by Sean Power and Michael Wong

In May 2013, Congresswoman Jan Schakowsky reintroduced the Nurse Staffing Standards for Patient Safety and Quality Care Act. The proposed bill mandates minimum nurse-to-patient ratios at hospitals across the country.

The bill was first introduced in 2011 in light of research that linked low nurse staffing levels with higher probabilities of adverse events. As Rep Schakowsky explains:

“This bill will help save the lives of patients by improving nursing care in our nation’s hospitals … It’s time that hospitals develop nurse staffing plans that meets safe nurse-to-patient ratios to ensure quality care and patient safety.”

The American Association of Colleges of Nursing (AACN) states:

“The United States is projected to have a nursing shortage that is expected to intensify as baby boomers age and the need for health care grows. Compounding the problem is the fact that nursing colleges and universities across the country are struggling to expand enrollment levels to meet the rising demand for nursing care.”

Importance of nurses in preventing adverse events

As Schakowsky’s bill declares:

“Numerous studies have shown that patient outcomes are directly correlated to direct care registered nurse staffing levels”.

One such study was a 2007 systematic review of research on the association of registered nurse staffing levels and patient outcomes by Robert L. Kane, MD, and a team of researchers behind him. Dr. Kane’s study states:

“Greater RN staffing was consistently associated with a reduction in the adjusted odds ratio of hospital related mortality … Higher RN staffing was associated with lower odds of several patient adverse events.”

An Agency for Healthcare Research and Quality (AHRQ) study by Mark W. Stanton, M.A., ”Hospital Nurse Staffing and Quality of Care” found that lower levels of hospital nurse staffing are associated with more adverse outcomes. More particularly, “Some adverse patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality.”

According to research conducted by Linda Aiken, PhD, RN, and her colleagues, “Educational Levels of Hospital Nurses and Surgical Patient Mortality” found that in hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

As Ms. Aiken explains:

“Adequate staffing is essential to patient safety. Our study found a direct correlation between the number of nurses holding a bachelor’s degree and a reduction in the likelihood of patients dying within 30 days of admission and the odds of failure-to-rescue. For every ten percent increase in the number of nurses holding bachelor’s degrees, there was a corresponding five percent decrease in both patient deaths and failure-to-rescue.”

Technology provides nurses with a monitoring safety net and can help to prevent adverse events

Providing nurses with the tools and support they need to care for patients and ensure their safety is also critical.

A time and motion study of 767 medical-surgical nurses in 36 hospitals found that only 7.2 percent of their time is spent performing tasks such as assessing patients and reading vital signs.

Patient monitoring and assessment are crucial for preventing adverse events. Technology can amplify the nurse’s ability to monitor and assess patients.

As Juliana Morath, RN, MS (chief quality and safety officer, Vanderbilt University Medical Center) says:

“Human vigilance is required but insufficient, continuous electronic monitoring needs to be there to support and back up nurses, and allow them to visit a patient while monitors are continuously assessing other patients for various physiological parameters (such as, oxygenation with pulse oximeter and adequacy of ventilation with capnography).”

For example, Kelowna General Hospital in British Columbia has been able to achieve better management of surgical patients with obstructive sleep apnea by bringing capnography monitoring (which assesses adequacy of ventilation) to the patient’s bedside.

Lynn Gerein, RN, BScN (Network Director, Emergency & Trauma Services, Interior Health Medical Affairs and Clinical Networks) explained in an email:

“Implementing this process has increased the capacity to monitor more patients with diagnosed sleep apnea and allow them to be recovered on the unit with the appropriately trained staff that aligns with their surgical needs.”

Providing such a technological safety net beneath each patient has been shown to decrease or even eliminate adverse events. Since implementing continuous electronic monitoring of patients using patient-controlled analgesia pumps with integrated capnography monitoring, St. Joseph’s/Candler Hospitals has been “event free” for more than eight years. Moreover, they have demonstrated that being patient safe provided a significant return on investment.

Greater Monitoring and Nursing Resources Improve Patient Safety

Hospitals in America need more nurses, according to some experts. Rep. Schakowsky’s bill seeks to address that need at a federal policy level for all hospitals. Moreover, as Ms. Morath emphasizes, increased patient safety is a combination of nursing vigilance with continuous electronic monitoring.

“The stakes are just too high,” explains Ms. Morath. “We have a life in our hands – someone’s family member or loved one.”

• Respiratory Compromise