The risk of a patient dying increases “significantly” following a period in hospital during which the number of nurses falls below the required level, according to emerging findings from a new study thought to be the first of its kind in England.
Previous research has often been contested because it has not been possible to show how staffing directly links to mortality – only that there is an association – and has also been based on data from overseas.
But in this latest study at an NHS trust, academics from the University of Southampton have shown that over the first five days of hospitalisation, for every day a patient was on a general medical or surgical ward with nurse staffing below what was typically required, the risk of death increased by 3%.
High-risk patients (those with an early warning score above six) were also more at risk of their observations not being taken when on a ward with lower numbers of nurses.
The academics found that, for every additional hour of care provided to a patient by a nurse in a 24-hour period, there was a 2% decrease in the likelihood of vital signs observations being missed.
In addition, higher levels of temporary nurse staffing were linked to an increased risk of patient death.
When 1.5 or more hours of nurse care were provided by temporary nurses to a patient in a 24-hour period, the risk of death increased by 12%.
The hospital’s average number of hours of nurse care per patient per day was 4.7, indicating that when around a third of those hours were delivered instead by a temporary nurse, the risk of mortality was heightened.
Patients whose stays included days with high patient turnover – in terms of admissions per nurse – were also associated with a significant increase in risk of death.
Meanwhile, for each day a patient was on a general ward that was staffed below what was typically required in terms of the number of care assistants, the risk of death increased by 4%.
The study results were based on data from 32 general medical and surgical wards in a large NHS hospital in England between 2012 and 2015.
It involved analysing around 914,000 patient days from 111,000 patients and three million sets of vital signs observations. Overall, 5.2% of patients died in hospital during that time.
The results from the study, called Nurse staffing, missed vital signs observations and mortality in hospital wards, have yet to be published in full, but early findings were presented at the Royal College of Nursing’s international nursing research conference in Oxford this month.
“This is an early analysis but these latest findings are consistent with a growing body of research that suggests having sufficient numbers of professional nurses spending time with patients and providing direct care will result in the best outcomes,” said Professor Peter Griffiths, who led the research.
“This is one of the first studies that directly links the nursing a patient receives to outcomes,” he told Nursing Times.
“The problems associated with the use of temporary nurses shown here highlights problems that arise from the significant shortage of nurses that is being experienced by the NHS,” he said.
I hope nurses across the country took a moment during Nurses Week 2015 to celebrate and reflect on all the amazing accomplishments of the year. I was amazed and inspired as I thought about the work of SEIU nurses, from the Ebola crisis to the continued attacks on the healthcare law, we played a critical role in shaping policy and educating our communities and patients.
If you haven’t already, consider sharing your story or nursing anecdote with all of us here.
As June approaches, we focus our energy on continuing to educate our colleagues and communities about what is at stake as the U.S. Supreme Court comes closer to a decision in the King v. Burwell case. The health of millions of Americans hangs in the balance and SEIU nurses have been out front on education efforts.
In this issue, we have some great information including:
Dian Palmer, RN
Chair, Nurse Alliance of SEIU Healthcare
Read More from Dian Palmer, President of the SEIU Healthcare Wisconsin
July 2, 2014
SEIU NURSE ALLIANCE ROUNDUP
Critical Month for Healthcare Law
This summer has brought many surprises already. While the shocking defeat of Congressman Eric Cantor — who led 50 votes to repeal the Affordable Care Act, supported Medicaid block grants and wanted to turn Medicare into a voucher system — may seem like good news, we should be worried that even that track record isn’t extreme enough for his Tea Party successor. It just reminds me how much is at stake in the 2014 elections for the Affordable Care Act.
A divided Supreme Court issued a decision in the Hobby Lobby case that is bad for women’s health, bad for working families and bad for basic workplace protections. It came down just minutes after the Harris v Quinn ruling, another closely divided ruling by the conservative wing of the Court that upheld collective bargaining rights for Illinois home care workers but also said that individuals, could reap the benefits of collective bargaining without paying a “fair share” fee.
