staffing

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How Many Patients Does One Nurse Treat: Ballot Question On Staffing

“Just Ask!” That’s the slogan for a new campaign by the Massachusetts Nurses Association (MNA). The union is encouraging people to ask how many other patients their nurses will be treating that day. The slogan is meant to draw awareness to what the nurses union sees as a growing disconnect between the profit-driven healthcare industry and the quality care of its patients.

Alex E. Proimos/flickr

Alex E. Proimos/flickr

The campaign’s goal is to enact minimum mandatory staffing levels, capping the number of patients per nurse. After a similar measure failed to pass the state legislature in 2008, the MNA wants to take the issue directly to voters through a ballot initiative. The union has submitted the text of the Patient Safety Act to the Attorney General’s Office; the act’s terms include limiting nurses to having up to four patients in surgical units and in emergency rooms. Once approved, the union will need to collect 70,000 signatures by November for the Patient Safety Act to appear on the 2014 ballot.

Currently, California is the only state that has mandated nurse-patient ratios. However, this topic may well seem familiar to Mass. voters: state nurses have sought staffing legislation since 1995, and 2011 saw fraught contract negotiations between Tufts Medical Center and its nurses. CommonHealth analyzed how Tufts’ lower nurse ratio affected patient care.

Lynn Nicholas, president of the Massachusetts Hospital Association, alluded to the idea’s long history by calling the current initiative petition a “repeat of an arcane idea that has no merit” in a statement. Continue reading

CommonHealth Analysis: Nursing Staff Levels At Tufts Medical Center Trail Competitors, Data Suggest

There’s a heated dispute currently underway between the Massachusetts Nurses Association — specifically the 1,200 RN’s at Tufts Medical Center — and management at the hospital. They are engaged in contract negotiations that haven’t been pretty. The nurses accuse the hospital of allowing staffing levels to fall so low over the past year that patient care has slipped and conditions have become dangerous; the nurses have complained to the hospital’s board citing numerous examples of egregious care. The hospital, in response, says its care has in no way faltered, and that the complaints are part of a national union strategy to boost the nurses’ bargaining power.

So what’s the truth?

We decided to look at the numbers, and came up with a simple analysis of nursing staff levels based on publicly available 2011 data from a statewide hospital-sponsored website called Patient Care Link. According to these numbers, it appears that registered nurses at Tufts Medical Center do spend less time caring for patients in key medical units such as the emergency department and adult critical care unit compared to nurses at the other Boston teaching hospitals. Tufts also has a more meager nurse-to-patient ratio in its combined medical-surgical unit compared to other hospitals with similar units, according to the data from Patient Care Link.

Nurses: Less Time With Patients

Our analysis basically calculated the number of hours nurses are scheduled to work, and divided that by the average number of patients seen in the particular unit. This measure is called “nurse hours per patient visit.” So, for instance, in its emergency department, Tufts provides 1.98 nurse hours per patient visit (again, the average number of hours a nurse cares for a patient during that patient’s visit to the ER), according to the website numbers. That’s fewer nurse hours compared to the other teaching hospitals: we calculated 3.2 nurse hours per patient visit at Massachusetts General Hospital; 2.36 hours at the Brigham & Women’s Hospital and 2.31 hours at Beth Israel Deaconess Medical Center.

Let me say here that Patient Care Link is far from a precise measurement of staffing levels. It’s a site sponsored by the Massachusetts Hospital Association. It’s voluntary and non-binding. And all it asks is that hospitals submit their staffing plans. Still, these are the numbers that are available. And short of sneaking into the hospital undercover and doing headcounts, this is all the public has to work with. If anyone out there has a better way to figure this out, please let us know.

A spokesperson for Tufts Medical Center doesn’t dispute our numbers, per se, but says such comparisons don’t offer the full picture and that patient care at the hospital remains top-notch. “The numbers don’t truly tell the whole story,” says Tufts’ Julie Jette.

Nevertheless, here are the numbers:

Boston Teaching Hospitals
Unit Type Tufts MGH BWH BIDMC
Emergency Department
RN Hours Per Patient Visit
1.98 3.2 2.36 2.31
Adult Critical Care-Surgical
RN Hours Per Patient Day (24 Hours)
15.2 20.49 19.79 17.54
Hospitals with ACC Med/Surg Combined
Tufts Newton-Wellesley Good Sam Winchester
Adult Critical Care- Medical / Surgical Combined
RN Hours Per Patient Day (24 Hours)
13.33 15.48 15.45 15.04

Longer Wait Times

Nurses say this dip in staffing — with fewer nurses available for more patients — has a detrimental effect on patient care. Barbara Tiller, an RN at Tufts for 21 years, says patients now wait a lot longer for a nurse. “These are patients in pain, ringing the bell, and waiting 20, 40 minutes,” she says, “or patients who can’t get out of the bed to toilet themselves, and then they end up waiting there in a wet, soiled bed.” Continue reading