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Problem Memorandum AssignmentTO: Senator Kemp Hannon, Chair New York State Health CommitteeFROM: Shannon R. O’Neill, RNDATE: February 18, 2015RE: New York State Legislation for Mandatory Acute Care Nurse to Patient Ratio Dear Senator Hannon:My name is Shannon O’Neill, I am one of over 227, 000 nurses in New York State, as a constituent it is a paramount concern I urge you to support The Registered Nurse Safe Staffing Act H.R. 876 that was referred to the Health Committee in April of 2013. Acute care nurse staffing ratios has a direct impact not only on the outcome of an individual patient but also impacts the state of the healthcare system. New Yorkers are entitled to healthcare that is high quality and ensures their safety, the best way to achieve those goals are to enact legislation that mandates hospitals to comply with nurse to patient ratios based on a unit and acuity. Poor staffing levels directly affect the quality of care that can be provided to patients. As a pediatric oncology nurse I can attest to the fact myself and my co-workers are able to provide the highest quality of care when we are staffed appropriately, a nurse to patient ratio of 1:3. Nurses review every order placed by a doctor and double checks the accuracy of the order, nurses constantly assess and observe for any change in patients condition and acts on those changes. If a nurse has a high patient ratio the nurse will not be able to provide frequent rounds to assess patient for changes in condition. According to Staggs V. S., & He, J. (2013) never events such as falls and pressure ulcers acquired in a hospital which are avoidable when RN staffing levels are higher. This is significant because never events are not eligible for reimbursement and are costly if they occur. “Nursing surveillance is an important aspect of monitoring quality improvement projects and for the evaluation of effective nursing care. A significant relationship was reported between staffing and length of stay, suggest that early recognition and treatment of potential adverse events led to earlier discharges.” (Lewis-Vogel, T., Pechlavanidis, E., Burke, C., et al 2012). Earlier recognition and treatment of adverse events will drive down healthcare cost. Staggs, V. S., & He, J. (2013) study also reported a reduction of patient days by 5.7% when there was an increase in RN staffing levels. High nurse to patient ratios has a costly impact on New York State. Factors that contribute to the costly effect include the fact that nurses have, increased incidence of nurse burnout and patients have poorer outcomes increasing both mortality and readmission rates. Nurses are a large component to keeping readmission rates down through spending time with a patient and educating and empowering patients on self-care through helping patients understand importance of medication regimen adherence, importance of diet adherence, ways to reduce infection and various other skills to care for self at home. Aiken et al (2002) a study of 168 hospitals “implies that that the odds of patient mortality increased by 7% for every additional patient in the average nurses’ workload in the hospital and the difference from 4 to 6 from 4 to 8 patients per nurse would be accompanied by 14% and 31% increases in mortality, respectively.” Aiken et al (2002) study also indicated “nurses in hospitals with the highest patient to nurse ratios are more than twice as likely to experience job related burnout and almost twice as likely to be dissatisfied with their jobs compared to nurses in hospitals with lower rates.” (Aiken,L.H., Clarke, S.P., Sloan, D.M et al 2002) Since nurses are 24 hour watch dogs for their patients ensuring appropriate nurse to patient ratios should be of utmost importance to assure safe, high quality and to cost effective healthcare. I greatly appreciate you consideration on this matter. I would like to see legislation enacted to ensure safe and appropriate registered nurse to patient ratios.Sincerely,Shannon R O’Neill371 Fort Washington Avenue 4CNew York, NY 10033917-664-2470oneillshan@ReferencesAiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993.Lewis-Voepel, T., Pechlavanidis, E., Burke, C., & Talsma, A. (2012). Nursing surveillance moderates the relationship between staffing levels and pediatric postoperative serious adverse events: A nested-case control study. International Journal of Nursing Studies, 50(7), 905–913?Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346(22), 1715-1722.Staggs, V. S., & He, J. (2013). Recent trends in hospital nurse staffing in the United States. Journal of Nursing Administration, 43(7/8), 388-393. ................
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