Regulating patient safety

There’s a famous “I Love Lucy” episode where Lucille Ball is working in a candy factory. Her job is to grab and wrap each candy piece as it goes by on a conveyer belt, but Lucy just can’t keep up. The candies go by faster and faster, and she eats some, wraps some and drops some. This is what it’s like on the job daily for hospital nurses, Linda Slattengren, president of the Minnesota Nurses Association, told the House Health and Human Services Committee April 22.

The conveyer belt has sped up to where nurses are just maintaining a level of productivity restricting their ability to have adequate staffing, she said. “I personally have not seen such deterioration of care as exists in our hospitals today,” said Slattengren, who has more than three decades of nursing experience.

Rep. Erin Murphy (DFL-St. Paul) sponsors HF3042 that would require a specific number of nurses directly related to the number of patients in a hospital unit. “This bill will yield excellent care for patients in our hospitals in Minnesota,” she said.

The committee hearing was informational, but Murphy plans to work on the issue for next session.

A companion bill, SF2742, sponsored by Sen. Sharon Erickson Ropes (DFL-Winona), was tabled March 5 by the Senate Health, Housing and Family Security Committee.

Nurse to patient ratios

The bill would define assignment limits as “the maximum number of patients for whom one direct care registered nurse can be responsible during a shift.” The number of nurses per unit would be reflective of patient acuity, the severity of patients’ illnesses or medical conditions.

Carol Diemert, nursing practice specialist with the Minnesota Nurses Association, said if a nurse’s patient load is four, adding one patient would increase the risk of death by 7 percent, and adding another would increase it by 14 percent.

Cairne Eytcheson, a registered nurse for the Fairmont Medical Center, said 2006 Minnesota Nurses Association records show that shifts in contract hospitals were not fully staffed 47 percent of the time. The problem arises when a unit is staffed at the beginning of a shift, but fails to add more nurses as more people are admitted, she said.

“It’s a roulette if you’re a patient in a hospital setting as to whether or not your acuity needs will be addressed on any particular shift on any given day,” Slattengren said.

Allowing staffing levels to be decided by individual hospitals is a recipe for disaster, Slattengren said. Currently, when more nurses are needed, it often takes several phone calls to get through the bureaucracy and diversions that are used to discourage staffing additions, she said.

The Mayo Clinic uses a system that examines every shift and the needs to determine staffing, and it allows for nurses to call in assistance. “We staff exactly to what the patients’ need and we do not want to enter into any type of discussion of an actual ratio number,” said Diane Twedell, director of education and development at the clinic’s Department of Nursing.

The Mayo Clinic and Mayo Health System oppose mandated nurse to patient ratios, Twedell said. Ratios have been enacted in California and there is no evidence of a relation between staffing ratios and improved patient outcomes, Twedell said. “Public policy must be guided by sound research evidence.”

It impacts all

Scott Parker of Minneapolis testified that while his wife was undergoing rehabilitation at Bethesda Hospital in St. Paul, she fell getting out of bed after no nurses showed up to help. He stayed in her room to ensure her safety, and time and again was left waiting when he would call for a night nurse. “I should not have to sleep in my wife’s room to ensure her safety. Isn’t this the covenant as the hospital’s primary responsibility?”

Rep. Maria Ruud (DFL-Minnetonka) said as a former nurse, she could empathize with the concerns expressed. Because of demands, she said there were nights where she walked away thinking, “I hope I didn’t kill anybody tonight.” She, too, stayed every night at a hospital when her son had emergency surgery because of staffing issues. “It got to the point where the nursing staff would ask my husband, ‘Is your wife on tonight?’”

“This is the start of a longer conversation,” said Rep. Paul Thissen (DFL-Mpls), noting patient quality and safety have to be at the heart of the issue.