Safe Staffing Levels…… What?? Are You Mad?

 I support this one. This is one nursing issue I can get behind.

“A memo in support of the bill states that safe staffing reduces adverse patient outcomes, citing research funded by the federal Agency for Healthcare Research and Quality. The data, the memo states, have shown hospitals with lower nurse staffing levels have higher rates of pneumonia, shock and cardiac arrest, among other adverse outcomes that lead to higher costs and mortality from hospital-acquired complications.(1)”

            Support for the bedside RN’s out there doing the daily grind in unsafe conditions. As a former RN then NP, I would cringe going into work sometimes at the unreasonable patient to RN ratio I was expected to care for. Often unsafe. I see it now too. It continues. I searched for the aforementioned memo citing the research and wasn’t able to find the exact one. I emailed the author hoping for the reference or citation of the evidence. There is a shortage of bed side RN’s and many are leaving for greener pastures in other careers, and part of the explosion of the NP’s is bedside RN’s seeking to leave the poor quality and poor unsafe working conditions. I’ve been there, done that. It’s one reason I left back then for NP land when I became an NP. As an MD now, I want safe bedside nursing care for my patients. Upon quick literature review, studies do pop up (2-5). They support the proposed bill. It’s beyond the scope of this blog to delve into each of the studies found, but suffice to say it can be summed up by: 

“Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes.”(5)

            Thus low staffing ratios lead to increased complications and poorer outcomes. But it’s about the money of course. Now, to be honest, this is a nursing issue to solve and I have written before about disciplines staying in their own respective lanes. This is true, and I support the bedside RNs solving this problem. However there is a bit of overlap here. Think for a minute about administrative costs and administrators salaries. These 2 items are the largest burden and cost within a health system despite the thought that it is physician salaries (6-9). To sum this up:

“This administrative complexity, with its associated high costs, is often cited as one reason the United States spends double the amount per capita on health care compared with other high-income countries even though utilization rates are similar.(9)”

            So cut the administrative costs, and there’s your cost savings to off set the cost of raising bedside RN staffing levels. Simple it seems, and maybe naïve of me to think it is simple, but sometimes the best solutions are the simplest ones. In addition, think about the costs associated with the poor outcomes the same evidence says will happen with low staffing ratios. There is more cost savings. Maybe these costs savings in addition to covering costs of bedside RN staff, could even further go to fund more residency spots given there is a physician shortage too. Where to start? well, I’m biased. I think that since physicians are more educated and trained than administrators that the admin salaries could be cut for cost savings to be used for more RN and physician staff.

“Adjusted for inflation, average compensation for CEOs at these medical centers increased from $1.6 million in 2005 to $3.1 million in 2015 — a 93 percent increase. During the same period, compensation rose by 26 percent for orthopaedic surgeons and 15 percent for pediatricians, reflecting the higher and lower ends of doctor salaries, respectively. For registered nurses, wages increased by three percent.(10)”

            And there you have it……………

REFERENCES:

  1. https://www.modernhealthcare.com/labor/mandated-staffing-ratios-would-cost-3b-year-ny-hospital-association?utm_source=modern-healthcare-am-wednesday&utm_medium=email&utm_campaign=20190626&utm_content=article5-headline
  2. https://www.ncbi.nlm.nih.gov/pubmed/29455061
  3. https://www.nejm.org/doi/full/10.1056/NEJMsa012247
  4. https://www.ncbi.nlm.nih.gov/pubmed/30516947
  5. https://journals.sagepub.com/doi/pdf/10.1177/1474515117721561
  6. https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system/
  7. https://www.beckershospitalreview.com/finance/us-healthcare-prices-reflect-huge-administrative-costs-6-statistics.html
  8. https://www.advisory.com/daily-briefing/2018/07/23/administrative-costs
  9. https://www.nytimes.com/2018/07/16/upshot/costs-health-care-us.html
  10. https://www.healthcarefinancenews.com/news/wage-gap-between-hospital-executives-and-doctors-widening-study-shows

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  2 comments for “Safe Staffing Levels…… What?? Are You Mad?

  1. Jerry
    July 25, 2019 at 8:01 am

    I just find it sad that someone had to actually do a study to come to the conclusion that inadequate staffing leads to worse outcomes. Really? Who would have thought?

  2. Dave
    July 20, 2019 at 6:48 am

    I’ve said it before: perhaps administration should make no more than the highest compensated physician, or no more than 10 times the lowest paid employees at the hospital…..

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