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Nurse Staffing Ratios Ohio Hospital Association

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   BACKGROUND
   Nurse staffing ratios and efforts to restrict hospitals’ staffing flexibility have been in the news recently.
   In April 2010 a study in the journal Health Services Research concluded that California’s mandatory
   hospital nurse staffing ratios “are associated with lower mortality and nurse outcomes predictive of
   better nurse retention.” In June 2010, a federal bill introduced in Congress – H.R. 5527, co-sponsored by
   Rep. Steven LaTourette (R-OH) – would, among other things, require hospitals to post nurse staffing
   data daily for each unit and place restrictions on the ability of hospitals to “float” nurses. In Ohio and
   across the country, the National Nurses United (which resulted from the merger of the California Nurses
   Association/National Nurses Organizing Committee with other smaller nurses unions) continues to push
   for legislatively mandated nurse staffing ratios for hospitals.

   The Health Services Research study and legislative efforts to mandate staffing ratios may result in an
   increase in inquiries from employees and the media surrounding these issues.

   Use the following key messages, talking points and resources to respond to arguments in favor of
   staffing ratios and other one-size-fits-all legislative mandates regarding hospital staffing.


   KEY MESSAGES
   Please use the following messages when talking about nurse staffing ratios. Additional messages, facts
   and resources are available on subsequent pages of these suggested talking points.

      Ohio’s common-sense staffing law is preferred over rigid, mandated staffing ratios.

      Numerous studies show mandatory staffing ratios negatively impact patients and increase
       health care costs.

      Ohio hospitals are leaders in patient safety and quality improvement.

   RESOURCES
           “Avoiding mandatory hospital nurse staffing ratios: An economic Commentary,” Nursing Outlook, 57(2),
            107-112.
           “Mandated Nurse Staffing Ratios in California: A Comparison of Staffing and Nursing-Sensitive Outcomes
            Pre- and Postregulation,” Policy, Politics & Nursing Practice, Vol. 8 No. 4, November 2007, 238-250.
           “Registered Nurses’ Perceptions of Nurse Staffing Ratios and New Hospital Payment Regulations,”
            Medscape, April 22, 2010, http://www.medscape.com/viewarticle/719034_print.
            “What is the Harm in Imposing Mandatory Hospital Nurse Staffing Regulations,” Nursing Economics, Vol.
            28, No. 2, March/April 2010, 87-93.
           “It’s Time to Stop the Regulation of Hospital Nurse Staffing Dead in its Tracks,” Nursing Economics, Vol.
            28, No. 2, March/April 2010, 110-113.
           “Ratios—If It Were Only That Easy,” Nursing Economics, Vol. 28, No. 2, March/April 2010, 119-125.
           “California’s Minimum-Nurse-Staffing Legislation And Nurses’ Wages,” Health Affairs, February 10, 2009,
            326-334.
           “Avoiding Mandatory Hospital Nurse Staffing Ratios: An Economic Commentary,” Nursing Outlook,
            March/April, 107-112.
           “Assessing the Impact of California’s Nurse Staffing Ratios on Hospitals and Patient Care,” California
            HealthCare Foundation Issue Brief, February 2009.
           Quality Improvement Collaborative Projects background,
            http://www.ohanet.org/Narrative/Quality%20Improvement%20Collaborative%20Projects

155 East Broad Street, Floor 15   Columbus, Ohio 43215-3620      www.ohanet.org     614.221.7614     614.221.4771 fax
                                                                                  Nurse Staffing Ratios
                                                                               SUGGESTED TALKING POINTS

           OHA Workforce fact sheet, http://www.ohanet.org/Narrative/OHA%20Fact%20Sheets

   Ohio’s Nurse Staffing Law
   Main message: Ohio’s common-sense staffing law is preferred over rigid, mandated staffing ratios.


