Staffing, Quality, and Costs

The New York State Nurses Association is supporting a bill currently under discussion in the New York state legislature that would establish required nurse staffing ratios in the state's 185 acute care hospitals.  The hospitals oppose the bill, noting that the suggested ratios would cost their institutions and nursing homes about $3 billion a year and would affect their ability to shift staff use as needed.

This is an important conversation, given that research is demonstrating that nurse staffing levels have a definite impact on the quality of patient care.

INQRI researchers Mary Blegen and Tom Vaughn examined the extent to which nurse staffing levels affected the incidence of complications and the failure to rescue from those complications, (i.e. death following complications). Their examination showed that nursing hours per patient day were strongly associated with lower rates of pressure ulcers and hospital acquired infections, and fewer deaths from complications. Further, more RN hours in the mix had additional benefit with still lower rates of failure to rescue and hospital acquired infections. Their work shows that higher levels of nursing hours per patient day and RN skill mix in intensive care units and in general units will lead to better patient outcomes, information that can guide states considering regulation of nurse-patient staffing ratios to address patient safety gaps.

Findings from the first study to look at the link between nursing and very low birthweight infants in the neonatal intensive care unit (NICU) indicate that nurse staffing and practice environment do matter. INQRI researchers Eileen Lake and Jeannette Rogowski examined care in more than 100 NICUs around the U.S. and found that when babies are treated in units where nurses have less support and less frontline experience they are at higher risk of developing infections. Babies in hospitals where nurses are supported and have more experience are less likely to have medical complications such as bleeding in the brain, which leads to costly complications. The study results could guide decisions related to setting standards for all hospitals to follow when creating and staffing a neonatal intensive care unit where infants thrive.

Click here to read an article about the New York legislation in the Wall Street Journal.
Click here to learn more about the Blegen-Vaughn study.
Click here to learn more about the Lake-Rogowski study.

Minimum Nurse Staffing Ratios, Mentoring Programs Are Part of New Senate Bill

Earlier this week, U.S. Senator Barbara Boxer (D-CA) introduced the National Nursing Shortage Reform and Patient Advocacy Act, aimed at improving patient care and addressing the nursing shortage. 

The bill would:

• establish minimum nurse-to-patient staffing ratios;
• invest in nursing mentorship demonstration programs; and
• provide for whistleblower protections to allow nurses to report violations of minimum standards of care without fear of reprisal.

 In a statement, Boxer said, “I am proud to introduce legislation that will help save the lives of countless patients by improving the quality of care in our nation’s hospitals. We must support the nurses who work tirelessly every day to provide the best possible care to their patients.”

Several INQRI studies (as well as numerous other studies) have established that higher nurse staffing levels improve patient outcomes, including research led by Mary Blegen and Tom Vaughn, and Linda Flynn and Dong-Churl Suh.

Bills in Missouri Legislature Would Aid Advanced Nurses

Last week, Blythe Bernhard, of stltoday.com, reported that two new bills have been introduced in the Missouri legislature aimed at giving advanced practice nurses more independence and the ability to practice to the full extent of their training. Similar to legislation recently passed in Ohio (and discussed on our blog here last week), the proposed law would give APNs the ability to prescribe controlled substances without a doctor's oversight in addition to allowing doctors to enter into 'supervisory' agreements with more than three APNs (the current limit). The effort to expand nurses scope of practice in Missouri is currently at an all time high with four difference pieces of legislation being debated to allow nurses to practice to the full extent of their training. These proposals align with reccomendations made in the IOM's Initiative on the Future of Nursing committee's report: "The Future of Nursing: Leading Change, Advancing Health."

Click here to read the full article.

Click here to read other blogposts relating to the IOM's Future of Nursing report.

Advanced-Practice Nurses Get More Prescribing Authority in Ohio

At the end of February, we reported the introduction of legislation (SB-83) in the Ohio Senate that would expand Advanced-practice Nurses' power to prescribe Schedule II controlled substances. We are pleased to share with you that this bill was passed in the Ohio Senate and signed into law by Gov John Kasich last week. The law, which will become effective 90 days after it was signed into law, also requires APNs to complete an additional six hours of training before prescribing narcotic drugs. With Ohio expanding advanced-practice nurses scope of practice, there are now 34 states total that allow APNs to prescribe Schedule II drugs. This legislative action aligns with the first reccomendation made in the IOM's Initiative on the Future of Nursing committee's report: "The Future of Nursing: Leading Change, Advancing Health."

Click here to read more about the bill signed into law in Ohio.

Click here to read more blogposts relating to the IOM's Future of Nursing report.

Minimum Nurse Staffing Level Legislation Introduced In Minnesota

Last week, Renee Passal, of local ABC affiliate WDIO, reported that the Minnesota House and Senate has introduced legislation aiming to establish minimum nurse staffing levels at hospitals. The article also features a video snippet further detailing the proposed bills.

Click here to read the article and watch the video.

Click here to read other blogposts relating to nurse staffing.

Bill Would Allow Non-Doctors To Perform Abortions In California

Last week, California state senator, Christine Kehoe (D-San Diego), introduced legislation that would allow licensed nurse practitioners, physician assistants and nurse midwives to perform aspiration abortions, which is a non-surgical procedure most often used to terminate a pregnancy in the first trimester. Currently, only four other states allow for non-physicians to conduct non-surgical abortions and Sen. Kehoe argues that this expansion would, "give many California women access to earlier, safer procedures in the first trimester of their pregnancy".

Click here to read the full article.