Senate Committee Debates Nurse Staffing Ratios

NJHA President and CEO Betsy Ryan testified yesterday before the Senate Health and Human Services Committee on nurse staffing ratios as part of the state’s hospital licensing regulations.

The hospital licensing regulations are set to expire this summer, which is an opportunity for the Department of Health and Senior Services to revisit policies contained in the regulations. The hearing yesterday, called by committee Chairwoman Loretta Weinberg (D-Teaneck), focused specifically on licensing regulations regarding staffing.

Ryan spoke about the industry’s commitment to protecting patient safety and improving healthcare quality but maintained that imposing rigid nurse-to-patient staffing ratios is not a proven way to accomplish quality goals.

“In our continued quest for quality improvement, it’s important that we focus on a broad, holistic strategy that can truly enhance patient care and safety, rather than an approach that may seem like a quick fix,” Ryan said.

Ryan discussed the telling outcomes from similar legislation that passed in California, citing a 2009 study by the California Healthcare Foundation where no link was established between quality outcomes in California hospitals and increased nurse-to-patient ratios.

Ryan highlighted a successful model called Transforming Care at the Bedside that uses nurses’ skills and leadership to improve healthcare quality. This initiative is being led nationally by the Robert Wood Johnson Foundation and in New Jersey by NJHA. This project works directly with frontline staff nurses and their managers to implement rapid cycle improvement processes designed to improve the work environment, streamline systems and processes and eliminate waste so that nurses can spend more time in direct patient care.

“It is initiatives like this that address fundamental quality of care issues, including providing safe, reliable care; enhancing organizational effectiveness and efficiency and adapting to the ever-changing healthcare environment,” Ryan said.

Richard Hader, chief nurse executive for Meridian Health System, testified alongside Ryan to give a hospital system perspective of the detrimental impacts of nurse-to-patient staffing ratios. Meridian was the first hospital system in the country to be named a magnet facility, the highest honor a nursing organization can receive from the American Nurses Credentialing Center, Hader noted.

"Meridian Health System measures its staffing based on patient acuity," said Hader. "The census in hospital changes too dramatically to be mandated with a one-size-fits-all model of staff numbers."

DHSS Deputy Commissioner Mary O’Dowd also testified on the licensing responsibilities of the Department. She focused on stakeholder groups formed by DHSS to address safe patient handling and violence prevention regulations.

Committee members discussed whether there is a link between staffing ratios and quality improvement. Sen. Joseph Vitale (D-Woodbridge) highlighted new laws already in place that make information about both staffing and infection rates publicly available on the DHSS Web site.