Real issue is staffing levels, not a nursing shortage

The Sept. 3 Bangor Daily News op-ed piece by Maine Hospital Association President Steven R. Michaud regarding nurse staffing levels in Maine was off the mark. Michaud criticized both the Maine State Nurses Association and the BDN editorial staff for advocating for patients’ health and safety by pushing for minimum nurse staffing levels. In a backhanded compliment to nurses, Michaud, and others like him, constantly talk about the importance of licensed professional nurses while also maintaining that hospitals should be free to cut critical nursing care.

First, let’s look at some facts that Michaud conveniently ignores:

? These were not new rules, the compromise was to strengthen the existing rules yet no changes were made on core staffing.

? Michaud claims there is a nursing shortage in Maine. That is simply not true, Maine has enough nurses. There are more than 20,000 licensed nurses in the state, more than enough nurses to meet staffing needs.

? The real problem is; thousands of licensed Maine nurses work outside the profession.

? Nurses cite understaffing and concern about appropriate patient care as a primary reason for leaving the profession.

? A federal study in 2000 concluded that Maine has more nurses working in non-nursing jobs than any other New England state.

The real issue is one of appropriate, safe patient care. On one side are the MSNA, patient advocates and, of course, the patients themselves. On the other side are hospital administrators, HMOs and other healthcare insurance companies who are constantly striving to maximize revenue by reducing expenses, often at the cost of dramatically compromised care.

In 1994, Maine hospitals instituted a nurse hiring freeze. That sparked the crisis of thousands of nurses eventually leaving the profession amid concerns of under staffing. That crisis continues today. With that in mind, MSNA initially approached the legislature about drafting minimum staffing legislation. Later, MSNA agreed to work with the Department of Human Services to strengthen the existing rules covering staffing levels. The department, hospital administrators, patient advocates and the nursing association worked diligently to strengthen the existing rules calling for a safe level of direct care nurse staffing.

It is important to understand, these are not new rules; they already existed. The idea behind negotiating a compromise was to strengthen the existing rules. The most important part of the rules was to assure safe staffing of direct care nurses for patients. The only part that was not strengthened, or even changed, was the level of staffing. In essence, Michaud and those on his side are merely supporting the status quo.

Unfortunately, much of what came from all that work was fluff. The DHS, at the behest of hospital administrators, insurers and others more concerned about costs than care counted many non-nurses in the final staffing levels. What this means is many people who never give hands-on patient care are counted as part of the nursing staff.

It is true that MSNA agreed with strengthening the existing rules, but negotiations ended too soon and did not address core staffing of direct care licensed nurses. Hospital administrators claim the negotiations produced a workable final product. On paper, the numbers look pretty good. Unfortunately, they are about as accurate as Enron’s books; rosy but dramatically inflated. MSNA believes the final rules drafted by the DHS’s Division of Licensing and Certification at best was a start, but nothing more.

Michaud, in his oped piece, falls back on the rhetoric of hospitals needing to provide more opportunities for nurses through continuing education, improved communications, leadership, and employee retention. Certainly those are laudable goals but when it comes to ensuring the highest possible patient care, the most important consideration is how many nurses there are in relation to the number of patients in any given unit. Studies have proven that a higher number of direct care registered nurses in a unit decrease the number of infections, complications, readmissions and death, ultimately saving healthcare dollars. In addition, more direct care nurses significantly reduce patients’ pain and suffering.

There are those who believe we should all give the revised rule a chance to work before asking for more direct care nurses. Professional nurses already know the new rule is inadequate. We believe it is not appropriate to adopt a wait and see attitude when it comes to your health care and that of your loved ones.

Patricia S. Philbrook, RNC, NP, is executive director of the Maine State Nurses Association.