Why would I as a legal nurse consultant want safe staffing you ask? Wouldn’t it bring in more work for you if things just maintained the status quo? Well of course. Medical malpractice attorneys thrive on mistakes. And when the status quo is maintained lots of mistakes are made. Mistakes make headlines. If you’ve been at all in tune to the news, or briefly to that little side bar on Facebook that shows the leading stories in any given day, a research study out of Johns Hopkins named medical errors as the third leading cause of death in the US behind heart disease and cancer. The study claims that a MINIMUM of 250,000 deaths a year are a direct result of medical errors.
That’s a heck of a lot of people. What if it was your significant other, your parent, or your child? You’d be upset, and you’d want someone to pay. And you’d call up an attorney who would review the case and find negligence on the part of the caregivers. Maybe someone would lose their job over it, or maybe if you were really lucky systemic changes would be made and no other person would end up in the same situation that your family member was in.
But much of this is off point, or general background information. It does not tell you why I support safe staffing and why I feel that everyone should be out there supporting safe staffing.
Mistakes happen, and they’ll continue to happen safe staffing or not, and so I’m not too worried about there being enough work for personal injury attorneys. No I’m more concerned with the stress we’re putting on the healthcare system as a whole and sustaining the entire system before we fall into a black money hole.
For me that starts with the nursing home and the long term care setting. In my previous post I discussed hospital staffing and hospital acquired pressure ulcers, and that appropriate staffing plays a HUGE role in pressure ulcer prevention. In the long term care setting it’s even more of an issue. Because patients in the long term care setting have different needs than the hospital the staffing needs are not the same. While many require nursing monitoring, more of what they require can be provided by unlicensed personnel (CNAs) and licensed practical nurses (LPN) allowing the registered nurse (RN) to assess and work on health maintenance behaviors and family education. Ideal staffing would be two patients/residents to every CNA, four patients/residents to every LPN, and eight patients/residents to every RN. So each RN would be responsible for four CNAs and two LPNS that would make up the primary care team. I would also assign them a set of rooms together so that the staff members aren’t running up and down the hall like crazy people.
There would be an increase in people watching their patients. I know from personal experience when I can closely watch a patient I can provide them with better care. I can also provide the family with better and more in person education and support. Many times in the long term care setting the patient isn’t going home for whatever reason and the nurses when they can provide support become family. They also have time to explore and really get involved in unique and appropriate therapies for their patients, such as busy mitts and books for dementia patients. But more importantly they have time for the every day things, like making sure patients are appropriately groomed, teeth brushed, and ambulated. In a traditional nursing home setting patients are regularly gotten up early or late, but not necessarily because the patient wants to, and by the time that the nurse finishes her AM care, its time for noon care, and then the shift is over, the nurse hasn’t sat down, let alone provided any care for her patient on any given shift.
A CINAHL (Cumulative Index of Nursing and Allied Health Literature) search of the terms “nursing home” and “staffing levels” returned 1,548 results, with the earliest articles dating back to 1986. It’s important to note that the majority of the research was done within the last five years. This is the time limit used to indicate the most recent research.
An Italian study by Sabatino, Kangasniemi, Rocco, Alvero, and Stievano in 2014 which was published in the Journal of Nursing Ethics in 2016 looked at how nurses perceive nursing, especially in light of the increased staffing ratios internationally. The conclusions that Sabatino et. al. draw from the study were that nurses define their professional dignity, and how they therefore perceive the role of the nurse value the inalienable dignity of humans as individuals, but at the same time connected to extrinsic values and material aspects (p. 285, 286). The extrinsic values, including poor nurse to patient ratios were cited by the nurses participating in this study as considered as urgent and as important as the intrinsic values related to perceived individual dignity (Sabatino et al., 2016, p. 286). Study authors identify weaknesses to include the Italian educational system. However as a United States nurse I see many of the same issues right here in the United States including balancing the workload and perception. In other words it’s not just the Italian educational system that sends its new nurses out unprepared, the US system does as well.
