ANA Advocacy Focuses on Safe Staffing, Looks to Opportunities in the New Year

  

Achieving safe staffing levels continues to be one of the biggest challenges facing nurses at the bedside. Workforce shortages, while not new, are being deeply felt across the country. The COVID-19 pandemic exacerbated existing shortages and has led to significant burnout among our nurses, driving even more nurses out of the profession. These shortages are unsustainable, making it even more vital that policymakers act now to identify and take action on new approaches to addressing safe staffing and other workforce challenges. 

At ANA, we recognize this issue is essential to our nurses and are working hard to make real change at the federal level by advocating for the Administration and Congress to recognize and address this crisis. Through our regulatory advocacy, ANA has reached out to Centers for Medicare & Medicaid Services’ (CMS’) Center for Clinical Standards & Quality as well as the White House Domestic Policy Council to call for more meaningful conditions of participation that provide additional requirements and enforcement mechanisms for staffing at acute care hospitals. 

More recently, ANA submitted comments on CMS’ proposal to institute the first-ever ratios for staffing in long-term care (LTC) facilities. As directed by an Executive Order issued by President Biden, CMS was tasked with studying staffing levels in these facilities and issuing regulations aimed at improving nurse staffing levels to enhance patient care quality. CMS issued a proposed rule in early September that would set minimum ratios for registered nurses (RNs) and nurse aides and require an RN onsite 24/7, among other implementation and enforcement requirements. When finalized, this proposed regulation will set a precedent for federal staffing requirements that could bolster our advocacy efforts related to safe nurse staffing in other settings as well. 

This proposed regulation is so significant that, in addition to our comment letter, we also submitted a coalition letter to the agency that included 25 state nursing and organizational affiliate associations. Both letters echo previous calls for the Administration—CMS and other federal agencies—to work closely with the nursing community and other stakeholders to take real action to address workforce needs and challenges.  

As part of our legislative advocacy, ANA recently endorsed the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 2530/S.1113), introduced by Senator Sherrod Brown (D-OH) in the U.S. Senate and Representative Jan Schakowsky (D-IL-9) in the U.S. House of Representatives. This bill would establish minimum nurse-to-patient staffing ratios in hospitals to help ensure patients have access to nurses who can provide them with the time and attention necessary to deliver high quality patient care. ANA sees the adoption of safe staffing levels as part of a multi-pronged approach to addressing the work environment challenges resulting in burnout and workforce attrition among nurses. 

As we look to 2024, ANA will continue the drumbeat with federal policymakers about the critical need to take real action to address safe staffing for our nation’s nurses. We will keep pushing federal agencies to use their existing authority to ensure safe staffing levels in the health care facilities under their purview, while watching closely for CMS to issue the final rule on LTC facilities. ANA will also seek opportunities to call on Congress to implement safe staffing standards, while identifying and pushing back against any policies that could further exacerbate the nurse staff workforce crisis. Together with our members, we will continue to make real strides in addressing safe staffing for nurses and the patients they serve. 

Introducing the Safe Staffing for Nurse and Patient Safety Act

  

Advocating for and passing legislation that helps nurses and patients is a fundamental part of our Year of Advocacy. Nurses advocate every day for their patients, their communities and the profession, but it is also important that nurses lend their expertise to elected officials as they draft and pass legislation relevant to the nursing profession.

Earlier this month our bipartisan champions in the House of Representatives and Senate introduced a bill that will improve care and help keep nurses and patients safe. Champions including Reps. David Joyce (R-OH-14), Suzan DelBene (D-WA-10), Suzanne Bonamici (D-OR-1), and Tulsi Gabbard (D-HI-2) as well as Senator Jeff Merkley (D-OR), came together to introduce the Safe Staffing for Nurse and Patient Safety Act of 2018 (S. 2446, H.R. 5052).

The bill requires hospitals to establish a committee, composed of at least 55 percent direct care nurses, to create nurse staffing plans that are specific to each unit. As nurses across the country know, patients risk longer hospital stays, increased infections, and avoidable injuries when units are understaffed. Understaffing also leads to lower nurse retention, higher rates of injury and burnout.

