Proposed D.C. Law Demands More Nurses in Hospitals

In a contest in which patient safety could hang in the balance, hospital administrators are facing off against nursing unions over a bill requiring hospitals in Washington, D.C., to maintain a minimum nurse-to-patient ratio.

As reported by (KHN), the bill is modeled on a California law that took effect in 2004. That state is the only one that requires minimum staffing ratios in its hospitals.

Hospitals claim the cost of additional nurses would put them out of business. Nurses claim that the proposed Patient Protection Act acknowledges that minimum staffing levels are needed to maintain patient safety.

So far, says KHN, the staffing ratio requirement seems to have a mixed effect in California hospitals. National Nurses United says it has improved patient safety, added 130,000 nursing jobs and helped to retain experienced nurses.

The proposed staffing ratios in D.C. are different depending on the department. In a pediatrics unit, the bill requires at least a 1-to-4 nurse-to-patient ratio. In the operating room, it would be 1-to-1-one nurse for every patient at all times.

KHN interviewed a nurse who has worked at MedStar Washington Hospital Center for more than 20 years. She said understaffing has forced her to take care of five or six patients at a time.

“There are times when I have to do the dressing on patients and I can’t get to it,” she said. “I have to put antibiotics on patients and they’re late. You have to turn patients every two hours and you can’t get to it. It infringes on their care.”

A hospital executive said that staffing levels are managed in conjunction with its nurses, and that levels fluctuate depending on the number of patients it has, and how sick they are.

One study showed that that the California law led to an increase in hiring and another showed a decrease in nurse turnover from burnout. But researchers also found that the law exerted financial pressure on some hospitals.

So we have to ask: At what price is it acceptable to risk patient safety? If you can’t run a sufficiently staffed facility without jeopardizing your financial well-being, aren’t you in the wrong business?

Trying to determine if the California law actually reduced patient mortality is tricky. Nursing professor Teresa Serratt from the University of Nevada, Reno, studied the effects of the California law, and told KHN that the data are inconclusive.

Nurses in D.C. certainly aren’t inconclusive about their work situation. In a union survey of them:

  • 57 in 100 said staffing is inadequate always or almost always;
  • 64 in 100 said they have less time to care for patients;
  • 60 in 100 said changes in their workload have led to worse outcomes for patients;
  • 88 in 100 said they have had to work through meal and rest breaks because of inadequate staffing;
  • 87 in 100 said that mandatory nurse-to-patient ratios, such as those in California, are needed in D.C.

Nurses and hospitals in D.C. haven’t gotten along for quite a while. Two years ago nurses staged a 24-hour walkout, and Serratt calls the relationship between hospitals and nurses in D.C. dysfunctional. “If you have really strong communication and good people on both sides of the table,” she told KHN, “we wouldn’t have the government getting in the middle of this kind of stuff.”

And patients can only suffer when there’s strife in the halls of a hospital.

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