BY FRANCINE KNOWLES SUN-TIMES COLUMNIST
When Andrea Buchheit became a nurse seven years ago, she was excited at the opportunity to take care of people during their most vulnerable times.
Today, she and other nurses say that too few hospital nurses and heavy work loads have her and other nurses worried they'll one day do more harm than good.
Buchheit, a registered nurse at St. Mary of Nazareth Hospital Center in Chicago, is among nurses supporting bills in Springfield that would mandate minimum registered nurse-to-patient ratios. The legislation, which has the support of major health care unions, but is opposed by the Illinois Hospital Association, passed out of the Illinois House Health Care Availability and Access Committee this month. Similar legislation was been proposed in the Senate and referred to a subcommittee.
The bills sponsors, state Rep. Mary Flowers (D-Chicago) and state Sen. Iris Martinez (D-Chicago), say the legislation is needed to improve quality care and patient safety.
The Illinois Hospital Association criticized the legislation as a bad "one-size-fits-all" approach that would drive up labor costs, and worsen the nursing shortage.
"I believe it's extremely necessary," said Buchheit, who typically is responsible for seven to eight patients. Five to six is more manageable with the diabetic and cancer patients she cares for, she said.
"There are some days when we're staffed appropriately, but on a lot of days when we have so many patients, we can barely give them the care they need," she said.
The bills would set minimum RN-to-patient ratios by hospital unit, and require hospitals to adopt staffing plans designed to address their unique situations developed with input from RNs.
The American Federation of State, County and Municipal Employees, the National Nurses Organizing Committee and the Service Employees International Union are among supporters.
With duties that include dispensing medicine, assisting with feedings, exchanging information with physicians, monitoring patients, checking vital signs and dealing with emergencies, proponents say at times the work load can be overwhelming for nurses, who're often left with little time to do important patient education.
"I feel bad, but sometimes I'll have just five minutes to say 'this is how you draw up your insulin, this is what you do, I'Il come back and check on you in an hour,'" Buchheit said. "That's poor education. That's why a lot of patients have to come back. They don't know how to eat right, how to take their medicine, because we're not educating them properly."
That contributes to driving up the cost of care, she and others contend.
Emergencies take priority, so patients in pain waiting on medication or elderly patients waiting in the bathroom for help to get back to bed, too often have to wait longer than they should because of insufficient staffing, Buchheit said, situations that are not unique, say the bills' backers.
"God forbid there's two emergencies," Buchheit said, adding her worst experience was when she had nine patients and two emergencies at once.
For nurses, it's not a situation of "Oh, God, I've got so much work to do," she said. "It's that these are people's lives. I'm so afraid someone is going to die and it's going to be because of me, because I couldn't get to them."
The stress of excessive work loads drives people out of nursing, contributing to the nursing shortage, proponents of the bills say. They contend the legislation would encourage those nurses to return.
But the Illinois Hospital Association disagrees.
"Imposing a ratio doesn't help you hire another nurse," said spokesman Danny Chun. "What it does is create demand that drives up wages."
"It would force hospitals to recruit more nurses, and there aren't enough nurses out there," said Beth Brooks, senior partner for health care with JWT Employment, a recruitment marketing and communications company.
Brooks and Chun also noted that since mandatory ratios went into effect in California, some emergency rooms have been forced into the position of not accepting patients and delaying care, and other hospitals have closed.
Labor costs have grown by 23 percent, Chun said.
The mandatory ratios also haven't been shown to improve patient care, Brooks said. A 2005 study of 268 hospital units at 68 hospitals in California found that required minimum nurse staff ratios didn't reveal significant reductions in the incidence of patient falls or pressure ulcers, she said.
AFSCME cites a 2002 study published in the Journal of the American Medical Association that found patients face a 7 percent greater likelihood of death for every patient above four assigned to a registered nurse. The report said as many as 20,000 deaths each year are linked to inadequate nurse staffing levels.
AFSCME also cites data showing inadequate nurse staffing contributed to nearly 25 percent of the cases of accidental injury or death reported to the Joint Commission on Accreditation of Healthcare Organizations.
D. Jo Patton, special projects director with AFSCME Council 31, said backers of the legislation plan to meet with the hospital association and hope to negotiate a bill that both sides can agree on.
Source:
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