Posted at: 06/11/2013 9:20 PM
By: Associated Press
A push to increase the number of nurses per patient at New York's 185 acute care hospitals pits promises of fewer patient deaths and complications against a billion dollars or more in annual health care costs.
Advocates say required staffing of one nurse for every two intensive-care patients and 1-to-4 ratios in regular medical-surgical units will improve patient care, reduce deaths, complaints and readmissions and leave hospitals financially intact.
Jared Birnbaum is a registered nurse who works overnight shifts in the emergency room at the 650-bed Westchester Medical Center, a regional trauma center. After 3 a.m., he says he's typically among five or six nurses for both the adult and pediatric emergency rooms, where one serious trauma patient can require three nurses. Those nurses, in turn, may not get back to their other patients for an hour or two, he said. When one nurse has to assess incoming patients for both rooms - say, because of a big car accident - someone walking in with a serious condition could wait 20 minutes to be seen at all, he said.
"What am I to do other than do the best of my ability to work with what we have?" he said. "It's a lot of prioritization. We pretty much get patient and family complaints all the time just for length of stay and how long it takes to do certain tasks."
The New York State Nurses Association is backing a bill currently making its way through the state legislature to establish required staffing ratios. The group said members at 57 unionized hospitals last year filed 19,292 separate protests of staffing assignments they considered unsafe.
New York hospitals oppose the measure. They say the ratios would cost them and nursing homes about $3 billion annually, infringe on the flexibility to shift staff as needed and likely reduce some hospitals' services and beds.
At Westchester Medical Center, where Birnbaum works, hospital spokesman David Billig said that as a Level One Trauma Center they can mobilize staff internally to address their variable needs and are confident in their ability to provide the best patient-centered care.
New York would be the second state to set mandatory nursing ratios, following California's 1999 passage and implementation in 2004. Both sides point to California as a basis for making their case.
The Healthcare Association of New York State, representing more than 550 nonprofit hospitals, nursing homes and home care agencies, said the staffing ratios would be "the largest-ever unfunded health care mandate." The requirements "would likely result in a reduction of specific services, as we have seen in California where mandated staffing ratios have led to reduced services and emergency room diversion," spokeswoman Melissa Mansfield said.
A 2002 study published in the Journal of American Medical Association found that hospitals with high patient-to-nurse ratios had higher death rates among surgical patients and nursing staff more likely to experience burnout. The study of more than 10,000 nurses and 230,000 patients found that with each additional patient assigned to a nurse, the likelihood of dying within 30 days after admission rose 7 percent.
"The bill would transfer patient care decisions from individual hospitals to Albany, cost financially struggling hospitals across the state $2 billion to implement, and force hospitals to lay off other staff," said Brian Conway, spokesman for the Greater New York Hospital Association. The bill would undermine its own goals by draining resources for support staff including nursing aides and licensed practical nurses, the group said, calling the California results "equivocal at best."
Nursing association President Jill Furillo said better ratios of bedside nurses - who can more quickly identify infections, medication errors or other patient issues - shortened hospital stays in California while also improving Medicare reimbursements. She said even a $1.5 billion increase in overall costs would be only 1 percent of what is already $150 billion in annual New York hospital revenues.