The Hobby Lobby ruling stripped away the right of millions of working women and their families to make their personal healthcare decisions in consultation with their healthcare providers — not their bosses. SEIU President Mary Kay Henry immediately issued a statement warning that this decision -which Justice Ginsberg called “startling” in its breadth — could harm not only women but all workers. As nurses, we’ve advocated for decades for our patients, and we will continue this fight.
We have a lot of work to do, but I can’t imagine better colleagues with whom to be in this fight!
In this issue we also highlight:
Dian Palmer, RN
Chair, Nurse Alliance of SEIU Healthcare
News From The States
California, Florida, Pennsylvania and Wisconsin
Nurses Joined President Obama at the White House to Discuss Immigration
On Monday, June 9, President Obama met with nurses from across the country in the Oval Office, to discuss common sense immigration reform. The President underscored his commitment to passing reforms and highlighted the importance of this issue to nurses and medical professionals.
SEIU was represented by Janielle Alana Bennett, Care Pavillion , Folcroft, PA; Patricia Noemi Lopez, Riverside Community Hospital, Riverside, CA; Mary Malaney, Meriter Hospital, Madison, WI; Lejla Sivonjich, Allegheny General Hospital, Pittsburgh, PA; Alvin Nadal Vitug, Providence St. Joseph’s Medical Center, Simi Valley, CA; and Eva Zavatti, St. Mary’s Hospital in West Palm Beach, Hobe Sound, FL. These SEIU nurses shared their own immigration stories and their experiences with workers and their families from the frontlines of care.
LETTERS: SEIU-member nurses key great care
SEIU member Michael Collins sets the record straight in a letter published in the Las Vegas Sun Journal.
To the editor:
Richard Berman, a Washington, D.C., lobbyist for special interests and large corporations, recently wrote a commentary in which he offered a dangerous misdiagnosis of what’s ailing American hospitals (“Congress must curb SEIU’s health care imposition,” June 5 Review-Journal). As a nurse for 30 years who has spent my career making patients my priority, I would like to share my perspective on why the united voices of nurses and other health care providers make an enormously positive difference for patients.
To read the full letter, click here: http://www.reviewjournal.com/opinion/letters-seiu-member-nurses-key-great-care
US Labor Secretary Perez Meets with SEIU Nurses in Pittsburgh
US Secretary of Labor Thomas Perez traveled to Pittsburgh on June 11 to meet with frontline nurses at Allegheny General Hospital and recognize their collaborative work with hospital administrators as a national model of innovation for improving patient care and satisfaction while reducing costs.
“One of the best way to change the culture at AGH is to involve as many nurses as possible in studying a process, seeing its successes and flaws and leading the way to help fix it,” said AGH Chapter President Cathy Stoddart, RN. “Our work has been made possible because we as union nurses have the ability to have a significant voice on the job and the ability to foster strong, collaborative relationships with hospital administrators through our union.”
RNs have been working with management at AGH since 2003 to create unit-based Patient Care Committees and a hospital-wide Nurse Collaboration Council allowing nurses and management to think through issues together to make the hospital run more smoothly. Through these, nurses and management launched a variety of initiatives to improve quality and contain costs.
SEIU Nurse Named Citizen of the Day
Vanessa Patricelli, a SEIU 1199NW member, was named Washington State Citizen of the Day by Governor Jay Inslee for her work for her work reaching out and educating those in her community about the expansion of Medicaid and about the new healthcare law.
Patricelli is a 31-year-old registered nurse who works at Harborview Medical Center in Seattle. Back in November, she took two weeks off from her job to work full time promoting the new healthcare law.
In addition to setting up information tables at her hospital and talking to people on the street, Patricelli and her fellow SEIU 1199NW members spent time visiting small business owners in the Seattle area. They let them know how they could guide their employees to some of the lower-cost or even free healthcare plans that were starting Jan. 1.
Read the full post here: http://www.seiu.org/2014/01/he-asked-for-a-large-stack-of-fliers-and-business.php#more
News Nurses Need
Uninsured rate holds at record low in survey
The ratio of those without health insurance has fallen dramatically since last year but held steady at a new low of 13.4 percent for May and April, according to a poll.
