With Survey Results on Patient Deaths, Nurses Hatched a Non-Cause Celebre

Friday, July 18, 2014

I’m still wondering why the nurses’ union didn’t get traction with its survey alleging thousands of patient deaths caused by inadequate nurse staffing.

I thought something would happen after the Massachusetts Nurses Association (MNA) announced on June 4 that one in four nurses were personally aware of patients having died in hospitals because there weren’t enough nurses around.
But nothing really happened that I could see.  The survey was a one-day blip on the news radar.   It didn’t make the front page of the Globe or Herald.  It didn’t dent the evening news broadcasts.  The Massachusetts Hospital Association barely lifted a finger to refute it.  And no government bigwig, caught in anguished surprise, declared her intention to launch an investigation.

The headline on the MNA news release touting the survey said: “Nearly One in Four MA Registered Nurses Report Patient Deaths That Are Attributable to Unsafe Patient Assignments.”
Under that was a long, explanatory paragraph in bold face, italic type:

78% of RNs agree that the quality of patient care in Massachusetts hospitals is suffering due to unsafe patient assignments including 59% of RNS who are aware of patient complications and 46% who are aware of patients who have been injured or harmed because hospitals are forcing nurses to care for too many patients at one time.

Here’s the scary list of particulars from the body of the news release:

·         …nearly one in four nurses (23%) report patient deaths directly attributable to having too many patients to care for at one time.

·         46% report injury and harm to patients due to understaffing;

·         51% report longer hospital stays for patients;

·         56% report readmission of patients due to unsafe patient assignments;

·         57% report medication errors due to unsafe patient assignments;

·         59% report complications for patients due to unsafe patient assignments;

·         68% report RNs don’t have the time to educate patients and provide adequate discharge planning;

·         82% report RNs don’t have the time to properly comfort and care for patients and families due to unsafe patient assignments.
The release ended with: “The 2014 survey respondents were all nurses currently working in Massachusetts hospitals randomly selected from a complete file of the 92,000 nurses registered with the Massachusetts Board of Registration in Nursing.  According to the researchers, the survey results can be assumed to be representative of the 92,000 nurses to within plus or minus 7% at a 95% confidence interval.”

In a June 6 blog post, I took a stab at translating that last sentence.  I said that, if you could somehow ask each of the 92,000 nurses if they were personally aware of a patient having died because there weren’t enough nurses to care for all of the patients needing care, you could be confident that between 16% and 30% of them would answer in the affirmative.  (Sixteen percent of 92,000 is 14,720; 30% is 27,600.)
I also said that, assuming just one witnessed patient death per surveyed nurse, the MNA is suggesting that at least 14,720 and as many as 27,600 hospital patients died because of inadequate staffing during the working lives of those 92,000 nurses.

Maybe the survey fell flat because the nurses’ union bought and paid for it.  That gave everyone a ready-made excuse to dismiss it.  We could say, “The nurses got the numbers they paid for; that’s what you do these days,” and move on to other news.
Maybe the survey got swamped by all of the other things happening in our world that day.  The torrent of news, or what passes for news, never lets up in the Internet age, even for a second.    Too much stuff competes for our attention.  How much of what comes before our eyes on a typical day can be remembered, never mind acted upon?

Or maybe it failed to achieve loft because the nurses’ union tried to accomplish too much with too little.  The news release said the results “can be assumed to be representative” of the experiences of 92,000 nurses.  It did not say how many nurses were actually surveyed by the union’s research firm, nor how much the union spent on the survey.  Skeptical minds could infer that: (a) the total number of respondents was not impressive, and (b) the project was done on a slender budget.
I’m being a little unfair when I say nothing happened as a result of the survey.  Later in June, after all, the legislature passed, and the governor signed, a bill mandating nurse staffing ratios in hospitals for the first time ever, House Bill 4228, An Act Relative to Patient Limits in All Hospital Intensive Care Units.  The survey might have nudged HB 4228 an inch closer to the goal line, but I think the legislature was ready to do something on this issue in any event. 

The new mandate is limited to hospital intensive care units.  It stipulates:  “…in all intensive care units the patient assignment for the registered nurse shall be 1:1 or 1:2 depending on the stability of the patient as assessed by the acuity tool and by the staff nurses in the unit, including the nurse manager or the nurse manager’s designee when needed to resolve a disagreement.” 
Literally for years, the MNA has been working on Beacon Hill to get a comprehensive nursing staff ratio bill passed.  While HB 4228 is truly a significant piece of legislation, it falls miles short of what the union was aiming for when it began its latest round of lobbying on this issue, way back in January, 2013, at the start of the current legislative session.

The hospitals seemed glad, having ceded only their ICUs, to leave the battlefield.  Said Lynn Nicholas, president of the hospital association, “The legislation focuses on the intensive care unit where there is a collaborative role for staff nurses, for nurses who manage care for all patients in an ICU, and for an acuity system to help determine the severity of an ICU patient’s illness.  Importantly, the legislation leaves flexibility throughout the rest of the hospital to properly address every patient’s needs.”
The nurses’ union vowed it would be back next session, trying to get a bill through to set mandatory nurse-to-patient ratios in all hospital units.   Many legislators no doubt have severe nursing-staff-ratio fatigue.  But every rep and senator who’s there for the 2015-16 session will hear the union out.  Nurses are respected, rightly so.  There’s a lot of them. They vote.


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