One of the key issues in the nurse's lockout in Nevada by Universal Health Care is patient-to-nurse ratios. From Taylor Marsh we discover some interesting statistics on the topic via the Department of Health and Human Service (thanks to Julia):
- The first study found that each additional surgical patient per nurse was associated with a 7-percent higher likelihood of dying within 30 days of admission and a 7-percent higher likelihood of failure to rescue. In the 168 hospitals with a mean patient-to-nurse ratio ranging from 4:1 to 8:1, 4,535 of 232,342 patients died within 30 days of being admitted. If the patient-nurse ratio had been as low as 4:1 in the 168 hospitals, then possibly only 4,000 patients might have died, and had the ratio been as high as 8:1, more than 5,000 might have died.
- A second study found that 30-day mortality rates among AIDS patients were lower where there was both a higher nurse-patient ratio and an AIDS specialty physician service. For example, the study found that an increase of 0.25 nurse per patient day would produce a 20-percent decrease in 30-day mortality.
In California the nurse-to-patient ratio is 5:1. In Nevada it can be as high as 10:1.
Rather than deal with problems like these, UHS has spent millions to hire "persuaders" who force nurses to attend mandatory meetings where they are lectured about the evils of unions.
Note to self: don't get sick in Nevada.
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Thanks Jane!
woohoo for the exposure!
Florence is smiling at you.
(I would guess there will be no more Yearlykos in Nevada til they fix this!)
yay for FDL!
10:1 patient to nurse ratio!!! That’s horrible. Maybe if nurses were actually paid decent salaries the chances of lowering that ratio might go up. Many places are using nursing assistants to do some of the work that was normal to RNs.
Thanks Jane- what are the other issues?
Over the past five years I have spent rather a lot of time in ER and in regular care in hospitals from California to Oklahoma, helping with elderly family members being cared for. And I have watched carefully what goes on. I honestly don’t have a clue how nurses cope. I couldn’t do it. I am not nearly strong enough. Something has got to give.
iowa christine @ 2
Agreed. Nurses are in much the same position as teachers–vastly underpaid relative to the effect their work has on the public at large. Benefiting society is a great thing, but a living wage would be welcomed more than any thanks.
How much do nurses make now??? It seems to me that it’s pretty good now for RNs.
Rather than deal with problems like these, UHS has spent millions to hire “persuaders” who force nurses to attend mandatory meetings where they are lectured about the evils of unions.
************************************************
That is one of the most disgusting things I have ever heard. Think of all of the good that money could have done. Think about all of the good that the money that Bush has spent in Iraq could have done. Greed is such an ugly thing.
EvilDrPuma @ 5
I teach in a rural, non-wealthy public high school. I appreciate your support for teachers. My hat is if off to the nurses caring for the sick and elderly. These folks are truly heroes. They humble me.
The acuity of patients has gone waaay up. You have to be very sick these days to be allowed to be in the hospital (insurance co.s and Medicare require that the ill person meet quite stringent criteria).
Staffing ratios vary quite a bit from their setpoint– nurses are traditionally agreeable to take on more of the load to make up for absent colleagues and on the off shifts are quite often taking on, as a matter of course, more patients than their daytime compadres. The eerie reality is that patients are sick around the clock and staffing levels are not the same as on day shift– there are always fewer of all staff eves/nights.
Very quiet……
Mom just retired from nursing. There were considerable pressures to cut costs, and she was frequently overran by events. Her last few years, her main dread was, out of fatigue or overload, to harm a patient.
She’s been out of it over a year, and she says she doesn’t have what it takes to go back. She has nightmares about it still.
Local nurses get paid bupkis - she topped out a little over $50 k.
And things were so bad, she couldn’t let any of her co-workers know her son was a union rep - her employers would have crucified her.
