Champaign County Health Care Consumers (CCHCC) held a press conference
on December 20, 2002 (Friday), which featured Faith Henson and Pat Weddig as
guest speakers. Claudia Lennhoff, Executive Director of CCHCC, coordinated the
event. There was also a nine minute re-broadcast of a Nightline TV show from
1996, which discussed staffing levels and hospital safety. About 15-20 people
attended the press conference, including staff from local news media.
Presentation of Guest
Speakers
Both Faith Henson and Pat Weddig
are registered nurses (RN) who used to work at Provena Covenant Medical Center
in Urbana, Illinois. They allege that they were fired from their jobs because
of their concerns about staff cutbacks and their attempts to form a labor
union. Nationally, hospitals have been pressured to cut costs as a result of
changes in reimbursements from HMOs, Medicare, and Medicaid during recent
years. According to Ms. Henson and Ms. Weddig, this often results in reduction
of staff relative to the number of patients in the hospital. They are
particularly concerned about the increase in the ratio of patients to
registered nurses. Ideally, a hospital should maintain a ratio no larger than 4
patients to 1 registered nurse on a hospital floor. In intensive care, this
ratio should be reduced to 2 patients to 1 registered nurse. Otherwise, patient
safety becomes jeopardized, and mortality rates for various illnesses will
rise.
Ms. Henson discussed several studies in support of her
views. According to the Institute of Medicine, medical errors kill 98,000
people in U.S. hospitals each year. Many of these deaths can be prevented by
maintaining appropriate staffing levels and using qualified personnel for
medical services. A research article in the New England Journal of Medicine,
which was published in May 2002, reported an increase in patient mortality and
illness as a result of inadequate staffing of registered nurses. This included
increased levels of mortality or illness for heart attacks, shock, urinary
tract infections, bleeding in the gastrointestinal tract, hospital-acquired
pneumonia, and various complications of surgery. The head author of this study,
Dr. Needleman, called registered nurses "the eyes and ears of the hospital." He
stated that nurses must have enough time to observe their patients in order to
identity problems early and arrange for their treatment quickly.
In another study, published in the Journal of the
American Medical Association in October 2002 by Aiken et al., it was found that
each additional patient per registered nurse was associated with a 7% increase
in the likelihood of dying within 30 days of admission to a hospital, and a 7%
increase in the likelihood that a patient will die from complications of
surgery. If the workload of a registered nurse is increased from 4 to 8
patients, this increased the mortality rate of patients by 31%. Even when
hospitals want to hire more registered nurses, they are sometimes unable to do
so because of a growing labor shortage. As the average age of the U.S.
population continues to rise, the demand for registered nurses has increased.
However, the number of college students entering nursing programs has failed to
keep up with this increased demand, while more registered nurses are leaving
their chosen profession because they have reached retirement age or have become
frustrated by the decline in working conditions.
To provide the people attending the press conference a
better idea of nursing responsibilities, Ms. Weddig described in some detail
what typically happens when a registered nurse examines or treats someone in
intensive care who displays symptoms of a possible heart attack. She also
stated that it was important to have adequate support staff, such as an EKG
technician, phlebotomist (a specialist that draws blood), and orderlies.
Because of misleading TV programs about hospitals, many people assume that
physicians perform services that are actually done by registered nurses. If
there are cutbacks in support staff, registered nurses can find themselves
cleaning patient rooms, fetching supplies, transporting patients, or doing
secretarial work, rather than observing and treating their patients. Sometimes
hospitals substitute licensed practical nurses (LPN) for registered nurses, but
there are many things that LPNs can't do without the supervision of a
registered nurse.
How To Assess Hospital Safety
and Reduce Your Risk
Information about staffing levels
at hospitals is difficult to obtain from third-party sources of information.
After being admitted to a hospital, a patient can ask who their registered
nurse is, and how many other patients have been assigned to him or her. This
should provide the ratio of patients per registered nurse on the hospital
floor. In requesting this information, only registered nurses who provide
direct care to patients should be included in the ratio. Other kinds of staff,
such as LPNs, charge nurses, discharge planners, floor directors or assistants,
should NOT be included in the ratio. It is also important to determine the
availability of support staff on the hospital floor. Are housekeepers cleaning
the room on a daily basis? Are there phlebotomists to draw blood? Are
secretaries available in the unit to handle paperwork or answer telephone
calls? When these support staff levels are inadequate, your registered nurse
will be spending more time engaging in these extra duties and will have less
time to observe and treat his or her assigned patients.
You should be suspicious of any
hospital administrator who refuses, or claims to be unable to answer, questions
about staffing levels, such as the patient to registered nurse ratio. Other
information that is useful in evaluating the safety of hospital include
re-admission rates, patient mortality rates, and hospital-acquired infection
rates. Some care should be exercised when making comparisons across hospitals,
as they don't necessary treat the same kinds of patients. For example, a small
community hospital may transport patients with more serious conditions to a
larger hospital in a city where there is appropriate equipment and
specialists.
If austerity measures have been
implemented at a hospital to cut costs, according to a publication that was
distributed by Claudia Lennhoff of CCHCC it may be necessary to do one or more
of the following: 1) Have someone stay at your bedside so they can assist you
with basic activities and report any problems to the hospital staff, 2) bring a
list of all the medications that you are taking to reduce pharmaceutical errors
or omissions, 3) be prepared to bring supplementary meals and snacks, 4) be
prepared to bring such personal items as toothbrush, toothpaste, razor, soap,
etc., 5) request that your bed linen be changed when necessary, and 6) monitor
what medications you are taking and their possible side-effects, so that any
problems can be reported as quickly as possible.
