Campaign for Patient Safety

Reform

Anne Tan PiazzaWSNA Assistant Executive DirectorGovernmental Affairs & Operations

“It’s the staffing, stupid.”

Judy Huntington, MN, RN

Mountain of Research

– Registered nurses intercept 86% of medication errors before there is harm to the patient

– Higher levels of nursing skill and nurses providing more hours of care are correlated with:

• better care• shorter hospital stays• fewer infections• lower rate of failure to rescue

Safe RN Staffing = Safe Patient Care

• Hospital reimbursement models such as paying for performance and value based purchasing, the focus is on financial incentives for higher quality care. Same reimbursement for same surgery regardless of length of stay.

• CDC estimates 1.7 million hospital acquired infections each year costing the US healthcare system between 28 billion to 33 billion dollars. The average cost of each healthcare acquired infection is estimated to be $43,000.

• In 2008, Medicare implemented a new payment policy of not paying hospitals for the cost of treating identified hospital-acquired conditions such as falls and hospital acquired infections.

Safe Staffing = Cost Savings

• New graduate nurse turnover in hospitals is estimated to be as high as 55%-61% with many nurses leaving their first hospital job after just one year.

• The cost for a hospital to replace a single nurse is $80,000 in recruitment, orientation and mentoring costs.

• Every percentage point increase in nurse turnover costs the average hospital $300,000 per year, and hospitals that have high nurse turnover spend about $3.6 million more than hospitals that have high retention of nurses.

Safe Staffing = Cost Savings

Patient Safety Reform Package1. Safe RN Staffing2. Uninterrupted Meal/Rest Breaks3. Limiting Mandatory Overtime

Legislative Solution

• A standard keeps patients safe• Hold Hospital CEOs Accountable• Facts show that patient safety standards work

Safe Staffing Bill

• Safety Standards - Establishes minimum statewide staffing ratios, maximum number of patients per nurse.

• Customization - Uses the current nurse staffing committees at each hospital to tailor staffing plans to the specific needs of each unit.

• Authority - Mandates that hospitals must implement the staffing plan approved by the nurse staffing committees above the minimum standard.

• Professional Judgment - Ensures that RNs are not assigned to other units without training and competency evaluation.

• Transparency - Collection and public disclosure of specific nursing sensitive patient outcomes data.

• Accountability - Prompt investigation of staffing complaints, corrective action required for violations with a potential civil penalty of $10,000 for violation.

Safe Staffing Bill

• Requires the Dept of Health to establish statewide minimum nurse staffing ratios (specific limits on the number of patients that hospitals may assign to any RN at any one time) with input by registered nurses and patient safety experts.

• Recognizes the uniqueness of each hospital and their patient needs by having the current nurse staffing committees at each hospital develop staffing plans for each unit and shift based on the minimum nurse staffing standard and criteria such as census, patient intensity (acuity), and skill mix of nursing personnel.

• Requires hospitals to implement the staffing plan approved by the nurse staffing committees which may not be less than the minimum nurse staffing standard.

Safe Staffing Bill

• Prevents registered nurse from being assigned to a nursing unit or clinical area unless the nurse has first received orientation in that clinical area, by mutual agreement between the nurses professional judgment and licensure standards and management, sufficient to provide competent care to that patient populations.

• Collection and public disclosure of specific nursing sensitive patient outcomes data including nurse staffing levels, nursing hours per patient day, failure to rescue, urinary tract infection rates, and pressure ulcers.

• Prompt investigation of inadequate nurse staffing complaints by the Department of Health. Corrective action required for violations with a potential civil penalty of $10,000 for each violation.

Safe Staffing Bill

Nurses have seen understaffing harm or kill patients, and many see it as a chronic problem.

38% of nurses have witnessed patients being put at risk due to inadequate nurse staffing

29% of those nurses saw a patient hurt by understaffing

5% believe that patient’s death occurred as a result.

