107th Congress

Registered Nurse Staffing: Acute Care

Message to Congress The most reliable and cost-effective way to ensure high-quality inpatient care is to provide an adequate number of registered nurses (RNs) at the bedside. ANA urges Members of Congress to support efforts to: Support the Patient Safety Act of 2001 (H.R.1804, S. 863) which would require Medicare providers to publically report nurse staffing levels and mix, and patient outcomes. Require acute care facilities to develop and implement valid and reliable staffing methodologies as a condition of participation in Medicare and Medicaid.

The Issues Surrounding the Registered Nurse Staffing in Acute Care

• Adequate staffing levels allow nurses the time that they need to make patient assessments, complete nursing tasks, and respond to health care emergencies. It also increases nurse satisfaction and reduces turnover. For these reasons, ANA supports efforts to require facilities to implement and use a valid and reliable staffing plan as a condition of participation in the Medicare and Medicaid programs.

• During the past decade, health care providers have implemented aggressive measures to reduce the costs of health care. As nurse salaries are the single largest hospital expense (representing 20% of the average hospital budget), we were some of the first to feel the pinch. In fact, census data shows that between 1994 and 1997 RN wages across all employment settings dropped by an average of 1.5 percent per year (in constant 1997 dollars). Between 1993 and 1997, the average wage of an RN employed in a hospital dropped by roughly a dollar an hour (in real terms).

• These changes have often resulted in RN staffing levels that are inadequate to promote and protect the safety and quality of patient care. These changes have occurred at the same time that the patient acuity has increased, the use of sophisticated technology has increased, and the length of stay has decreased. The combination of these factors has created a situation that threatens patient safety.

• ANA has long maintained that the safety and quality of care provided in the nation's health care facilities are directly related to the number and mix of direct care nursing staff. In fact, four agencies with the Department of Health and Human Services recently sponsored a joint study on this very topic. The resulting report (Nurse Staffing and Patient Outcomes in Hospitals, released on April 20, 2001) found strong and consistent evidence that increased RN staffing is directly related to the decreased incidence of urinary tract infections, pneumonia, shock, upper gastrointestinal bleeding, and shorter hospital lengths of stay.

• Recent research conducted by the Center for Health Outcomes and Policy Research at the University of Pennsylvania shows that 70-80% of more than 43,000 registered nurses surveyed in five countries reported that there are not enough RNs in hospitals to provide high quality care. Only 33% of the American nurses surveyed believed that hospital staffing is sufficient to "get work done."

• ANA's recent survey of American nurses states that 75 percent of nurses surveyed feel that the quality of nursing care at the facility in which they work has declined over the past two years. Out of nearly 7,300 respondents, over 5,000 nurses (68 percent) cited inadequate staffing as a major contributing factor to the decline in quality of care. More than half of the respondents believed that the time they have available for patient care has decreased.

• The public at large should be alarmed that more than 40 percent of the respondents to the ANA survey stated that they would not feel comfortable having a family member cared for in the facility in which they work.

Return to U.S. Federal Affairs.

Search	Contact ANA	Join/Renew Membership	Members Only	Online CE
NursingInsiderSpecial Offersnursesbooks.org © 2008 The American Nurses Association, Inc. All Rights Reserved Copyright Policy | Privacy Statement