“RN staffing makes a critical difference for patients and the quality of their care,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association. “Appropriate nurse staffing keeps patients safe and protects them from preventable complications, even lowering the risk of death. Nursing care is like medication—we would never withhold a medication when we know its lifesaving effects. The Safe Staffing for Nurse and Patient Safety Act empowers direct care nurses to determine the unique and variable needs of their patients to ensure the safety and quality outcomes of care.”

Our Congressional champions also understand why this legislation is so important.

“As a husband of a nurse, I have experienced first-hand the many challenges and responsibilities nurses face on a day to day basis,” said Joyce. “Ensuring patient safety and care has always been a priority but has faced many challenges when nurses are over worked and hospitals are under staffed. As Co-Chair of the House Nursing Caucus, I am proud to introduce legislation that addresses the issue and protects our patients and nurses.”

“As the husband of a nurse, I know firsthand the many challenges nurses face and how critical their care is to patients,” said Merkley. “Safe staffing enhances the quality of patient care, reduces medical errors, and increases nurse retention.”

But introducing this bill is just the first step. We need your help getting more cosponsors for this legislation – let your Senators and Representatives know why safe staffing is so critical. Click here to send them an email asking them to support this bill and be sure to include a personal note on why nurse-driven ratios are so important.

On Lobby Waterfalls and Safe Staffing

  

Limousine service, upgraded television setsnurse-to-patient “scripts,” gourmet food service, nurse uniform requirements. Hospitals all over the U.S. are offering more “customer-centric” patient care in order to increase patient satisfaction scores, which are becoming ever more important to raise and maintain Medicare reimbursement amounts.

These efforts, however, often have unintended consequences.

In the first place, customer-centric interventions rarely (if ever) improve the quality of care patients receive. Rather, they merely improve patients’ perceptions of care.

Perhaps the biggest issue with this approach is that nurses have little control over the factors that research shows improve patient satisfaction scores the most. Quality of food service, wait times, physician attentiveness, even staff uniform colors are all factors in patient satisfaction scores—none of which nurses have control over.

Crucially, nurses also have little control over nurse staffing, which research demonstrates is a significant factor in patient satisfaction scores. Short staffing is inherently unsafe and puts patients at risk.

Contrary to gourmet food service, however, improving nurse staffing actually improves the quality of care patients receive, not just their perception of it. The literature shows that improving nurse staffing while controlling for variables (including physicians, LPNs, and nursing assistants) significantly reduces the risk of mortality, lowers the incidence of medication errors and other adverse eventslowers patient readmission ratesreduces nursing-sensitive negative outcomes, and even saves hospitals and insurance companies money—and that’s just the tip of the iceberg.

In an effort to mitigate the unintended consequences of patient satisfaction scores and improve nurse staffing, the American Nurses Association has long advocated for Medicare to include nurse staffing measures next to patient satisfaction scores on its Hospital Compare website.

By doing so, public reporting of nurse staffing on a 1-5 scale will push hospitals to staff more safely and shift patient care interventions from those that improve perceptions of care to those that actually improve care itself. Think about it: nurse staffing is perhaps the single greatest indicator of patient quality of care. Would you rather go to a facility with a five star rating on nurse staffing, or one with a three star rating on nurse staffing, two lobby waterfalls, great patient scripting, and state of the art flat screen tvs?

lobby-waterfall

Give me the better nurse staffing every time.

Unfortunately, Medicare recently declined to include nurse staffing measures on Hospital Compare for Fiscal Year 2018. But the fight is not over. While ANA is proud that we were able to help generate 1,363 comments in support of these staffing measures, and is thankful for the 26 advocacy groups who co-signed our comment letter to the Center for Medicare Services, we are already gearing up for an even bigger grassroots movement next year.

But we’re going to need your help. Stay tuned for more: #nursesunite.