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RNs Welcome Introduction of House Bill to Set Safe RN-to-Patient Staffing Ratios in Every Hospital

National Nurses United Press Release, 5/9/13

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Joining U.S. Senate Bill and Broad Statewide Campaigns

National Nurses United, the nation’s largest organization of nurses, today greeted the re-introduction of a bill in the House of Representatives by Rep. Jan Schakowsky of Illinois – appropriately during Nurses Week – that would set specific limits on the numbers of patients each RN can care for in hospitals throughout the U.S.

HR 1907, the Safe Nurse Staffing for Patient Safety and Quality Care Act establishes minimum RN ratios for every hospital unit at all times. It also provides whistleblower protection to assure that nurses are free to speak out for enforcement of safe staffing standards.

The bill complements Senate legislation, S 739, recently re-introduced by California Sen. Barbara Boxer.

Both bills are modeled on a California law that studies have documented has saved patient lives, improved the quality of care in multiple other ways, and reduced nurse burnout keeping the most experienced RNs at the patient bedside.

Schakowsky is joined on her bill, initially by co-sponsors Representatives Judy Chu, Barbara Lee, Zoe Lofgren, and Brad Sherman of California, Keith Ellison of Minnesota, Stephen Lynch of Massachusetts, Gwen Moore of Wisconsin, Allyson Schwartz of Pennsylvania, and Eleanor Holmes Norton of the District of Columbia.

“Rep. Schakowsky, Sen. Boxer, and the co-sponsors have earned the thanks of patients and nurses throughout the country for standing up for the one staffing reform that has the greatest immediate impact on protecting patients and saving lives. In California we have seen the results. The law works, and all Americans deserve the security that real safe staffing laws provide,” said Deborah Burger, a California RN and co-president of NNU which is the lead sponsor of both HR 1907 and S 739.

Schakowsky, Boxer praise role of nurses in saving patient lives

“Nurses play a critical role in providing patient safety and quality health care,” Schakowsky said. “I’m very proud to introduce the Safe Nurse Staffing for Patient Safety and Quality Care Act which will help save patients’ lives while requiring hospitals to develop safe staffing plans that meet minimum nurse to patient staffing ratios.”

Similarly, of her bill, Boxer noted, “I am proud to introduce legislation that will help save the lives of countless patients by improving the quality of care in our nation’s hospitals. We must support the nurses who work tirelessly every day to provide the best possible care to their patients.”

In addition to the two national bills, NNU is sponsoring or supporting patient protection act, nurse ratio campaigns in the District of Columbia, Florida, Illinois, Massachusetts, Michigan, and Texas.

Decades of studies document link between improved RN staffing and safer care

On the California law in particular, a prominent 2010 University of Pennsylvania study comparing California hospitals to New Jersey and Pennsylvania hospitals found that New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California’s ratios in surgical units, and fewer California RNs miss changes in patient conditions because of their workload, and nurses have more confidence that patients can manage on their own after discharge.

A September 2012 report by the Agency for Health Care Research and Quality of the U.S. Department of Health and Human Services, titled “State Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction,” emphasized the correlation between higher nurse workloads that are associated with more patient deaths, complications, and medical errors.

And a new study in the online journal BMJ Quality and Safety in Health Care just this week established a direct link between nursing staff ratios and hospital readmissions for children with common medical and surgical conditions. It found an increase of just one patient in a hospital's average staffing ratio raised the likelihood of a medical patient's readmission within 15-30 days by 11 percent – and the odds of readmission for surgical patients by 48 percent. Another study just this month, published in JAMA Pediatrics, found that inadequate nursing staff in the neonatal intensive care unit led to higher levels of infections in low birth weight infants.

Studies have also cited cost savings through improved patient outcomes with safer staffing, such as the lower readmission rates cited in the BMJ report.

California hospitals which have had ratios in place since January, 2004 made $4.4 billion in profits alone in the most recent year for which data was available. A vice president of the California Hospital Association, which tried repeatedly to block and reverse the California law, recently admitted hospitals didn't suffer financially "to any significant degree."

“The case for RN staffing ratios should be closed,” Burger said. “Now it is just a question of the political will of our legislators to act. Nurses and patients around the U.S. will remind them of why safer staffing, and HR 1907 and S 739, should be a top priority.”

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