Please join other Pennsylvania Medical Providers in opposing pending legislation before the General Assembly of Pennsylvania. If passed, House Bill 106 will significantly impact our ability to provide care to our patients on the medical floors of hospitals and especially through the emergency department. Pennsylvania House Bill 106 introduces mandatory staffing ratios for registered nurses across all hospital departments.
I will not report all the ratios but will highlight a few:
Emergency Department – 1:4
Telemetry Unit – 1:3
Medical/Surgical Unit – 1:4
Psychiatry Unit – 1:4
Pediatrics Unit – 1:3
These ratios are inviolable and will be enforced by steep fines. The first violation results in a warning, the second violation results in a $7,500 fine and each subsequent violation results in a $15,000 fine.
At first glance these ratios may seem reasonable and preferred. However, there are no variations allowed for time of day (overnight workload for medical surgical patients is significantly less than the daytime workload), no concessions made for ancillary staffing (i.e. the use of LPNs cannot affect the ratios), no concessions made for surge situations and no concessions made for staff call-outs.
Functionally, this will result in available but unstaffed beds on the inpatient floors. This in turn will lead to inpatient boarding in the emergency department. This results in fewer beds available to care for Emergency Department patients.
In addition, the Psychiatric Unit ratios will lead to a similar scenario with our behavioral health patients. There will be available but unstaffed beds at the various psychiatric hospitals we rely on. This will once again result in prolonged boarding of behavioral health patients in the Emergency Department.
The reported goals of these mandated ratios include nursing recruitment and retention as well as improved patient care outcomes. The case-study for these reforms is the state of California which instituted mandated ratios in 2004. A 2009 Assessment by the California HealthCare Foundation reported no change in patient length of stay or in adverse patient safety events despite these mandated lower nursing to patient ratios. Specifically, the rates of DVTs, Decubitus ulcers and post-operative sepsis rose slightly. While this law did result in more employed nurses at California hospitals it did not result in the primary goal of improved patient care. Also, California ranks in the top 10 (or bottom 10 depending on your perspective) for length of stay in the emergency department despite these mandated low nursing staffing ratios.
Please add your voice to ours in opposing this ill-conceived legislation before our patients suffer.
References:
1) Patient Safety Act (PA House Bill 106) - btCheck.cfm (state.pa.us)
2) Assessing the Impact of California’s Nurse Staffing Ratios on Hospitals and Patient Care (chcf.org)
3) ER wait times, by state (beckershospitalreview.com)
Updates
May 31, 2023
I honestly did not think this would gain this much steam so quickly and my inbox has been absolutely exploding with notes from others who see exactly why these ratios are going to break the system. It feels like we are finally starting to get some real traction which is wild because I was just staring at my computer screen feeling frustrated late at night when I started this whole thing.
5 Comments
This will all just back up into the ED and result in patient deaths of all the patients we will never get to see.
Simply, there are not enough nurses in the United states to make this restrictive bill effective. A study done in california on which this bill is based failed to show improvement in any significant patient metrics, in fact they got more DVTs!
This will cause huge backlogs in the waiting room. It will slow down the ER.
Vote no !
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Please join other Pennsylvania Medical Providers in opposing pending legislation before the General Assembly of Pennsylvania. If passed, House Bill 106 will significantly impact our ability to provide care to our patients on the medical floors of hospitals and especially through the emergency department. Pennsylvania House Bill 106 introduces mandatory staffing ratios for registered nurses across all hospital departments.
I will not report all the ratios but will highlight a few:
Emergency Department – 1:4
Telemetry Unit – 1:3
Medical/Surgical Unit – 1:4
Psychiatry Unit – 1:4
Pediatrics Unit – 1:3
These ratios are inviolable and will be enforced by steep fines. The first violation results in a warning, the second violation results in a $7,500 fine and each subsequent violation results in a $15,000 fine.
At first glance these ratios may seem reasonable and preferred. However, there are no variations allowed for time of day (overnight workload for medical surgical patients is significantly less than the daytime workload), no concessions made for ancillary staffing (i.e. the use of LPNs cannot affect the ratios), no concessions made for surge situations and no concessions made for staff call-outs.
Functionally, this will result in available but unstaffed beds on the inpatient floors. This in turn will lead to inpatient boarding in the emergency department. This results in fewer beds available to care for Emergency Department patients.
In addition, the Psychiatric Unit ratios will lead to a similar scenario with our behavioral health patients. There will be available but unstaffed beds at the various psychiatric hospitals we rely on. This will once again result in prolonged boarding of behavioral health patients in the Emergency Department.
The reported goals of these mandated ratios include nursing recruitment and retention as well as improved patient care outcomes. The case-study for these reforms is the state of California which instituted mandated ratios in 2004. A 2009 Assessment by the California HealthCare Foundation reported no change in patient length of stay or in adverse patient safety events despite these mandated lower nursing to patient ratios. Specifically, the rates of DVTs, Decubitus ulcers and post-operative sepsis rose slightly. While this law did result in more employed nurses at California hospitals it did not result in the primary goal of improved patient care. Also, California ranks in the top 10 (or bottom 10 depending on your perspective) for length of stay in the emergency department despite these mandated low nursing staffing ratios.
Please add your voice to ours in opposing this ill-conceived legislation before our patients suffer.
References:
1) Patient Safety Act (PA House Bill 106) - btCheck.cfm (state.pa.us)
2) Assessing the Impact of California’s Nurse Staffing Ratios on Hospitals and Patient Care (chcf.org)
3) ER wait times, by state (beckershospitalreview.com)
Updates
May 31, 2023
I honestly did not think this would gain this much steam so quickly and my inbox has been absolutely exploding with notes from others who see exactly why these ratios are going to break the system. It feels like we are finally starting to get some real traction which is wild because I was just staring at my computer screen feeling frustrated late at night when I started this whole thing.
5 Comments
This bill will negatively impact patient safety as an increased number of patients will boarded in the emergency department as floors on the hospital are closed to comply with the legislation.
This will all just back up into the ED and result in patient deaths of all the patients we will never get to see.
Simply, there are not enough nurses in the United states to make this restrictive bill effective. A study done in california on which this bill is based failed to show improvement in any significant patient metrics, in fact they got more DVTs!
This will cause huge backlogs in the waiting room. It will slow down the ER.
Vote no !
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This bill will negatively impact patient safety as an increased number of patients will boarded in the emergency department as floors on the hospital are closed to comply with the legislation.