45% of nurses who have experienced understaffing threatening care say the problem occurs often

41% who have encountered the issue only once or twice

Critical Care Units

43% of these nurses experienced patients put at risk by understaffing

9% of thosesaw patients die in that situation

ER and Psychology Units

46% of these nurses have had at least one situationwhere patients were put at risk by understaffing

41% of those had patients hurt or die in that situation

Nurses strongly support a law to set minimum staffing levels for patients.

82% of nurses favor “a proposed law that would set minimum nurse to patient staffing ratios in each hospital unit”

California RNs RatioType of Care RN to Patients

Intensive/Critical Care 1:2

Neo-natal Intensive Care 1:2

Operating Room 1:1

Post-anesthesia Recovery 1:2

Labor and Delivery 1:2

Antepartum 1:4

Postpartum couplets 1:4

Postpartum women only 1:6

California RNs Ratio

Type of Care RN to Patients

Pediatrics 1:4

Emergency Room 1:4

ICU Patients in the ER 1:2

Trauma Patients in the ER 1:1

Step Down, Initial 1:4

Step Down, 2008 1:3

California RNs Ratio

Type of Care RN to Patients

Telemetry, Initial 1:5

Telemetry, 2008 1:4

Medical/Surgical, Initial 1:6

Medical/Surgical, 2008 1:5

Other Specialty Care, Initial 1:5

Other Specialty Care, 2008 1:4

Psychiatric 1:6

• By adding just one more full-time RN per day, hospitals decreased the number of deaths in ICU’s by 9% and in surgeries by 16%

• A standard has already been implemented in California, and they’ve seen an 11-14% drop in postsurgical patient deaths

Safe RN Staffing = Safe Patient Care

• Nurses intercept 86% of medication errors before there is harm to patients

• Real breaks mean better care• We can still put our patients first

Real Breaks Keep Patients Safe Bill

• Requires hospitals to provide uninterrupted meal and rest breaks.

• Preserves the nurse’s professional judgment by allowing breaks to be interrupted or delayed when the nurse on, or scheduled for, a break determines a clinical circumstance could lead to patient harm without his/her skill, expertise, or knowledge.

• Provides flexibility by allowing the rest break to be taken at any time during each 4 hour period. Hospitals are free to determine how to provide the breaks by working with the staff nurses in each unit in the development and implementation of mechanisms to ensure breaks.

Real Breaks Keep Patients Safe Bill

• CEOs are using a loophole to rig the system against nurses and our patients

• Forced overtime isn’t safe

On-Call Nurses are for Emergencies Bill

• On-call nurses should be for emergencies only and prevents hospitals from scheduling non-emergency procedures that require forced overtime

• Limits the use of prescheduled on-call for immediate and unanticipated patient care emergencies instead of chronic and foreseeable staff shortages

• Prohibits the scheduling of nonemergency procedures that would require overtime

On-Call Nurses are for Emergencies Bill

The vast majority of nurses are not getting the breaks they need, and they are being called in to work overtime to address chronic

staff shortages.

Only 9% of nurses say they always are able to take an uninterrupted 10-minute break every 4 hours and an uninterrupted 30-minute meal break.

44% of nurses say they very rarely or never get to take those breaks

Nurses are seeing lack of breaks and on-call abuse cause fatigue and jeopardize patient safety.

57% of nurses believe that lack of breaks, call requirements, and call back hours are causing nurse fatigue and jeopardizing patient safety at their hospital

Nurses are seeing lack of breaks and on-call abuse drive people out of nursing.

50% of nurses say that a lack of breaks and concern for patient safety has caused someone they know to leave their unit or profession, or it has caused them to consider doing so themselves

Nurses overwhelmingly support a law mandating an uninterrupted 10-minute break every 4 hours.

88% of nurses support “a law that required hospitals to give nurses at least a ten minute break for every four hours they worked, and required those breaks to be uninterrupted”

"The idea of the mind as a cool calculator that makes decisions by weighing the evidence bears no relation to how the brain actually works."

