State Senate Introduces Bill to Protect Pennsylvania’s Patients and Nurses

Today, registered nurses are gathering in Center City Philadelphia to learn about the details of a sweeping patient safety bill just introduced into the Pennsylvania State Senate. The Pennsylvania Hospital Patient Protection Act of 2009, introduced by Senator Daylin Leach (D-17), would save the lives of countless Pennsylvania patients by requiring hospitals to abide by mandated, safe RN-to-patient ratios on all units at all times, as well as provide for genuine whistle-blower for RNs who report unsafe care conditions. 

The bill is mirrored on a highly successful California law that has brought more RNs into the workforce.  Since the law was enacted, the number of active RNs in California has grown by nearly 100,000, with a yearly increase that is triple the number before the law. 

“In California, with ratios, RNs now have the support and time they need to provide higher quality care,” said Hedy Dumpel, RN, JD, National Director of Nursing Practice and Patient Advocacy for the California Nurses Association/National Nurses Organizing Committee  “We have ratios for schoolteachers and prison guards, and specific standards for clean air and water.  Why not in our hospitals?”

The Pennsylvania RN ratios would require minimum ratios by unit, with increased staffing when needed based on the severity of patient illness. Research has shown the need for such an approach.  One study found that cutting ratios to one RN per four patients could save 72,000 lives nationally, (The American Journal of Public Health, August 2005) while another found that up to 22,000 American lives are lost each year due to unsafe ratios. (Journal of the American Medical Association, October 22, 2002).   Other studies have linked everything from the rise of staphylococcus infections to the spread of pneumonia to unsafe ratios for direct-care RNs.

“Pennsylvania’s nursing shortage is getting worse by the year,” said Senator Leach. “This law will guarantee patients safer care while creating conditions in our hospitals that will help retain and recruit RNs.  Ratios reduce costly medical errors, hospital infections, and the significant expense of replacing the increasing numbers of RNs who leave the bedside due to unsafe staffing conditions.”

An increase of one patient per RN leads to a 23percent increase in burnout and 15percent increase in job dissatisfaction. Meanwhile, the cost to replace an RN is about $42,000 for each general medical/surgical unit RN, and $64,000 to replace each specialty RN. (The Journal of the American Medical Association, October 23/30, 2002.)

“Safe staffing is our most pressing issue.  While we’re ahead on the issue because we have a union, staffing issues hurt the whole profession,” said Rose Szybka, RN, who works at Butler Memorial Hospital in Butler, PA.  “Safe staffing legislation is necessary before more harm is done to patients, and more RNs leave the profession.”

“Now that the facts have been established that California’s safe staffing bill has helped reverse the nursing shortage in California, Pennsylvanians should have to wait no more,” said Teri Evans, RN, who works at Crozer Chester Medical Center. “What has been won in California should be won in Pennsylvania for the sake of safe patient care.”

A similar RN -to-patient ratio bill, House Bill 147, has already been introduced in the Pennsylvania House by Representative Tim Solobay (D-48). 

PASNAP represent 5000 nurses and healthcare professionals throughout Pennsylvania. The National Nurses Organizing Committee, founded by the California Nurses Association in 2004, today represents 85,000 RNs in 50 states, making it the largest and fastest-growing association of direct-care RNs in the nation.

For more information, visit www.pennanurses.org

• Establishes minimum direct care registered RN-to-patient staffing ratios in all acute-care hospitals.
• Requires hospitals to “staff-up” from the ratios, based on individual patient acuity as set forth by a patient classification system created with RNs input. 
• Provides whistle blower protection for RNs who report unsafe patient care conditions or refuse unsafe patient care assignments.
• Affirms the duty and right of direct care nurses to advocate and provide care in the exclusive interests of patients.

Ratios and Patient Safety

• Increasing the number of full-time RNs on staff per day by one, there were 9percent fewer hospital-related deaths in intensive care units, 16percent fewer in surgical patients, and 6percent fewer in medical patients. — Healthcare Risk Management, February 2008
• Cutting RN-to-patient ratios to 1:4 nationally could save as many as 72,000 lives annually, and is less costly than many other basic safety interventions common in hospitals, including clot-busting medications for heart attacks and PAP tests for cervical cancer.  — Medical Care, Journal of the American Public Health Association, August 2005

Ratios and the Nursing Shortage
Since the passage of the nation’s first RN-to-patient ratio law in California:

• The number of actively licensed RNs in California increased by nearly 100,000 following enactment of the staffing ratio law.  (CA Board of Registered Nursing).
• The number of actively licensed RNs has grown by an average of more than 10,000 a year, compared to under 3,000 a year prior to the law. (CA Board of Registered Nursing). 
• There has been a 60percent increase in RN applications.

Ratios and Cost Savings
Safe RN ratios have produced cost savings for hospitals in reduced spending on temporary RNs and overtime costs, lower RN turnover, shorter patient lengths of stays, and improved patient outcomes.

• Adding 133,000 RNs to the U.S. hospital workforce would produce medical savings estimated at $6.1 billion in reduced patient care costs.—Medical Care, January 2009aising the proportion of RNs by increasing RN staffing to match the top 25 percent best staffed hospitals would produce net short-term cost savings of $242 million. — Health  Affairs, January/February 2006
• Preventing medical errors reduces loss of life and could reduce healthcare costs by as much as 30 percent. Insurers paid an additional $28,218 (52 percent more) and an additional $19,480 (48 percent more) for surgery patients who experienced acute respiratory failure or post-operative infections, compared with patients who did not experience either error. The post-discharge costs savings achieved by reducing adverse events might just be enough for the hospital to break-even on the investment in nursing. — Health Services Research, July 2008