Enacting Safe RN to Patient Staffing Ratios

Running head: SAFE RN STAFFING 1

Sam Lastre RN, BSN

EM University

February 21, 2017

February 7, 2017 Israa Berro 28840 Rush St. Garden City, MI 48135 SAFE RN STAFFING 2

The Honorable Tory Rocca State Senator 201 Townsend St. Suite #3600 Lansing, MI 48933

Dear Senator Rocca, As a voter in your district, I, Israa Berro am reaching out to you today to seek your support of the non-existing Registered Nurse Safe Staffing Bill S.864. Representation of this bill would benefit registered nurses to make choices related to staffing ratios by promoting a safer environment for patients and improved quality of care.

The reason I am supporting this bill is because many studies have proven that a safe nurse- patient ratio will promote effective patient outcomes. There is strong evidence that an increased workload on registered nurses will cause drug administration errors, missed nursing care, and increased patient length of stay. This is also correlated with decreased patient safety and nursing burnout.

As a bedside nurse, I believe that S. 864 is an effective plan to the nursing shortage that I am currently experiencing at my work environment. The bill identifies and supports many factors that contribute and resolute nursing shortage without endangering patient safety and nurses satisfaction. The bill mandates hospitals to implement unit specific nurse-to-patient ratios based on patient acuity. This will provide an adequate number of ancillary staff to support nurses, and prohibiting mandatory overtime.

I am asking you to please reconsider and review this bill to help make many differences in the healthcare field. Thank you in advance for supporting the health and well-being of our community.

Sincerely,

Israa Berro, RN, BSN SAFE RN STAFFING 3

The National Nursing Shortage Reform and Patient Advocacy Act (S.864) displayed a strong position in promoting a safe working environment for registered nurses. Its purpose was to institute safe nurse-to-patient ratios that would improve the quality of care in hospital settings.

The commitment of the bill was to establish a policy to have a nurse care for a certain number of patients depending on the acuity of the unit. According to S.864 (2015), the nurse-to-patient ratio for a medical-surgical floor should be 4:1. Several studies have proven that an amplified workload on registered nurses instigates increased medication errors, missed nursing care, and prolongs hospital stays.

Nursing knowledge and responsibility are often compromised during medication administration, which is interconnected to multiple factors. Nurse burnout, high patient acuity, and distraction are some factors that compromise the safety of patients. According to the findings of Frith, Anderson, Tseng, & Fong (2013), the staffing of nurses is an essential source to keep patients safe from medication errors. Frith et al. (2013) found that when the proportion of registered nurses increased, the medication errors decreased. These conclusions are the definitive reasons why registered nurses can lose their license, which in turn, can lead to the loss of their jobs. This causes a decrease in the number of registered nurses needed desperately in the healthcare field.

When registered nurses are physically and emotionally stable, the value and safety of patients is increased along with the quality of care. Dabney & Kalisch (2015) state that errors of omission in nursing such as failure to reposition patients, missing medications, and not answering call lights have received little attention in patient safety. On the other hand, Dabney &

Kalisch (2015) found that patients conveyed suffering skin breakdown, new infections, intravenous infiltrations, and other adverse incidents during their hospitalization. SAFE RN STAFFING 4

The effects of missed nursing care elicited by inadequate nurse staffing can lead to increased hospital stays. According to the research of Avalere Health LLC (2015), higher RN staffing levels have been shown to decrease patient length of stay and reduce preventable hospital-acquired conditions such as inpatient falls and pressure ulcers. Avalere Health LLC

(2015) discovered that the reduced length of stay was 24-31% when there was an increase in RN staffing. Overall, inadequate staffing leads to nurse burnout, linking to increased medication errors, missed nursing care, and prolonged hospital stays. SAFE RN STAFFING 5

References

Avalere Health, LLC. (2015). Optimal nurse staffing to improve quality of care and patient

outcomes: Executive summary. American Nurses Association, (September 2015), 1-5.

Retrieved from http://www.nursingworld.org/DocumentVault/NursingPractice/

Executive-Summary.pdf

Dabney, B. W., & Kalisch, B. J. (2015). Nurse Staffing Levels and Patient-Reported

Missed Nursing Care. Journal of Nursing Care Quality, 30(4), 306-312.

doi:10.1097/ncq.0000000000000123

Frith, K.H., Anderson, E.F., Tseng, F., Fong, E.A. (2012). Nurse staffing is an important

strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5),

288-294. Retrieved from https://www.nursingeconomics.net/necfiles/specialissue/2012/

Frith_Staffing.pdf

S .864, 114th Congress (2015). Retrieved from https://www.gpo.gov/fdsys/pkg/BILLS-

114s864is/pdf/BILLS-114s864is.pdf SAFE RN STAFFING 6

Meeting with Senator Tori Rocca was unsuccessful, however we had a chance to meet with his staff member, Mr. Dave Szewczyk. My classmate and I perceived this process as challenging in the beginning, since most of our attempts to meet with a legislator were unsuccessful. Setting up the meeting was not as difficult as we expected, however, the meeting itself was fun and valuable. To be better prepared, we arrived a half hour early to discuss our topic and the proper questions to ask prior to the meeting. We acknowledged and addressed our issue and its impact in the healthcare setting. As advocates for other nurses, our goal was to inspire the staff member to understand our issue to support any future bill related to nursing shortage. The positive aspect of our goal was that the staff member’s parents were both nurses!

We were all highly fascinated and engaged in sharing our perceptions to why this bill should have been passed.

We were highly effective and prepared in lobbying our issue, while maintaining professionalism. We took the opportunity to be well informed about evidence-based research that supports our issue, to promote a clear standing point. Our views were specific and expressed clearly. We provided the staff member a handout that recapitulated our issue. The staff member was quite impressed that we were continuing our education and prepared to take action to promote a safer environment for nurses and patients. The staff member was prepared and educated about health policies related to our issue. He provided us an analysis of the Senate Bill

No. 574 that is related to our bill and explained how the process of passing a bill works. He encouraged us to continue sharing our concerns and feedback to help make a difference in decision-making. What I would do differently next time is get in touch with different legislators at an earlier timeframe. Also, I would choose a bill that exists, as I believe it will provide the SAFE RN STAFFING 7 legislators and staff members a stronger motivation to support any health policy related to nursing shortage. SAFE RN STAFFING 8