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Quality care should not be subjective

Worcester Telegram, 4/8/11

By: Clive McFarlane
Friday, April 8, 2011
Worcester Telegram

If you had a loved one hospitalized at St. Vincent, you would want the hospital and its staff to provide that person with the best care.

Should it alarm you, then, that St. Vincent nurses in the past 15 months reported more than 1,000 incidents in which they believe inadequate staffing conditions jeopardized patient safety?

Dennis Irish, a vice president of the Vanguard Health Systems, which runs St. Vincent, said you shouldn’t be.

“The claim that the hospital is unsafe is false and is an absurdity,” he said. “By most measures, we are one of the safest hospitals in the country, and our quality of care is superior to most.”

Labor contract talks are too complex to understand most times, and this one is no different.

But while most lay people might not know the significance of a Massachusetts Nurses Association safety incident report or the value of a Thomson Reuter’s award, they can easily understand how patient care might vary, depending on how many patients a nurse is asked to care for on each shift.

And this nurse/patient ratio is one of the more critical issues at play in the current contract negotiations.

A typical nurse/patient ratio (medical/surgical units) at St. Vincent is 1-6, according to Marie Ritacco, a MNA spokeswoman. Nurses, she said, would like to bring that ratio down to 1-4 during the day and evening shifts, and 1-5 during the nights.

“The research tells us that if you have more than four patients the morbidity and mortality rate increases, by 7 percent for each patient over four, 18 percent for each patient over six and 21 percent for each patient over 8. Our 1-6 ratio is the highest in the city,” she said.

It is not uncommon for a nurse who is assigned six patients on the evening shift to find herself discharging five and admitting six others, she said.

“We are failing our patients on the floor, because we don’t spend enough time at their bedside,” she said. “We are missing cues, signs and symptoms that might be signaling an emerging problem. Patients are falling, developing bedsores, urinary track infection, severe blood pressure. Sometimes we have returned to find patients languishing on the floor.”

Jane Metzger, the chief nursing officer at St. Vincent and one of four members of the administration negotiation team, said Ms. Ritacco is an alarmist.

Ms. Metzger noted that the hospital has a strong, documented record in preventing falls and ulcers among elderly patients, and infection and pneumonia in critically ill patients.

She also points out that St. Vincent has won a number of safety and quality awards, including the Harvard Pilgrim Health Care award for “Excellence in Quality and Safety” two years in a row, and the Thomson Reuters award for being in the top 100 hospitals in the country in the area of safety, quality, efficiency and patient satisfaction.

The hospital also has one of the lowest nursing turnover rates in the Vanguard System, which seems to reflect that the working conditions are not as bad as the union is making them out to be.

Nevertheless, Ms. Metzger acknowledged that the current nurse/patient ratio is unacceptable, which is why the administration has proposed a 1-5 ratio. The hospital is also moving forward in hiring about 15 additional full-time nurses.

But to provide that level of care, the hospital had to “right size” its current operations. She noted, for example, that the hospital was keeping patients in ICU units that could have been cared for in a less intensive care environment. As a result, the hospital has proposed cutting ICU beds from 24 to16, she said.

Ms. Ritacco said these changes will exacerbate the problems nurses currently have in providing adequate patient care.

The proposed cuts in ICU beds, for example, did not take into account that there generally are a number of patients waiting in the recovery room and the emergency rooms, because of lack of beds in the ICU unit.

A number of states have passed legislation providing a basis for hospitals to develop staffing plans.

Massachusetts has tried unsuccessfully over the past decade to pass such legislation.

Mr. Irish said he does not believe legislation that saddles hospitals with fixed nurse/patient ratios “represent the best quality of care we can offer.”

However, as the St. Vincent contract talks seem to show, leaving the decision to individual hospitals doesn’t seem to guarantee quality health care either.

It merely makes quality health care a more subjective practice, which is only good when you are not the patient.

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