A bill that mandates new, more extensive nurse staffing levels at hospitals, ambulatory surgery centers and other health care facilities was supported by nurses and opposed by hospitals at a legislative hearing Monday afternoon in Trenton.State Sen. Joseph F. Vitale (D-Woodbridge), chair of the Senate health committee, sponsored S1183 and convened the 1 p.m. hearing before his committee.
The state Department of Health currently requires hospitals to have a patient acuity system in place to determine the number of nurses needed per shift, based on the level of patient illness; on certain units, such as intensive care, DOH requires specific nurse/patient ratios.
The bill would require one registered professional nurse for every six patients on a medical/surgical unit for the first year after the regulations are adopted, and one nurse for every five patients thereafter. And it would set specific nurse/patient ratios in a number of clinical areas, such a trauma units, surgery and maternity.
“New Jersey laws and regulations governing patient safety have failed to keep pace with changing technology, nurse practice and the health care needs of our patients,” Ann Twomey, President of HPAE, representing 12,000 nurses and health care workers, said in a statement.
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Alongside nurses’ groups, staff working for the DOH responsible for conducting hospital inspections called for additional measures to ensure compliance with staffing standards.
“The purpose of this bill will only succeed if there is oversight to ensure compliance. Patients and their families need the security of safe nurse staffing regulations, but nurses need the State Department of Health to enforce the rules and take timely action. Without regular, proactive hospital inspections, adequate resources and prioritization at the state level to ensure compliance, these facilities will fail patients when staffing cuts undermine quality care,” said Adam Liebtag, president of Communications Workers of America Local 1036, representing state inspectors and investigators.
Neil Eicher, vice president, government relations, at the New Jersey Hospital Association, said the state’s hospitals are making quality improvement strides without this bill, which he said would significantly increase hospital costs. NJHA estimated that the bill would require the state’s acute care hospitals to hire 2,054 additional registered nurses at an annual cost of $159 million.
This bill has been introduced in the past but hadn’t come up for a vote by the Legislature, something Vitale said he expects will happen in the current legislative session.
“There are hospitals in our state that do a very good job at maintaining appropriate staffing levels and there are others that I fear don’t,” Vitale said. “The argument of course at times is economic, but if patients are not receiving around-the-clock care in the appropriate manner because of a poor staffing level, that is something we have to address as a Legislature.”
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Scott Bergman, chair of the government relations committee of New Jersey Association of Ambulatory Surgery Centers, said “While we oppose the bill in its current form, we are currently reviewing the bill and its impact on ambulatory surgery centers and patient care. We look forward to working Senator Vitale on this.”
Eicher of the NJHA noted that New Jersey hospitals ranked fourth in the country in the latest Hospital Safety Score from the nonprofit Leapfrog Group, with 52 percent receiving an “A” Grade. And he said the NJHA’s Partnership for Patients has significantly improved patient safety.
Eicher said hospital staffing is addressed by federal guidelines as well as state Department of Health regulations.
“If mandated staffing standards puts additional financial pressure on hospitals, unintended consequences such as unit or hospital closures, lower technology or infrastructure investments, or reductions in quality or access may ensue,” Eicher said. “New Jersey hospitals continue to make the delivery of quality care a main priority for their institutions. During this unprecedented time of transformation, hospitals are making the financial and community investments in improving the quality of care at their facilities.
“Enacting a law that would specifically prescribe the way hospitals must staff every unit of the hospital would detract from the hospital’s path toward achieving this goal.”
Elfrieda Johnson, president of District Council 1 of the union JNESO, representing 5,000 nurses and health care workers in New Jersey and Pennsylvania, said: “Research and experience have demonstrated that safe nurse staffing ratios lead to better patient outcomes, better nurse retention, and a cost savings for hospitals. Every person in the state of New Jersey should be able to walk into a hospital and expect the same standard of care regardless of where they live or what hospital they visit. New Jersey’s patients should expect nothing less.”
The nurses contended that, in some cases, nurses have resigned in the face of understaffing that they felt threatened the safety of their patients.
“Registered nurses focus everyday on providing safe and effective care for our patients. That’s why we went into nursing in the first place. Without appropriate levels of nurse staffing, we fall short of our professional obligation and purpose, and we are losing nurses as a result. We know that having enough nurses by the bedside improves patient outcomes and their ability to care for themselves upon discharge.” said Maria Refinski, president of a unit of CWA Local 1091, representing 1500 RNs.
Charles Wowkanech, president the New Jersey AFL-CIO, said: “The nurses advocating for patients and safety are doing so because they have protection from retaliation as unionized nurses. They are asking for standards on behalf of every patient in New Jersey, and every nurse and health care worker who cannot speak up. Their voices need to be listened to.”
The consumer organization New Jersey Citizen Action is a member of the coalition supporting the bill.
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