A Gallup survey published Thursday shows the uninsured in the U.S. dropped from 17.4 percent in the last quarter of 2013, when HealthCare.gov launched, to 15.6 percent in the first quarter of this year, before eventually landing at 13.4 percent.
“The uninsured rate for U.S. adults appears to be leveling off since the open enrollment period for buying health insurance coverage through the marketplace ended in mid-April,” said Gallup. “Across nearly every major subgroup, the uninsured rate is lower now compared with the fourth quarter of 2013.”
Read the full article in the Hill: http://thehill.com/policy/healthcare/208340-uninsured-rate-holds-at-record-low-in-poll#.U5BuLJb2Nq8.twitter%23ixzz33lr4gHXf#ixzz34oTJquMj
Parkland’s Unique Wage Plan Spurs Employee Pay Discussion
At a meeting of the board, Parkland Health and Hospital System decided to raise the wages of their minimum wage employees with funds from an executive bonus pool. This decision created a great deal of discussion. Read an excerpt of the article below:
What makes the Parkland situation “unusual,” according to Reich, is how the wage hike is being funded. The cost of the new wages for low-income earners will be covered from an executive incentive pool, said Jim Dunn, Parkland’s executive vice president and chief talent officer. And this is not a one-time event. Dunn said the new $10.25-per-hour rate will become system policy going forward, even if Parkland doesn’t have executive incentives to cover the costs.
It sounds like a bold initiative for a safety net health system that nearly had its Medicare and Medicaid funding revoked, lost more than $450 million from operations in 2013, and is wrapping up construction of a new $1.3 billion hospital.
“If there is a year that Parkland does not have (incentives), Parkland will find a way to fund the increase through other efficiencies,” Dunn said. “We anticipate this will be very sustainable, post the move into the new hospital.”
“Our entry-level positions are just as valuable as our executives,” he added.
Click here to read the full article at Modern Healthcare: http://www.modernhealthcare.com/article/20140613/NEWS/306139940&utm_source=AltURL&utm_medium=email&utm_campaign=am?AllowView=VXQ0UnpwZTVEUFdkL1IzSkUvSHRlRU92ams4ZEErSmQ=&mh
Countdown to Coverage
Bloomberg News Poll: People Don’t Want Repeal
The Washington Post provides an analysis of the new Bloomberg News poll and finds that it will pose an additional problem to those who simply refuse to accept the reality that, while disapproval of the law remains high, the American people still want to stick with it:
What is your opinion of the health care law?
It should be repealed: 32
It may need small modifications, but we should see how it works: 56
It should be left alone: 10
So 66 percent support giving the law a chance to work with possible small modifications or leaving it alone, versus only 32 percent who want it done away with. This seems like fair wording.
To read the full story at the Washington Post: http://www.washingtonpost.com/blogs/plum-line/wp/2014/06/12/morning-plum-republicans-still-not-winning-argument-over-obamacare/
See the Bloomberg News poll: http://media.bloomberg.com/bb/avfile/rx0TpnA7.IPc
For Women Just Out Of Jail, Health Care Could Be Key To Better Life
The San Francisco Sheriff’s Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they’re released will help prevent them from committing another crime and coming back.
Read the full article in Kaiser Health News: http://www.kaiserhealthnews.org/Stories/2014/June/12/For-Women-Just-Out-Of-Jail-Health-Care-Could-Be-Key-To-Better-Life.aspx
Report: Medicaid expansion would help thousands of uninsured veterans
The chief executive of the Kansas Hospital Association, Tom Bell, penned an opinion piece highlighting the negative impact that the refusal to expand Medicaid is having on veterans and their families. Below is an excerpt from Bell’s opinion piece:
But for many, a local access point is problematic. One in 10 of the nation’s nonelderly veterans has no health insurance and does not use VA services — that’s 1.3 million veterans. Nearly 950,000 of their family members also lack coverage. That’s because nearly half of uninsured veterans have incomes below 138 percent of the federal poverty level — $26,951 for a family of three. At this level, veterans would be eligible for coverage under Medicaid as states expand their programs. In fact, if all states would expand Medicaid, nearly half of the nation’s uninsured veterans would have access to affordable health coverage.
