The Legislature is the right forum to examine nurses' staffing concerns.
Inside the walls of Twin Cities acute care hospitals, all is not as healthy as the public relations flacks would have you believe. In fact, their own consultants have issued a report that substantiates the internal turmoil nurses describe. Press Ganey Associates Inc., a nationally respected employee relations firm specializing in health care, recently released "Pulse Report 2010 -- Employee and Nurse Perspectives on American Health Care." It blows the lid off this problem.
A total of 235,122 hospital employees from 383 U.S. hospitals (including Minnesota) were interviewed, and the facts are bruising:
•Nearly half of all nurses are disengaged, disempowered and unhappy on the job.
•This discontent translates into compromised patient outcomes.
•Nurses don't feel their patients are safe and don't recommend their own hospitals as centers of care.
Hospitals aren't as safe as they claim because they collect incomplete data, allowing them to be opaque about the realities nurses witness. Death and severe permanent disability are the adverse events that are mandated for public reporting. While these are tragic events, they represent only a small part of the events within hospitals that should be reported.
We are scrambling every day to overcome a system that doesn't allow us the opportunity to do basic nursing, let alone prevent suffering and grief caused by medication errors, missed dressing changes, infections, pressure ulcers, uncontrollable pain, allergic reaction and confusion.
Why shouldn't the public have access to data that is more than just severe adverse events? What about near misses? What about reporting factors that are known to promote patient safety such as adequate staffing levels?
This is a matter of trust. The hospitals have fashioned a good spin game that the Star Tribune has obviously bought hook, line, and sinker ("Nurses push on for unproven ratios," July 19). We don't accept the hospital's claim of a $250 million price tag placed on MNA's staffing proposals. They have provided no evidence of this claim. We find it appalling that you help them advance the red herring of the lack of a causal relationship between ratios and patient outcomes. The Tuskegee experiment was a causal study in which care was withheld from a group of persons. Do we want to withhold nursing care to determine if it is, in fact, causal? It is difficult to determine absolute causality in human research.
Simply and plainly, hospitals are behaving badly -- and they need to be regulated regarding appropriate staffing.
Pursuing the regulation process is not out of line. It is the option citizens have to balance rampaging free market behavior. Elected officials hold public hearings from all stakeholders on an issue, looking to experts and professionals to name what is appropriate. Lawmakers don't have to race around the state to determine what speed is safe on specific roads. And, they at least listen to all sides of the story -- unlike our employers.
Lawmakers reflect carefully and then create a law that makes all parties accountable with incentives or just punishment.
MNA's proposal on staffing offers a comprehensive solution in which actual ratios are less than one page of a six-page bill. It considers how sick the patient is (patient acuity), how much nursing care time it takes to do certain patient care tasks (nursing intensity), the skill level of the registered nurses on the unit, the availability of support staff, and the type of environment.
But we butt our heads up against a culture that idolizes the theory of risk management. They maximize profits by calculating the financial risk of allowing "little" things to occur, like an excruciatingly painful stage three pressure ulcer (vs. a reportable stage four). It is a system that operates on the backs of nurses' professional ethics, valuing profit over care, seriously challenging every nurse's core value of caring for patients in a safe environment.
These are two irreconcilable forces -- and we believe in our democratic system to help mediate the path forward.
Carol Diemert is a nursing practice specialist, and Carrie Mortrud is a governmental affairs and public policy specialist with the Minnesota Nurses Association.
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