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Statewide Standard of Care Critical for MN Hospitals

February 25, 2013 By Linda Hamilton, RN, BSN, Guest Commentary

In hospitals across Minnesota, patients are at risk because not enough nurses are on duty. It’s become routine for nurses to never know what kind of situation we face as we walk onto that floor. Sometimes we could be two nurses short, sometimes five. But even “sometimes” is too frequent when you are trying to save lives, and that sometimes is occurring more often.

My colleagues and I confront the circumstance of ignoring someone in order to care for someone else. Someone doesn’t get medication on time and suffers in pain. Someone else hits the call light because they need to get out of bed and can’t. In my case, another someone is a child being discharged whose parents will not fully understand what to do once they leave the hospital because I’ve had to rush through the discharge instructions.

I see patients who are sicker and sicker; who need more medications, new equipment, and life-saving new therapies. We are saving lives, but this requires much more skilled nursing care that is not factored into the scheduling or staffing equation. As a result, I am cutting out important time in assessment, observation, and the time it takes to comfort and manage pain of a child and their family. This is not only frustrating to nursing professionals, but it results in failure to prevent events that can cause serious disability and at times even the end of life.

As much as our network of hospitals claims safety as their primary goal, our reality paints a different picture.

We witness real suffering. Real wasted health care dollars. Real crises that are preventable. But our employers make a decision in a corner office not to fill the holes in the schedule sheet. Not to replace the nurse who quit last month. To put five new graduates alone on the night shift. And this is just the tip of the iceberg. Nurses all across the state submit reports of unsafe staffing situations where a tragedy would have happened if not for nurses overcoming systemic obstacles.

Minnesota nurses report these events to our supervisors. We’ve been calling attention to this situation for years, but our professional judgment is often dismissed. When surveyed, MNA members revealed that hospital management ignores our warnings when a staffing situation is unsafe for our patients. When we report to our supervisors that patients are at risk, 17 percent of the time we get no response. 27 percent of the time, we are told to “make do.”

That is why the members of the Minnesota Nurses Association are advancing legislation that makes it incumbent upon hospitals to ensure enough nurses are on duty according to patient needs per unit and per shift. The Standards of Care Act further states that, in developing patient assignments, hospitals will abide by nationally accepted, evidence-based standards established by professional specialty nursing organizations. In addition, assignment limits would be adjustable for patient acuity and nursing intensity. The measure would also enforce consequences for facilities that fail to meet these standards.

The hospitals claim this measure this is too expensive—that employees, even nurses, will have to be laid off. But a report by California hospitals, four years after that state instituted a similar policy, shows that more nurses reduced serious injury and death. What’s more, the same report claims an improvement in the overall financial picture for California’s network of hospitals.

The fact is, however, this bill is not a California solution. The Standards of Care Act uses the best of all ideas and ensures that Minnesota hospitals are held accountable to them. It’s not a one-size-fits-all approach. Standards for a hospital in Marshall or Montevideo would be different than for a Minneapolis facility.

From the Twin Cities to the Detroit Lakes, every hospital needs to be held accountable for providing an environment that ensures nurses at the bedside can safely care for those in our care.

Linda Hamilton, RN, BSN is president of the Minnesota Nurses Association and a 31-year registered nurse, who works bedside in the Newborn Intensive Care Unit at Children’s Hospital in Minneapolis.

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