nursing ratios

Safe staffing saves lives in craniotomy patients

June 24, 2021 by Rayan Calimlim Leave a Comment

A study of data from Korea’s National Health Insurance Service has found that in-hospital mortality of craniotomy patients could be decreased by more than half if nurse-to-patient ratios were reduced in both post-surgical and intensive care wards.

The study analysed data from 46,779 craniotomy patients in 203 hospitals in Korea, which found statistically significant differences between patients who had received care in well-staffed hospitals compared to those without.

In particular, they determined after accounting for variables such as hospital size and patient comorbidities, that patients cared for in post-surgical wards with ratios of 4.5 patients per nurse were twice as likely to die compared to those in wards with ratios of less than 3.5 patients per nurse.

Similarly, patients who had to be admitted to intensive care wards post-craniotomy were more than half as likely to survive if they were staffed to a ratio of 0.88 patients per nurse or lower, as compared to being staffed to a level of 1.25 patients per nurse

“The results provide evidence that higher RN staffing level was associated with a lower risk of in-hospital mortality,” the authors concluded.

“Since the RN staffing level is related to the in-hospital mortality rate of craniotomy patients, sufficient staffing level of RNs should be ensured to reduce in-hospital mortality”.

The NSW Nurses and Midwives’ Association is campaigning for safe nurse-to-patient ratios across the state. To find out or more or to support their cause, visit their campaign website.

“NSW Health thinks staffing is safe and there are no workload problems”

June 1, 2021 by Rayan Calimlim Leave a Comment

Our ratios claim is backed by incontrovertible clinical evidence. In Queensland, ratios are paying for themselves and more. A host of economists, including the head of the Reserve Bank, is calling for significant pay rises to boost the Australian economy. Yet, the NSW government wilfully refuses to listen. Least of all, to the voices of nurses and midwives who have given their all at the frontline.

“Enough is enough”. That’s the message NSW nurses and midwives are taking to their communities in the face of intransigence from the state government in response to our pay and conditions claim.

NSW Health has rejected all our 2021 Ratios and Conditions Claim. On 15 April it offered a 1.04 per cent pay rise. This is well below the 4.7 per cent increase claimed by the Association to make up for the 0.3 per cent wage freeze imposed on nurses and midwives last year.

NSWNMA General Secretary, Brett Holmes, said the government and NSW Health think nothing needs to change.

“They think your staffing is safe, there are no workload problems and that nurses and midwives’ registration is safe,” he said.

“They need to hear that the system is in crisis and it is nurses and midwives holding the precarious health system together.”

Brett says the Association wrote to the premier asking the government to work with us to implement shift-by-shift ratios and to seek a meeting with a group of nurses and midwives.

“To date, the premier has ignored nurses and midwives,” he said.

NSWNMA members have not taken the government’s insulting response lying down.

During May, nurses and midwives turned out in large numbers in rallies held throughout the state, including the combined branches in the Lower Hunter, Shellharbour Hospital, Prince of Wales Hospital with the Royal Hospital for Women, Prince of Wales Mental Health and Sydney Children’s Hospital.

Westmead; Cumberland and Westmead Kids Hospitals; Mount Druitt, Auburn, Blacktown Hospital, Canterbury; Maitland, John Hunter Hospital and Belmont Hospital; Balmain Hospital and South East Regional Hospital, Bega, have also held lunchtime rallies.

As The Lamp goes to press, members are conducting extraordinary branch meetings to vote on whether to accept the state government’s paltry offer of a 1.04 per cent pay rise and no improvements to staffing.

Research debunks criticism of ratios

Our campaign for shift-by-shift ratios has been boosted by a groundbreaking study of Queensland’s ratios by an international team of researchers (see pp 10–11).

Experts from the University of Pennsylvania, in collaboration with the Queensland University of Technology’s School of Nursing, say Queensland’s experience with ratios “offers insights for the jurisdictions that are debating minimum nurse-to-patient ratio policies”.

The Queensland study adds to decades of research showing that improved nurse staffing levels lead to better patient outcomes.

But the Queensland evaluation goes further. It also debunks criticisms of ratios that have been levelled after their implementation in Victoria and California.

“Opponents argued that little information existed about the return on investment from the additional nurses required as a result of a ratios mandate. Our findings fill these gaps,” it said.

The evaluation found that savings due to fewer readmissions and shorter length of stay were more than twice the cost of the additional nurse staffing.

Another criticism was that ratios were “inflexible”.

“Queensland mandated a minimum average staffing level at the ward level – an individual could have more or fewer as long as the average number of patients per nurse didn’t exceed ratio limits,” the researchers said.

“This offered more flexibility in patient assignments. Our analysis suggests that Queensland’s flexible design is feasible and yields good outcomes.”

“The results … suggest that minimum nurse-to-patient ratio policies are a feasible policy instrument to improve nurse staffing, produce better patient outcomes, and yield a good return on investment.”

Decent pay rises are good for the economy

The pay component of our claim is also consistent with what prominent economists say is necessary for the Australian economy to bounce back from the pandemic.

The Governor of the Reserve Bank of Australia has made it clear that wage growth in Australia needs to be at least three per cent per year for the country to prosper.

This is in line with analyses by the International Monetary Fund and the International Labour Organization.

In other Australian states, governments have rewarded their nurses and midwives with pay increases well in excess of NSW.

