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Local Nurses Speak Out on Movement to Regulate Nurse to Patient Ratio
(Photo courtesy of Nurses of Pennsylvania)
Nurses of Pennsylvania is a grassroots, non-profit organization of nurses focused on improving the care nurses provide by creating a healthcare system that puts patients first. Currently, one of the organization’s main focuses is state legislation that would regulate nurse to patient ratios in hospitals and care facilities.
Locally, Tina Siegel, a Clarion resident and LPN with over 30 years experience; Shelbie Stromyer, a Venango County resident and RN with a bachelor’s degree and over 30 years experience; and Eileen Kelly, a Warren County resident and RN with a bachelor’s degree and 20 years experience, are among the local nurses involved in the organization.
According to Stromyer, the organization, which was officially founded in 2017, grew out of some serious issues in the healthcare industry. She said that “it started with a few nurses who had enough.”
The problem, Stromyer explained, is an issue with the staffing of nurses in facilities across the state and the number of patients or residents each nurse is expected to be responsible for.
“It is getting ridiculous, our patients are dying, our babies are dying, there’s so much going on, and no one cares. It’s all about the dollar, but nobody is taking a look at these patients. These nurses decided we are responsible for these patients and it’s time to stand up.”
The statistics are telling. A recent survey of 1,000 bedside nurses across Pennsylvania found 94% say their facility does not have enough nursing staff, 95% have been unable to provide the best care as a result, and 84% said high turnover is a problem where they work.
Kelly told exploreClarion.com, “Right now, nurses are working on their breaks, they’re working on their lunches that they’re not getting paid for. They’re working to finish their charting, so they don’t stay overtime and get in trouble for staying overtime. It’s wage theft.”
“These facilities are not paying for the work that all of these nurses are doing on their own time because they’re pushed so hard. They’re stealing money, and I believe that. I’ve done it. When I was a younger nurse, I did it, I stayed on my unit, I did charting while I was eating all the time. One of my jobs, when I started I was told I couldn’t leave the facility to go for lunch, I couldn’t leave the unit. I drove an hour and a half to get there and an hour and a half home and worked 12-hour shifts that turned out to be 14 hours and all I wanted was my thirty minutes off the floor, and I was told ‘no.’ I left shortly thereafter. I really truly couldn’t function that way anymore. I had no choice.”
“And, that’s a standard practice,” added Stromyer.
“You talk to any healthcare professional or worker, they’ll tell you, ‘no, we don’t get breaks. You’re lucky if you have a bag of chips out of a vending machine and a cold cup of coffee.'”
According to the Nurses of Pennsylvania, such long shifts under the constant stress of too many patients, and without breaks, is contributing to everything from a high rate of occupational injuries and nurse burnout to patient infections and even deaths, and the statistics seem to support their conclusions.
Siegel said that “at one point they said working in a nursing home, as far as injuries, you’re only second to coal miners.”
According to the Bureau of Labor Statistics, in 2017, nursing and residential care facilities actually had the highest rate of nonfatal occupational injuries and illness of any industry in the nation.
“I had an orthopedic surgeon tell me he sees more nurses with major injuries than he sees construction workers. Then I went on the CDC site and started looking it up, and it was almost verbatim what he told me, and no one is addressing it because if we break, we’re just out the door and the next one comes in,” noted Stromyer.
While injuries may contribute somewhat to a high turnover rate, nurse burnout is also a serious problem.
The Pennsylvania Department of Health’s most recent licensure survey showed that the highest factor in job dissatisfaction for registered nurses was staffing, and burnout was the most common reported reason for those under the age of 50 leaving the field.
These problems don’t just affect nurses, though; they also affect the patients in their care. Research on issues affecting patients lean toward supporting a need for change.
According to a study on staffing and patient mortality published in the Journal of the American Medical Association, each additional patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase in the odds of failure-to-rescue.
Nurses are aware of these problems, as well, and say their concern for both their patients and themselves is a part of the issue.
