and what can easily be perceived as corporate stinginess when even one more patient is added to the workload of even one more nurse on even one more shift.

And now that the baby-boom generation is getting old, it will only need more nursing care, but there’s no reason to believe that the number of registered nurses will keep pace with that need.

The way it looks right now, working conditions for RNs won’t be getting better anytime soon.



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