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State nurses rail against bill requiring minimum nurse-to-patient ratios

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The New Jersey State Nurses Association, a trade group that represents roughly 125,000 registered nurses in the state, is arguing against a new bill that would require medical care facilities and hospitals to establish minimum nurse-to-patient ratios.

The bill, S-989, sponsored by state Sen. Joseph Vitale, D-19th District, states that “minimum nurse-to-patient ratios will vary depending on the type of unit, and will range from one registered professional nurse for every five patients in a behavioral health or psychiatric or a medical/surgical unit, to one registered professional nurse for every patient under anesthesia in an operating room. The regulations adopted by the Commissioner of Health are not to decrease any nurse-to-patient staffing ratios that are already in effect on the bill’s effective date.”

Judith Schmidt, NJSNA’s CEO, argues the new bill could decrease the quality of care for patients because it could set up situations in which an inexperienced nurses would have to handle emergency situations. She added “ratios are rigid and dictate a set number of staff, which is not the best model for optimal patient care, which constantly changes. We need to give the nurses at the bedside the authority and the accountability for staffing their units as needed.”

Instead, nurse managers need to be held more accountable for staffing based on the patient needs and nurse skill levels, Schmidt said in a statement.

“This bill does not address some of the key issues that occur with staffing, such as the constantly changing needs of patients,” said Schmidt in a public statement. “Staffing is not about a specific number, but the appropriate mix of how sick the patients are, which dictates how much care they need, plus the level of experience of the nurse.”

Schmidt also said that the bill does not address the availability of assistive personnel such as nursing assistants, transporters and technicians. 

“With healthcare economics the way they are, hospitals are going to have to eliminate some of the assistive positions,” she said. “Nurses and their assistants have the most contact, one-on-one time and direct care of patients within the healthcare system.”

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Vince Calio

Vince Calio

Vince Calio covers healthcare and manufacturing for NJBIZ. You can contact him at vcalio@njbiz.com.

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Suzan Shinazy February 8, 2018 1:22 am

This is the obvious problem with what Schmit wants: Medical errors are the #3 cause of death in the US, with 440,000 deaths and millions more left disabled, and these numbers are increasing. Study after study proves patient outcomes are much worse when nurses are given too many patients, as is happening now. Do you want your loved one safe in a well staffed hospital? I do, and that is why I stand for safe nurse:patients staffing ratios. I do agree the aides and ancillary staff should also have mandated ratios because when Califonia implemented safe staffing ratios for RN's, the hospital laid off ancillary staff and gave the RN's more jobs to do that way.

Andrew Lopez, RN February 8, 2018 4:19 am

Which state nurses exactly? Did the NJSNA poll it's nurses? Exactly what percentage of NJ nurses are members? Seems the NJSNA,is quite out of touch with the daily grind, needs of bedside nurses.

Michelle February 8, 2018 1:20 pm

I am a registered nurse in the State of New Jersey. The NJSNA does not speak for me. We need patient ratios. Healthcare is a business and all the hospitals want to make money. This type of Bill has been law in California for years and all the studies have shown increased care and benefits for patients since it was enacted. Nurse's save lives, but only if they have the necessary time to spend with their patients.

Nurse M February 8, 2018 1:49 pm

Do you have any idea what nurses face? Too few nurses, too many patients. We don’t even get the resource staff they say will be taken away. Nurse managers load us up with absolutely unsafe assignments. We have NO input into staffing. ANA is nothing but suits, long removed from bedside care. This all boils down to money. It’s disgraceful.

Kris February 9, 2018 9:06 pm

Nurse/Patient ratios make sense for the benefit of patients as well as nurses. Stop giving lip service to the need for nurses to keep their "bedside authority" which is non existent. Put in place mandatory max patient to nurse ratios AND include empowerment within nursing units to call for and receive additional staff as necessary during a shift. BOTH should have been in place long ago! The days of profits before patients must end!

Kristine Fry February 9, 2018 9:34 pm

Nurses are not rallying against it, the nurse managers and those in the pockets of hospital corporations are willing to come out against it because it will cost the hospitals money. But what it will also do is improve patient outcomes. Research has shown that lower nurse to patient ratio's improve patient outcomes.

Kathy February 10, 2018 12:04 am

6:1 ratio on a Med sure floor is considered “good”. With that, it leaves the nurse only 10 minutes per patient per hour. To assess, treat and Medicate, barely enough time to actually connect with the patient. God forbid the nurse has a discharge, which takes 30 minutes at minimum to double check that the doctor ordered the correct discharge meds, because the RN will be in trouble if she does not remind the doctor to do what’s right. And of course, the nurse will hand if the patient has not been offered and/or given the flu or pneumonia vaccine. Then there’s always an admission waiting as soon as that patient leaves, and that takes at least an hour to complete. So, now we have 6.5 hours left in our day. Even less time to spend with the patients. Lunch break? Bathroom break? RARELY. And this is on a good day. Other days it’s 7:1 or 8:1. Judith Smith does not speak for the bedside nurse.

AhmadCCRN February 10, 2018 1:40 am

Judith does not represent NJ Nurses- the ANA and the NJSNA are governed by nurse managers and nurse executives and hence they are supporting measures that benefit the hospital administrators and their trade association NJ Hospital Association.

Minimum patient ratios does NOT prevent hospitals from adjusting staffing based on patient acuity or nurse experience. Rather, it prevents the hospital from forcing nurses to take unsafe patient assignments which lead to more injuries, medication errors, infections, and deaths.

Countless literature state the increase in mortality and infection rates for patients who are cared for by nurses who have high patient loads. Why are we allowing patients to be cared for in unsafe environments? It’s truly sad that patients and the community have the perception that the hospital is a safe place to receive care. I always encourage my friends and family and even patient family members to stay in the hospital and remain very present while their loved one is admitted in a hospital. The hospital is one of the most dangerous places to be and that is a sad fact.

The reality is, corporate greed is preventing patients from receiving safe care.

We need minimum patient ratios now. The nurses at the bedside providing care for patients support this bill because we have our patients best interest at heart, whereas the hospital executives and nurse managers prioritize economics and budget bonuses.

@ahmadccrn on Twitter

Barbara February 10, 2018 12:43 pm

This comment does not reflect the thinking of thousands of bedside nurses. It is the reflection of nurses who have not seen a bedpan in years and would not know what to do with one. Nurses who are in administration are only worried about their paycheck and how to make the rank and file do more with even less. The bottom line is not money. It is patient and nurse safety.

Steve W RN February 9, 2018 12:59 pm

I am saddened to see a Nursing Organization, which claims to speak for 125,000 NJ Nurses has chosen the side of the AHA and hospital administrators, do not be fooled Mr. Adubato, this organization does not speak for the nurses who toil at the bedside in this great state. Most of the members of this organization are decades removed from the bedside, which isn't a bad thing per say, but it blinds them to their bias, and their bias is to side against the very people and profession they claim to represent.

Not in my name.