I hope we both live to see her friends organize, a la the Houston janitors.
rwcole @
6
Not so. Check here:
http://www.allied-physicians.c.....s/nursing/
Jane — if you just experienced a hiccup, it’s because I accidentally put the wrong time stamp on tomorrow’s post. I fixed it, I think. Sorry about that.
Everyone Refresh, F5 please.
Sorry OT…New faces same bullshit ?…
Newsweek: “In a surprise twist in the debate over Iraq, Rep. Silvestre Reyes, the soon-to-be chairman of the House Intelligence Committee, said he wants to see an increase of 20,000 to 30,000 U.S. troops as part of a stepped up effort to ‘dismantle the militias.’ The soft-spoken Texas Democrat was an early opponent of the Iraq war and voted against the October 2002 resolution authorizing President Bush to invade that country. That dovish record got prominently cited last week when Speaker designate Nancy Pelosi chose Reyes as the new head of the intelligence panel.”
Larry
So Gates tells us we are not winning in Iraq, but that we could be there a long time. Well now I feel so much better.
Salaries at the UIHC range from very low 20ks to 70k. Here’s a link to the Iowa City paper that lists everyone’s salaries: http://www.press-citizen.com/a...../304100024
There are certain professions like teaching and nursing that have inherent limits on their productivity. You can only teach or take care of so many people, period. The system is not flexible. Hospitals and the corporations behind them like to pretend that it is. The result is greater stress on staff and higher rates of morbidity and mortality in patients. The answer simply is lawsuits for providing insufficient levels of care. It is amazing how responsive (and fearful) hospitals and physicians are to the “medico-legal” aspects of medicine. It is often not an easy or short process but once hospitals start losing in the courts, notions about accepted practice change quickly.
rwcole @
3
We’ll be writing more about this but basically the nurses want them to stop being rotated around to different specialty areas where they have no opportunity to build up expertise (it’s a way to keep them disempowered), and to stop mandatory overtime (all of which work to the detriment of patients). Rather than observe a 30 day cooling off period called for by the governor, speaker elect and county commision chairman (to which the SEIU nurses agreed) UHS locked them out.
Scarecrow @ 12
No problem, scarecrow, I do it all the time.
BTW, you’ve been doing a magnificent job in the morning, and it’s really allowed Christy to get through some of the filing stuff and also to work on research for more substantive posts. Much appreciated.
Jane Hamsher @ 18
i second that
Jane Hamsher @ 17
So I’m assuming that “supervisory personnel” (otherwise known as even more overworked nurses who do all the departmental paperwork too) or scabs (lovely medical imagery, that…) or LPNs cared for the patients?
In want to chime in on what a great job scarecrow has been doing. I’m not just picking a straw man, here.
Thanks. Happy to help.
Glad to see you and Taylor focusing more attention on the nursing ratio and related issues. The whole subject area deserves a lot more spotlighting. Back later.
Watching Olbermann and James Moore talking about the Bush family, two words come to mind: ’screwed up’.
In case you guys have not noticed yet, health services are pretty much rolling up the carpet and going away. We are moving towards third world health ?care? if that is such a word. I’m a nurse of 25 years and have watched as the system has sliden down a rough and rocky terrain to near about a complete stop. I just watched a clip on Crooks and Liars about autism and families trying to get care for their kids. Lyme patients have been disenfranchised and my advice is, don’t get sick . Should you get sick, please please have a responsible adult to assume responsibility for you as a patient. Nurses must be watched and doctors too. There are tons of mistakes not even caught in hospitals. Keep some watchful eyes on yourself should you have to be hospitalized…… trust me the health system is broken and full of lies.
The rotation of nurses into different specialty areas is enormously important.
Nurses are proud of their expertise and value the collegiality and knowledge of those they trust. Some brave souls don’t mind wandering out to experience a different environment and specialty, but it should be asked from them free of any kind of pressure and they should elect to do it voluntarily and only when the receiving units are instructed and made to be welcoming, instructive, and appreciative to the “float”. That’s management’s responsibility to make happen.
