Hospitals assign nurses based on a number of factors, including the nurses’ experience, number of patients and how ill the patients are. Nurses say that staffing is often inadequate and that they want specific nurse-to-patient ratios that would depend on the hospital unit.
“I think this bill is today’s version of the eight-hour day — something that we will see business resist but, on the other hand, makes good sense and leads to quality care,” Mendelson (D) said.
Nurse staffing has been an ongoing concern for the nurses and hospital administrators. It was a concern during a labor dispute in 2010 between the National Nurses United union and MedStar Washington Hospital Center.
But the issue has taken on greater importance as hospitals face greater pressure to meet federally mandated standards on patient safety and quality of care or face financial penalties, according to union officials. Improved nurse staffing, while increasing costs, could improve patient care, experts say.
Hospital executives said they oppose any legislation that would require a specific nurse-to-patient ratio. Officials said that they meet high quality and safety standards and that the only way to ensure patient safety and quality is to give the entire team of caretakers the flexibility to make staffing decisions.
Under Mendelson’s proposal, the nurse-to-patient ratio would vary by unit. In the operating room, there would be one nurse per patient. In the intensive-care and neonatal intensive-care units, the proposed ratio is one nurse for two patients. For non-trauma or noncritical care in the emergency room, the ratio would be one nurse to four patients.
Amy Freeman, chairwoman of the D.C. Hospital Association, which represents many of the District’s hospitals, said such requirements are an oversimplified prescription for complex problems.
“There is no doubt that patient safety and enriching the professional lives of nurses are real issues,” said Freeman, who is also chief executive of Providence Hospital. But she said nurse staffing is only one variable in patient care.
“Quotas don’t equal quality,” she said.
And some hospital officials said mandatory staffing could be costly.
Barry Wolfman, chief executive at George Washington University Hospital, estimated the proposed legislation would cost the hospital $10 million to $15 million a year. Wolfman previously served as chief executive of a Los Angeles-area hospital. He said the mandated nurse staffing ratios did not lead to overall improvements in patient care, but union officials pointed to a pair of published studies showing otherwise.
Mendelson’s legislation, the Patient Protection Act, includes a prohibition on mandatory overtime and whistleblower protections for nurses. It has the early support of nine D.C. Council members — enough to guarantee passage.
One of those who spoke out Monday in favor of the pending legislation was Bonnie Linen-Carroll, an operating room nurse at MedStar Washington Hospital Center. She said patients are regularly wheeled into the hospital’s surgical unit uncleaned and unprepared for their procedures. Some patients, she said, have been left to soil themselves because overworked nurses are unable to help them use the bathroom quickly enough. Hospital officials disputed that portrayal.
Margaret Shanks, a transport nurse in the neonatal intensive care unit at Children’s National Medical Center, said nurses regularly care for three patients each when two patients is standard. Some very sick infants, Shanks said, should have one nurse’s sole attention. But “that one-to-one attention is rarely authorized,” she said.
The union surveyed nurses at nine hospitals in the District last fall. Of more than 800 nurses who responded, 60 percent said changes in their workload have led to worse outcomes for patients, the union said.
The nurses surveyed worked at Washington Hospital Center, MedStar Georgetown University Hospital, George Washington University Hospital, Howard University Hospital, Providence Hospital, Sibley Memorial Hospital, United Medical Center, Children’s Hospital and the Washington VA Medical Center.
National Nurses United represents about 1,700 nurses at the hospital center and about 2,300 nurses at six other hospitals and some D.C. government departments.