washingtonpost.com
Nurses call level of staffing unsafe

By Lena H. Sun
Washington Post Staff Writer
Tuesday, November 2, 2010; B08

The largest nurses union in the United States asked the D.C. Health Department on Monday to investigate nurse understaffing at Washington Hospital Center that the union says is jeopardizing patient care.

In a 19-page report filed with the department, National Nurses United documented 50 instances of what it described as unsafe patient care this year in all departments in the hospital. No deaths were reported.

The reports describe instances of patients not receiving medication on time, newborn infants not being fed promptly and a patient who was rushed back to the operating room after the patient had stopped breathing and suffered cardiac arrest. The union did not know whether the patient survived.

A group of nurses hand-delivered a copy of the report to hospital officials Monday morning and urged them not to wait on regulatory action by the District but to return to the bargaining table and address staffing issues immediately, union officials said. Shortly afterward, the report was filed with the health department's health-care facilities division.

A spokeswoman for the hospital said that the report "is seriously flawed and misleading."

"In our initial inspection of the document, we see factual errors and gross misstatements," So Young Pak said. She said there were no deaths this year related to inadequate nurse staffing.

Hospital officials have said that they are committed to strengthening staffing. The union says that the hospital has not hired enough nurses to address high turnover; many nurses have left because of staffing levels, union officials said.

The hospital said it plans to hire 200 nurses by June 30. It also said that it has hired 385 new nurses since Jan. 1 but that 239 nurses have left the hospital, a net gain of 146. With 926 beds and 1,666 nurses, Washington Hospital Center is the area's biggest hospital.

Nurse-to-patient staffing ratios were part of contract talks this year. The union and managers had agreed to staffing goals for each shift. But after contract negotiations broke down, management unilaterally imposed a wage and benefit plan Oct. 1 that effectively cuts many nurses' take-home pay for working evenings, nights and weekends.

The labor dispute has prevented the staffing goals from being put in place as policy. A few days after the wage plan was imposed, the local union representing the nurses voted overwhelmingly to join National Nurses United, which has about 155,000 members. Monday's action appears to signal a new aggressiveness by the union on staffing.

Union officials have said that previous complaints about nurse understaffing have not produced a satisfactory response from hospital managers.

"We felt there was a need for a regulator to get involved," said Kenneth Zinn, who directs strategy for National Nurses United.

Under federal and D.C. law, hospitals are required to provide adequate nursing staff. The health department monitors compliance and investigates complaints, and it can issue violations and suspend licenses.

The incidents are among hundreds of reports that nurses at Washington Hospital Center have filed, saying that they have worked without enough staff or have been directed by managers to work in a manner in which patient safety was at risk, the union said.

Since April 2009, nurses have filed more than 500 of the reports - known as assignments despite objections, or ADOs - to the union, which shared them on a regular basis with hospital managers. Not every incident of short staffing is documented, because nurses are sometimes afraid to report them for fear of retaliation. At the same time, the same incident might get reported by several nurses working the same shift.

The union said that the copy of the report it gave to health officials provides dates for each incident; the copy provided to The Washington Post had dates and all identifying information redacted because of privacy issues. The copy that nurses gave to hospital staff also had that information redacted because the nurses did not have an appointment with managers in charge of patient care; in handing documents over to clerical staff, they did not want to violate patient confidentiality rules, Zinn said.

Pak, the hospital spokeswoman, said that the lack of specifics made it difficult to validate or invalidate the claims or respond to questions.

But hundreds of the ADOs, upon which the report was based, were provided to hospital managers this summer, and hospital executives have acknowledged reading them.

"The problem is not that the hospital does not know about these incidents but what they choose to do or not do about them," Zinn said. He said the union would be happy to sit down with patient care managers and go over every incident.

Many instances describe patients being assigned to a team leader known as a resource nurse. Resource nurses aren't supposed to have patients because they are supposed to be free to help other nurses.

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