Mandatory OT is just very stupid and dangerous.
Oklahoma kiddo @ 23
yes, very. shorter Olbermann and James Moore: bush sr. was blubbering b/c wrong son is president. chimpy is no close with daddy and possibly feels pressured into being president - therefor, he doesn’t like the responsibility of the job and resents it.
liz @ 24
God knows the system is broken. Everyone should have a living will and a durable power of attorney for medical care. Also, most people need to become much more educated about their own health. Even the best doctors can’t necessarily “cure you” if you don’t participate in your own care.
As a medical transcriptionist I hear doctors’ notes about patients who, while they know what their medical issues are, refuse to take medications as prescribed or follow treatment regimens. I work for a tertiary level ENT practice in a teaching hospital and the number of patients who have NO IDEA what medications they are taking or why they are taking them is staggering. I don’t know where this comes from, but it surely makes it hard to care for some folks. /rant
From Think Progress:
Rep. Jim Moran: Bush Was Warned To Be ‘Extra Sensitive’ About Webb’s Son. At a recent White House reception, President Bush asked Sen.-elect Jim Webb (D-VA), “How’s your boy?” referring to Webb’s son Jimmy, who is serving in Iraq. Webb answered, “I’d like to get them out of Iraq, Mr. President,” to which Bush responded, “That’s not what I asked you.” Webb then replied, “That’s between me and my boy, Mr. President.”
The right wing has been attacking Webb for his reaction to Bush’s question. Last night, Fox News host Bill O’Reilly said Webb was “rude,” “inappropriate,” and “disrespectful,” because Bush was merely trying to extend a “nice gesture.” The National Review’s Corner called him “classless” and conservative columnist George Will labeled him “a boor.”
But according to Rep. Jim Moran (D-VA), Bush was told that Webb’s son had a recent brush with death in Iraq and was warned to be “extra sensitive” when talking to the Sen.-elect. ThinkProgress yesterday spoke with Moran’s office and confirmed the congressman’s statement, first reported by hcc in VA:
Not only did Bush know about it, he was specifically briefed on the incident before meeting with Webb, and was cautioned to be extra sensitive in speaking with Webb about his son.
After such a briefing, Bush perhaps shouldn’t have been so surprised about Webb’s unwillingness to chit-chat about his son.
Marion in Savannah @
11
thx for link. looks like ~$40,000 ave. like to know what the docs make by comparison. Also, interesting from link: Surveys suggest that 86% of Nurses are women. gee… any connection there?
Having a responsible adult watch over you is very important, a durable POA is great.
Make sure your living will is fully understood by your proxy and that the proxy is present.
Too many times I have argued the contents of a living will with other caregivers. Sometimes they are not really read in ERs and are “simply” seen as a “do not resuscitate” in those situations.
(Not good if that’s not what you meant, if you know what I mean…)
and self education is key– even if you’re treated as a pain– ask, write things down, record conversations if it’s not possible to have another person present during consultations. it’s your right.
angie @ 30
Exactly. And twice on Sundays. Here’s to “being a pain.” It’s much better to be one than to live in it.
OK at 28 — boosh makes worse person in the world for that on KO!
http://www.ft.com/cms/s/41470e.....e2340.html
aside but not unrelated
Richest 2% hold half the world’s assets
nina @ 33
It’s the new Gilded Age. My guess is before I die I’ll see people rioting in the streets in this country unless something is done, very soon, to counteract this.
I worked for a nurse’s union for too long. I’m impressed that the RNs in Nevada are taking a stand. Safe nurse/patient ratios are always the key in negotiations. Everything else flows from that issue (salary, benefits, floating, shift rotation) because one of the causes of short staffing is hospital’s inability to recruit.