COD considers all options

At our latest Committee of Delegates meeting, a resolution passed that expressed “frustration and anger at the recent rejection of members’ ratios and safe staffing claims, along with the meagre pay offer by the Ministry of Health”.

“The Ministry has failed to recognise and address the  current staffing crisis in NSW Health. The evidence is clearly demonstrated in Queensland and Victoria, showing that shift-by-shift ratios is the solution to this staffing crisis,” it said.

“We see no other option but to … consider all options to convince the government of the need for a fair pay increase and mandated shift-by-shift ratios in NSW, to ensure safe patient care.”

Our campaign takes to TV

The NSWNMA has launched a TV ad to alert the public to the critical state of our public hospital system, under even more pressure as the result of the pandemic:

Watch the ad at www.ratioslifeordeath.org.au

Strong link between understaffing and healthcare associated infections: study

May 20, 2021 by Rayan Calimlim Leave a Comment

A study conducted by the Columbia University School of Nursing has found an association between nursing understaffing and healthcare associated infections (HAIs), resulting in billions added to healthcare costs annually.

The study, which examined more than 100,000 patients, found that patients were 15% more likely to develop HAIs on or after the third day of exposure to understaffing, as compared to their counterparts in properly staffed wards.

“As they often serve as coordinators within multidisciplinary health care teams, nurses play a critical role in preventing HAIs, which is a top priority for improving quality of care”, said study author Dr Jingjing Shang, an associate professor at Columbia.

“Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses, and our study shows that hospitals should ensure adequate nurse staffing to provide the safest patient care.”

Dr Shang also noted that reducing understaffing within nursing teams provided an opportunity to “reduce hospital costs”, noting that the increase in infections and complications caused by understaffing” adds billions to healthcare costs annually.

The study also noted that where units were understaffed, nurses experienced excessive workloads, leading to compromised infection control practices and surveillance activities.

Understaffing linked to omissions in care: study

March 29, 2021 by Rayan Calimlim Leave a Comment

It sounds pretty obvious, but a study by an international team in the Journal of Advanced Nursing has found a link between understaffing and reported incidents of missed care.

The study, called The Association between Nurse Staffing and Omissions of Care, was conducted in inpatient medical and surgical wards across Europe, Asia and the USA.

It found overwhelming evidence of an association between lower levels of staffing and reports of missed care. For instance, the study found that in eight of the European studies, 75% of nurses reported missing at least one element of necessary care on their last shift.

Further, the study also found that in wards where there was a higher nurse-to-patient ratio, the odds of missing care increased.

Instances of missed care included emotional support and education, patient mobility and mouth care, as well as proper assessment and documentation.

These tasks are critical to the provision of proper care to patients, and their omission can lead to poorer patient outcomes or mistakes being made.

It’s further evidence that safe nurse-to-patient ratios are needed across the board. Safe staffing reduces missed care – and puts patient safety first.

You can read the report on the National Institute for Health Research website here.

Better ratios mean improved outcomes in paediatric emergency

March 22, 2021 by Rayan Calimlim Leave a Comment

Increased nurse staffing has a marked effect upon patient outcomes in paediatric emergency departments, a recent study has shown.

The study, published in the Journal of Clinical Nursing, analysed administrative data of 21,956 patients gathered from a university hospital’s paediatric emergency department in the first half of 2019.

It found that increases of nursing numbers reduced the average stay of patients in the emergency department by 2% per additional nursing staff member.

Further, the study found that a decline in nurse-to-patient ratios correlated with an increase of patients leaving before treatment completion.

It concluded that nurse-to-patient ratios did in fact affect patient outcomes and quality of care in the scenario studied.

While studies on the effects of nurse-to-patient ratios on patient outcomes have been commonplace over the past few decades, the study is the first to focus on a paediatric emergency department.

The study was conducted by a Finish team, led by nursing academic Katja Janhunen.

High nurse-to-patient ratios put COVID response at risk: study

March 19, 2021 by Rayan Calimlim Leave a Comment

An American study has concluded that the lack of nurse-to-patient ratio legislation in much of the country has jeopardised their COVID-19 recovery.

The joint study by the University of Pennsylvania, the Leonard Davis Institute of Health Economics and the National Council of State Boards of Nursing found that high and variable nurse-to-patient ratios in much of the United States left nurses working burnt-out and understaffed – affecting both patient care and staff morale in the early stages of the pandemic.

The study analysed survey data from nurses and patients in 257 hospitals in Illinois and New York, and compared it to data collected from California, where nurse-to-patient ratios have been legislated since 2004.

It found that nurse-to-patient ratios varied from 3.3 – 9.7 patients per nurse in medical and surgical wards, while intensive care unit staffing ranged from 1.3 – 3.6 patients per nurse.

This variability and often large ratio led to over half of survey respondents indicating that they had been suffering from burnout from before the pandemic. Many rated the quality of care at their hospitals as being sub-standard, as did many patients.

As a result of this burnout, the authors of the study found that many nurses entered the pandemic with mental and physical health issues, which resulted in adverse outcomes for patients and negatively affected the American health response to the pandemic.

“The COVID-19 pandemic has highlighted shortcomings in US healthcare”, the authors said in their conclusion.

“Our findings point specifically to the risks posed to the public’s health of wide variation in hospital nurse staffing if allowed to persist. Such risks could be addressed by safe nurse staffing policies”.

The NSW Nurses and Midwives’ Association is currently campaigning for safe nurse-to-patient ratios to be mandated in NSW. To find out more about this campaign, visit their website.