“There’s not a nursing shortage,” Kelly said. “There’s plenty of nurses, but there’s a lot of nurses that don’t want to work the job anymore because, for one thing, I can absolutely say, we fear for our licenses, as well as the patients. Our licenses are ours, they’re not the companies’ that we work for. They don’t own them, we do.
“The state board of nursing oversees us and makes sure that we, as nurses, are doing what we committed to do, but we’re being torn. We’re being asked to do more than we’re capable of, which puts ourselves and the patients at risk, and when something goes wrong, what’s going to happen? A patient may die, and we’re the ones in trouble.”
“I kept going to my administration and saying I can’t do this. One nurse can’t do all this,” Siegel noted.
“I never got out of there on time, and I would wake up in the middle of the night with a cold sweat. ‘Did I do this? Did I give that person their medication?’ It ended up I had to take time off because I just couldn’t handle it anymore, it was just too much. Now I’m back in it again, but during that time I learned, if I don’t speak up for myself and my residents, nobody else is going to do it.”
Burnouts may also contribute to other issues with patients.
A study on nurse staffing, burnout, and healthcare-associated infection found that hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, which also saved an estimated 68 million dollars.
“This is for the good of our community. It’s not like we’re saying we want more money. We’re asking for nothing as far as a wage increase or anything like that. We just want to take care of our patients. We want to make sure they’re getting the best care. And, we want to make sure we’re safe on the floor, as well,” Stromyer said.
“You’ve got elderly people who are dying in nursing homes because nurses don’t have time to get to them. I had a CNA tell me she had 20 people she was responsible for. Now, some people take an hour just to feed, so who’s not getting fed? People are getting really upset, and it’s not because they don’t want to work hard, it’s because they’re upset at what’s going on with these patients. Things have to change.”
The change the Nurses of Pennsylvania organization is supporting comes in the form of safe patient limit laws.
They are asking legislators to co-sponsor House Bill 867 sponsored by Rep. Gene DiGirolamo and Senate Bill 450 sponsored by Sen. Maria Collett RN that would establish safe patient limits in Pennsylvania hospitals and care facilities.
“Hospital administrators are focusing on staffing committees, but there’s no accountability. Every single committee, in every single facility, could want something different and could say they want this, but if you don’t meet it, well, that’s okay, maybe next time. There’s just no accountability, and that’s not working. We’ve been there. We’ve seen it,” Kelly said.
The legislation the nurses are supporting would create that accountability, along with regulations mandating the minimum nurse to patient ratio in different facilities. They’ve been lobbying in Harrisburg and attempting to meet with local legislators to garner support for the bills.
“We’re generally hearing from some legislators that they don’t like mandates: ‘We don’t want to have the government control this,'” Kelly said.
“Well, a good comparison we came up with is childcare. You take your child to a childcare facility, that one childcare worker can only have so many children, and that’s mandated by law. That’s great; that’s a good thing. We want that, too, and there are ways to cover nurse staffing.”
According to Kelly, some facility administrators have voiced concern about having a nurse call in sick and suddenly being out of compliance with the law, but that argument doesn’t hold much sway.
“You have back-up plans, and we can tell you many of them because we’ve done them for years and years,” she noted. “We have float nurses in the hospital that come in, and that’s all they do is float and they go where they’re needed when they’re needed at that time. If one unit is overloaded, you take one nurse from that unit and move them to the unit that doesn’t have enough. You can also have on-call nurses. They don’t get paid a full nursing wage while they’re on-call. ORs in the country do it seven days a week, 24 hours a day: why can’t you do it for the rest of the hospital and have a couple of float nurses? There are ways to handle this.”
The discussions of cost versus savings and how shifts would be covered are all important, but according to the nurses, what really matters most is the people.
“All we want to do is just take care of our patients the best we can,” Stromyer said.
“We’re just trying to get the word out, and get people to understand, this would set up how many patients are regulated to each nurse, and it’s a doable thing.”
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