Floating is not horrible, if done appropriately. It is not appropriate to float a adult nurse to a pediatric floor (or visa versa) or a med surg nurse to a critical care unit. It is also not appropriate to use floating nurses as replacements for sick calls. Lastly, if the hospital wants to engage in “safe floating practices” then it must define, via negotiations with the nurses, which units are appropriate and provide training to those who float. Frquently, the lack of training is the biggest problem.
As to rotating shifts, studies (can’t cite any, but try google) show that it is harmful to the people who rotate. RNs who rotate are tired. Tiredness leads to patient harm. Then, of course is the impact of rotation on family life–especially if rotation is not scheduled in an organized fashion. Shift rotation allows hospitals to higher fewer RNs. It also covers up for bad management–hospitals that do not staff on 12 hour shifts find they cannot fill evening shift schedules. That’s why rotation occurs.
In NYC, RNs start at 70K. They receive over a thousand dollars per year of experience. They also work their asses off and are frequently placed in unsafe conditions. The salary is high (probably not high enough) because these RNs have been unionized for 30 years. Despite the high salary, there is a shortage.
RNs are the key to quality health care. We must all support their efforts to improve their to do their job.
For more info on union RNs, try nysna.org.
Finally, cudos for Jane for featuring this story!
healthcare in the US sucks, its an abomination.
you can’t put moneychangers in charge of healthcare and expect to get good health results, you’ll only get good money results.
.
I wrote a friend in Las Vegas about this.
Excerpted from her email:
The nurses for my [surgical procedure] were severely overworked. There were 34 beds and at times only two nurses!
More and more it looks as if there is going to be a regional war in the Middle East. If so, do we think the U.S. is going to standby and let our economy shut down due to a lack of oil?
Marion in Savannah @ 34
Somethings are being done. Wealthy customers can purchase flamethrower kits for their vehicles so they may barbecue encroaching ne’er-do-wells. Saw it about two years ago in the Right Wing rag Popular Science.
Marion in Savannah @ 34
Oh, but Paris Hilton needs inheritance tax relief!
hackworth @ 39
http://www.eatmyflames.com/?gc.....UAodTBtx_Q
not to belabor the point, but there is a new thread
dems need balls @35,
In NYC 70K wasn’t all that much to try to live on when I left NYC in 1990. Today it’s barely enough to live decently on, given the cost of living there.
Glad you picked it up Jane. This really is about saving lives v. corporate profits. These nurses are fighting the good fight. I am so glad to see the blogosphere support them
I am an RN with over 30 years of experience, working 21 years acute hospital care in 5 states. I left acute care in 1991 after working 11 years evening shift.
Staffing ratios have crept up but there are additional issues that have made the job harder and harder. First is the transition from the standard 8 hr shifts to 12’s. That is when I found that I was just too old to work full time. Try working 4 12hr sifts doing the heavy physical work standing, walking and running throughout the sift on floors with indoor carpet on concrete floors.
The next cost cutting is attendent help, such as aids and orderlies, they are either cutting their numbers while RN’s are doing more or they are cutting the number of RN’s and adding attendent help which means the RN’s are supervising more staff. Also the latest changes in the NLRB change in what defines a supervisor which are excempt from being in a union, Team leaders or Charge nurses are now prevented from being in a union. The issue is that they do not have hiring or firing responsibility, they are just the person who is ultimately responsible for that shift.
Also there state laws which make it harder. First I was rated as “emergency” staff which exempt me from breaks and lunch periods from the labor laws. This means that even getting a bathroom break can be a logistical event!
If my next shift replacement did not show, I was required to stay regardless if I just finished 12hr shift or be charged with felony abandonment. Many a double shift was worked for a no show or the DON (director of nurses) could not find a agency nurse.
Then, there is the issue of agency nurses, (rent-a-nurse). Trying working with fresh Ortho-Neuro postop patients with three agency nurses who have NO clue how to care for that type of patient.
The average age of nurses in the USA is between 45-50 yrs old. Nursing education centers are not opening new slots to train new nurses fast enough to replace the aging workforce.