Because money speaks louder than words ever do, in the
era of big data, even nurses collect data. Using information like the
nursing management minimum data set helps define the value of nurses and
what the costs truly are, as well as helps provide some of the
resources for the researchers to help define the financial costs of the
lack of safe nursing (Pruinelli, Delaney, Garcia, Caspers, & Westra, 2016, p. 71).
A CINAHL search of the term “safe staffing” returned 615 results the
earliest in 1986. Since 2011, 299 pieces have been published that
encompass the term “safe staffing.” Of those 299 pieces 199 were peer
reviewed, and only 5 were peer reviewed research studies. Safe staffing
research needs to be done yesterday. We have no idea of the impact that
the lack of safe staffing is causing. With articles such as Makary’s
focusing on medical errors as the third leading cause of death, and a
lack of research into safe staffing we cannot even begin to correct the
problem of medical errors. We need to know all of the causes of medical
errors, from lack of sleep for the medical residents to mandatory
overtime for the nurses, each problem individually and systemically
needs to be addressed before we can make medical errors something other
than the third leading cause of death.This problem isn’t unique to the US. One of the few peer reviewed articles that I pulled from my above search was a UK article on safe staffing in senior care areas in their hospitals. Even after recommendations from the Royal College of Nursing to improve staffing levels in 2011, no improvement had been made a year later. Hayes and Ball (2012) reported that the current ratio of nurses to patients to start care was 1:9 and the goal was 1:7 with the goal of providing more registered nurses when the patients are sicker, and allowing those on the unit, and those with knowledge about the patients to make the call about staffing (p. 21).
So I’ve talked about what I feel is ideal staffing, what the research shows related to safe staffing, and a bit about why as a legal nurse consultant consultant might not want safe staffing, but I haven’t talked about why I would want it. I want safe staffing because I’m not just a provider, I’m a consumer of healthcare services. I want the best, because as a healthcare consumer I deserve the best. We all deserve the best. It shouldn’t be accessible to only the wealthiest who can pay for the caregivers, or those who have great insurance, but to everyone. And to me, that is the bottom line, the most important, and the reason that I am a consultant. It’s a way, small, and insubstantial in some ways, but extraordinarily powerful in others, for me to make a difference in the system. Going forward from time to time I will look at the changes in staffing rules in the US and the publicity around this in this blog, but the posts may not be as long as this one, nor as detailed. In light of what has happened recently, this morning eight people are not part of this world who were the change are not part of it, and the world is talking about what it takes to keep the people on the street safe, as police officers or from the police, but less and less is heard about what happens to keep those of us in hospitals safe as patients. It is important to keep talking and keep having the discussions and continue to make our voices heard, not because its easy, and not because it benefits me as a legal nurse consultant, but because it’s right.
I am an active Rotarian and our Past International President’s message was be the good. Standing up for safe staffing, taking the time to put the message out there, and speaking out in my own way are my way of being the good on this issue. How are you going to be the good for an injustice that you see in the world?
References
Hayes, N., & Bell, J. (2012, May). Achieving safe staffing for older people in hospital. Nursing Older People, 24(4), 20-24. Retrieved from http://www.nursingolderpeople.co.ukMakary, M. A., & Daniel, M. (2016, May 3). Medical error– the third leading cause of death in the US. BMJ, 353. http://dx.doi.org/10.1136/bmj.i2139
Pruinelli, L., Delaney, C. W., Garcia, A., Caspers, B., & Westra, B. L. (2016, March April). Nursing managment minimum data set: Cost-effective tool to demonstrate the value of nurse staffing in the big data science era. Nursing Economic$, 34(2), 66-71, 89. Retrieved from http://www.nursingeconomics.net/
Sabatino, L., Kangasneimi, M. K., Rocco, G., Alvaro, R., & Stievano, A. (2016, May). Nurses’ perceptions of professional dignity in hospital settings. Nursing Ethics, 23(3), 277-293. Retrieved from http://nej.sagepub.com/