Dr. Drew Westen, The Political Brain

"In politics, when reason and emotion collide, emotion invariably wins."

Dr. Drew Westen, The Political Brain

• Classic elements of story– A quest and a threat– Heroes and their tools– Villains and their weapons

• Shared values– Honesty & integrity– Hard work– Equal opportunity

The Narrative

QUEST -- Every nurse can care for their patients as if they were their own family.

Our Story

THREAT -- Patients are suffering due to inadequate staffing, lack of breaks and abuse of overtime

Our Story

HEROES -- Nurses who work hard and look out for their patients

Our Story

HEROES’ TOOLS• What nurses need to care for patients • Safe staffing standard: maximum number of patients

per nurse• Real breaks– so that nurses can be sharp when it

counts• On-call nurses for emergencies• Government that works for “we the people”

Our Story

VILLAINS -- Hospital CEO’s who put profits above the needs of patients and rig the system against nurses and their patients.

Our Story

VILLAINS’ WEAPONS• Rigging the system against nurses who want to care

for their patients• Shortsighted cutbacks that cost more than money,

they cost lives.• Choosing to spend money on fancy lobbies and

inflated CEO salaries instead of what patients need• Politicians who are working for Hospital CEOs instead

of nurses and our patients

Our Story

• Nurses intercept most medical errors before any harm is caused to a patient

• Nurses work harder, faster, longer hours to care for patients like their own families

• It is time to hold hospital CEOs accountable for putting patient care first, just like nurses do

• Different kind of patient care • We have the power to make a change

NURSES ARE HEROES

Almost 2/3 of voters believe nurses are definitely or probably overworked

70% support a law to "set a maximum number of patients each nurse could care for in a

hospital unit"

87% of voters favor a law that “requires hospitals to give nurses at least a ten minute break for every four hours they worked, and

requires those breaks to be uninterrupted

http://www.youtube.com/watch?v=4z7gDsSKUmU

Keys to a Successful Meeting with Legislators

"The idea of the mind as a cool calculator that makes decisions by weighing the evidence bears no relation to how the brain actually works. . . In politics, when reason and emotion collide, emotion invariably wins."

Dr. Drew Westen, The Political Brain

Making a Heartfelt Case

• Dress respectfully – Business or nursing attire.• Research your legislator(s) in advance – know

their background & legislative interests, and their contact information.

• Bring a detailed, written summary of your point(s) to leave with them afterwards, and make sure it has your contact information.

• Bring a camera to get a picture with them at the end.

Getting Ready to Meet - 1

• Bring “Cheat Sheet” set of notes for yourself• Practice what you’re going to say:

-Stay on track; avoid unnecessary details.-Hone the logic of your remarks so that each point relates clearly and persuasively to your final request (or “ask”).

• Bring a pen and paper to take notes.

Getting Ready to Meet 2

• Don’t share personal information about a patient.

• Don’t use jargon – reflect carefully on your terminology and explain things in lay-person’s terms.

• Stay positive and friendly – even if the legislator appears impatient or rude.

• Speak clearly and in full voice.

Getting Ready to Meet 3

• Introduce yourself briefly. Emphasize. . .- that you’re a nurse, & the sort of work you do, - the specific neighborhood in which you live (telling them you’re in their district).- what specific action you want them to do.

• Don’t get side-tracked on “small talk”!

In The Actual Meeting 1

• Frame your request or “ask” as pointedly as possible, i.e., “Will you vote for bill XYZ?”

• After making your ask, listen carefully to what they say, and take notes.

• If you don’t know the answer to a question, say so, but be diligent about getting back to them.

• At the end, re-state the “ask” & get a picture!

In The Actual Meeting 2

• Report what happened to Sofia and/or other WSNA legislative staff.

• Send a follow-up email message to the legislator, including. . .

- a restatement of who you are & what day you met the legislator,- a restatement of your legislative “ask”.- an answer to any questions they had.- the picture you took with them.- your contact information.

After the Meeting. . .