More info about nursing shortages can be found here- http://www.nurseweek.com/news/nursingshortage.asp
I have been waiting for years for someone to finally listen to the call of help that the nursing profession has been screaming for years.
I really support this spotlight on the health care issues. I hear about the combination of “bottom line” administrators with no medical background but phenomenally high salaries and the corporatization of healthcare. What with insurance and big pharma on top of it all, we have this rise of health care profiteers. Hospitals become like assembly lines. Nurses are laid off and/or worked to the bone. I hear about this a lot, because people close to me work in healthcare.
I’ve seen the Neveda nurse story on a few blogs. I’d like to point out that the nurses at Northern Michigan Hospital in Petoskey, MI have been on strike for 4 years! And now NMH has declared their strike over. Not because anything has been settled, but because the hospital decided it has effectively replaced the nurses!
http://www.record-eagle.com/2006/oct/27strike.htm
What’s happening to nurses (and other health industry staff) in the health industry is indicative of what’s happening to the majority of professionals in the labor industry in the US. Nursing isn’t manufacturing and you can’t treat it as such. Not to mention that we’ve seen what’s happened to manufacturing in this country. Health Care, Insurance industry, Big Pharma does not make for a good equation.
It’s sad that on most patient’s hospital bills “nursing care” doesn’t even appear anywhere. Instead it’s lumped into “housekeeping”.
Julia (juls) Rosen @
44
Veryy good post and nice blog, Julia. Thanks for your insights.
Jane Hamsher @
48
Thanks. It is all of about 3 weeks old. Today, will be a good traffic day, now that you Matt and Taylor linked to the post :)
grs @ 47
What you just said about the general trends in manufacturing reminds me of a book by Heather Menzies, Fast Forward and out of Control. It’s about how even professional jobs are fast becoming MacJobs. Administrators/Management start to invest heavily in technology and see employees as cogs in the wheel operating the technology. It all leads to an ugly management philosophy that sees employees as human resources “ideally” working in an automated style. I know doctors who fear this is happening to the profession. But BigPharma and Insurance are all vectors that play into & influence this all. Some insurance companies are convinced that doctors’ roles should be one of merely medication maintenance, since BigPharma has them convinced that their drugs are most efficient and the one-on-one particularly in mental health is no longer needed.
I hope I got that right, since I am not good at grasping the philosophical stuff.
And Jane! This is an uphill battle, but a good one and I think extremely important. I’ve been in the mindset, because I’ve had this role conferred on me by virtue of growing up in a “medical family.”
Nurse to patient ratios are only one rough measure of patient safety. I write (mostly to myself, it seems) on the many issues which face nurses and patients at the blog, Universal Health (http:/www.universalhealth.wordpress.com).
There are several compelling studies which clearly demonstrate that mortality (death) rates and morbitidy (complication) rates are reduced with the presence of baccalaureate prepared registered nurses in satisfactory intensity (how much direct patient nursing care) and acuity (how much high tech and constant nursing observation)patient ratios. Linda Aiken of the University of Pennsylvania is the primary investigator, and you can read the Institute Of Medicine Quality Study Series at:http://www.iom.edu/CMS/8089.aspx and in particular, the Keeping Patients Safe - Transforming the Work Environment of Nurses study at: http://www.iom.edu/?id=19376
There are also major problems with overburdened emergency department nurses and patient access to inpatient beds.
Read my posts, The Shell Game, Professional Practice Groups for Nursing, Nursing: key Demographics, Get Rid of the Nurse, and Nurses: Nurse Nurses for starters.
I’ll be happy to entertain questions - and readers.
Thanks for writing this. It’s important to keep this in front of readers. Also - the recent NLRB ruling that puts clinical nurses who assume shift charge duty in the role of supervisor is going to make big waves. It burdens the already overwhelmed nurse who is caring for patients, and makes her assume managerial duties without overtime eligibility.