   Talking Points
    Ohio’s existing common-sense staffing law meets the mutual goals of OHA, the Ohio Organization for
       Nurse Executives and the Ohio Nurses Association to ensure:
           1. hospitals have flexibility in meeting patients’ needs when determining staffing levels; and
           2. greater direct care nurse input in staffing decisions.
    The common-sense staffing law requires hospitals, with substantial input from direct care nurses, to
       create a nurse staffing plan, consistent with evidence-based standards established by accrediting
       organizations that allow hospitals the proper flexibility to adjust staffing to the needs of patients.
    The anticipated national and statewide shortage of nurses would make it impossible to adhere to
       mandated ratios.
    H.R. 5527 is not necessary. This federal bill would require hospitals to post nurse staffing data daily
       for each unit, restrict the ability of hospitals to “float” nurses, and impose additional requirements
       on hospitals related to nurse staffing. Ohio’s safe staffing law:
           1. provides the flexibility hospitals need to tailor nurse staffing to the needs of patients based
               on proven standards of care and within the limited financial, technological and workforce
               resources available to hospitals; and
           2. ensures that direct care nurses are engaged in the process of developing a hospital’s staffing
               plan.
    Ohio’s safe staffing law represents years of hard work, mutual respect and compromise by Ohio’s
       nursing community and hospital community in reaching shared goals.

   Facts
           Ohio’s current staffing law became effective in 2008.
           In 2009, 14 other states and the District of Columbia enacted a nursing staffing law or
            regulations.
           In 2009, 17 other states proposed nurse staffing laws.
           Ohio is predicted to reach a shortfall of almost 32,000 registered nurses by the year 2020, a 29%
            shortagei.
           Ohio’s current RN vacancy rate is 6.2%ii
           5,000-6,000 qualified nursing applicants are turned away from nursing school each year in Ohio
            due to lack of capacityiii



   Studies on Staffing Ratios
   Main message: Numerous studies show mandatory staffing ratios negatively impact patients and
   increase health care costs. (see Resources on page 1)


   Talking Points
    Studies show mandatory staffing ratios do not improve patient outcomes, lead to delays in treatment
       and disruptions in care and increase emergency room wait times.

155 East Broad Street, Floor 15   Columbus, Ohio 43215-3620   www.ohanet.org   614.221.7614   614.221.4771 fax
                                                                                     Nurse Staffing Ratios
                                                                                  SUGGESTED TALKING POINTS

       Mandatory staffing ratios result in increased costs to hospitals, which diverts resources from treatment
        and results in higher overall health care costs.
       Mandatory staffing ratios negatively impact the efficiency and effectiveness of hospitals and the health
        care workers who provide care to patients.

   Facts
           The total estimated annual cost for California hospitals to implement ratios was $87 million.iv



   Leaders in Quality
   Main message: Ohio hospitals are leaders in patient safety and quality improvement.


   Talking Points
    [Outline HOSPITAL’s patient safety initiatives]
    [Outline HOSPITAL’s participation in OHA quality collaborative projects]
    Hospitals in Ohio are involved in four regional and one children’s quality collaborative project to
       collectively:
            1. reduce heart attack mortality
            2. reduce central line catheter-associated blood borne infections
            3. reduce health care-associated MRSA infections
            4. improve surgical care
            5. improve pneumonia care
            6. reduce 30-day readmission rates
            7. reduce preventable codes
            8. reduce surgical site infections
            9. reduce c. diff infections
    The Health Services Research study is limited by the fact that researchers did not compare quality in
       California hospitals before and after the implementation of staffing ratios. Rather, they used other
       states’ quality measures to draw their conclusions, without taking into account the numerous
       quality initiatives that have been undertaken in those states to improve quality.
    The Health Services Research study did not take into account California hospitals’ patient safety efforts,
       which certainly contributed to the improved patient outcomes noted in the study.

   Facts
    Ohio hospitals participate in four regional and one children’s quality collaborative projects.
    OHA’s c. diff quality collaborative saves an estimated 34 lives per month.
    Ohio’s hospital quality collaboratives have saved 1,300 lives since 1998.
    Four of the top 10 hospital systems in the country are in Ohio.v


   i
      National Center for Health Workforce Analysis, Health Resources Services Administration
   ii
       2010 OHA Salary Survey Report
   iii
       “The Future of the Nursing Workforce in Ohio,” Health Policy Institute of Ohio, November 2009,
   http://www.healthpolicyohio.org/pdf/Nursing_Paper.pdf
   iv
       “Avoiding mandatory hospital nurse staffing ratios: An economic Commentary,” Nursing Outlook, 57(2), 107-112
   v
       Thompson Reuters, June 2010, http://thomsonreuters.com/content/press_room/tsh/tr_research_identifies_top


155 East Broad Street, Floor 15   Columbus, Ohio 43215-3620    www.ohanet.org      614.221.7614    614.221.4771 fax

				
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