Monthly Archives: March 2014

7 questions about nurse-patient ratios

KS97487What would you like to see for nurse-patient ratios? California implemented ratios per unit. Florida and Massachusetts legislatures are currently debating similar bills. Waiting for your state to legislate the answer can’t be the best approach.

Variable ratios based on the unit seems reasonable. Florida is considering: 5 patients to 1 RN for rehabilitation and skilled nursing units; and 1:1 for patients in active labor, receiving conscious sedation, in the ER, or in the OR. Does a CNS count the same as an MSN or ADN?

The upcoming RN shortage is undeniable. 50 states legislating RN ratios would be a real problem. Is there a place for LPNs in your hospital?

The Affordable Care Act is pushing more and more healthcare to outpatient settings. Will they legislate RNs at urgent care clinics and surgical centers?

Congress seems unwilling to consider any of the national bills on nurse-patient ratios (insert for favorite jab here). Has your state hospital association come to a consensus? Do you agree with it?

The American Nurses Association (ANA) argues that hospitals should personalize staffing plans for individual hospital units, accounting for individual patient needs and staff experience levels. That doesn’t sound bad, does it?

26 states allow the public to place issues on the ballot. They just wants the child, parent, or grandparent to get well. Do you want the public to decide our ratios? If not, then we better be proactive and find a solution.

How’s your hospital’s quality? Are you sure? Who told you?

Anyone can rate your hospital’s quality of care. Without transparency, each opinion is as valid as your dad’s (didn’t say mom’s cause no one crosses her!).  Defining the metrics, where and how was the data gathered, what period is measured vs. what’s an extrapolation, etc. Learned in college, ‘you can prove anything with enough numbers’ and ‘statistics don’t lie, statisticians do’ (dad was a statistician).

The AAMC (Association of American Medical Colleges) convened a panel of quality experts who developed the Guiding Principles for Public Reporting of Provider Performance (pdf). These 25 principles to evaluate Provider Quality reports call for data and reporting methodologies to be well-defined in terms of purpose, transparency, and validity.

When hospitals are rated, “[they] want to know, ‘How do we talk with our boards, why we should put a lot of emphasis on this rating system or why we shouldn’t, and where is it important?’” explains Joanne Conroy, MD, chief healthcare officer for the AAMC, which spearheaded the project last year. “They need a clear set of principles that’s not their opinion to justify why they should emphasize one [rating] system and not another.”

In fact, none the rating systems published to date, including those from The Joint Commission, the Leapfrog Group, Consumer Reports, Hospital Compare, the Commonwealth Fund, Truven, Healthgrades, and U.S. News and World Report, meet all of the AAMC’s guiding principles. “Nobody meets them all,” Conroy says.

Read More: HealthLeaders Media (3-10-2014)

This is not breaking news. Washington state legislature wants to mandate a statewide Healthcare Procedures Cost Database in response to its ACA implementation. I applaud the efforts for transparency and have trouble trusting those organizations that don’t want to cooperate.