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

– 98,000 preventable hospital deaths each year– 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 and lower rate of failure to rescue

Safe RN Staffing = Safe Patient Care

• 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

• 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

"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

• 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

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”

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

Patient Safety Standard Bill

• Safety Standards - Establishes minimum statewide staffing standards, 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.

Patient Safety Standard 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”

• 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

Member Outreach

Unprecedented effort including:• RN Heroes Handbook• Webpage info • Webinars• Phone calls• Targeted local unit activities• Advocacy Camp• Lobby Days

Grassroots ActionE-mails to Legislators • 1000+ unique people used capwiz• 3000+ individual emails sent Hand-written Letters• 500+ handwritten letters collected and

mailed to LegislatorsAdvocacy Camp & Legislative Day• 800+ attendees

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

Next Steps• Public Outreach• Member/RN Outreach• Policymaker Engagement• Community Partners Engagement• Plans for 2013 and beyond