Campaign for
Patient Safety Reform
Anne Tan Piazza
WSNA Assistant Executive Director
Governmental Affairs & Operations
“It’s the staffing, stupid.”
Judy Huntington, MN, RN
Mountain of Research
Safe RN Staffing = Safe Patient Care
– 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 Staffing = Cost Savings
• 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 hospitalacquired 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.
"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 ARE HEROES
• 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 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 those
saw patients die in
that situation
ER and Psychology Units
46% of these
nurses have had at
least one situation
where 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”
Patient Safety Standard Bill
• 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.
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”
Real Breaks Keep Patients Safe Bill
• 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.
On-Call Nurses are for
Emergencies 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 nonemergency 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
Member Outreach
Unprecedented effort including:
• RN Heroes Handbook
• Webpage info
• Webinars
• Phone calls
• Targeted local unit activities
• Advocacy Camp
• Lobby Days
Grassroots Action
E-mails to Legislators
• 1000+ unique people used capwiz
• 3000+ individual emails sent
Hand-written Letters
• 500+ handwritten letters collected and
mailed to Legislators
Advocacy 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
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Public Outreach
Member/RN Outreach
Policymaker Engagement
Community Partners Engagement
Plans for 2013 and beyond