For states like Kansas, that have rejected Medicaid expansion for the last two years, the situation is unfortunate. Kansas has 15,000 veterans and 10,000 family members without health insurance. Using the national percentage of 48.8 percent of veterans with incomes below the poverty level, the estimated number of Kansas veterans and family members who would be eligible for Medicaid coverage under expansion would be 12,200.
To read the full opinion piece click here: http://media.khi.org/news/documents/2014/06/11/Opinion_Tom_Bell_-_Veterans_Deserve_Better_June_11.pdf
To read the article about the release in the Kansas Health Institute click here: http://www.khi.org/news/2014/jun/11/report-medicaid-expansion-would-help-thousands-uni/
To read the Urban Institute Report click here: http://media.khi.org/news/documents/2014/06/11/Uninsured_Veterans.pdf
What We’re Reading
The App-Based Healthcare of the Future
At the Northside Festival in Brooklyn on Thursday (6/12/14), a small panel convened to discuss the ways our data-driven tech scene can work to the advantage of every patient in health care–but hasn’t. Called “Empowering the Most Important Caregiver: The Patient,” members included Chris Bradley, CEO of Mana Health, Mario Schlosser of health insurance startup Oscar, Rachel Winokur of Aetna’s tech services division Healthagen, and Paul Wilder of The NY eHealth Collaborative.
“All of this data is being generated in healthcare,” said Chris Bradley, “but it’s not helping the people who need it most.”
Recent announcements from companies like Apple suggest that the next big push in tech is going to be for our health.
To see the full article click here: http://www.thedailybeast.com/articles/2014/06/13/the-app-based-healthcare-of-the-future.html?utm_medium=email&utm_source=newsletter&utm_campaign=cheatsheet_afternoon&cid=newsletter%3Bemail%3Bcheatsheet_afternoon&utm_term=Cheat%20Sheet
‘Bionic Pancreas’ Works for 5 Days in Outpatient Settings
Progress toward the development of a closed-loop “artificial pancreas” has hit a new milestone, improving blood glucose levels in adults and teenagers with type 1 diabetes for 5 days straight in real-world settings.
The findings, from 2 separate studies of 20 adults and 32 adolescents, respectively, were presented here at the American Diabetes Association (ADA) 2014 Scientific Sessions by Steven J. Russell, MD, PhD, of the diabetes unit at Massachusetts General Hospital and Harvard Medical School, Boston. The study results were also simultaneously published in the New England Journal of Medicine.
Read the full article at Medscape: http://www.medscape.com/viewarticle/826779
The Nurse Alliance Roundup is now online.
Want to see past issues of the Nurse Alliance newsletter, beginning in 2013? Now you can.
I would like to say thank you to the over 400 nurses who recently traveled to Pittsburgh, Penn. for our biennial Nurse Alliance Conference. I heard from many nurses that they left reinvigorated to take on the challenges ahead and with a new network of colleagues to call upon. I too returned home feeling energized and excited about the future of nursing, the healthcare law and our Nurse Alliance. Check out the photographs from the conference (password is Bedside2Community, available until Nov. 15) as well as the highlight video that reflects on our work over the past two years.
I’d like to thank Jen Stange, for her stalwart and calm leadership in helping to plan this event, and Kathy Magaro, former Coordinator of the Nurse Alliance of Pennsylvania, who came out of retirement (again). They teamed up to make the conference a success. I also deeply appreciate the work of SEIU Healthcare PA.
The health marketplaces opened October 1, and have been met with overwhelming interest and enthusiasm by Americans. Over 19 million people have sought out information about lower-cost plans through healthcare.gov and state-based exchange websites. While there have been real technical challenges with the website, the Department of Health and Human Services (HHS) has brought on more staff to resolve the problems and is confident that they will be resolved.
In the mean time, we are emphasizing that for states like California and New York that are running their own marketplaces, Americans can go directly to their state marketplaces for more information and assistance. And SEIU members across the country are continuing to emphasize to their communities that that there are four ways to apply for lower-cost healthcare in federal exchange states: in person, over the phone, through the website and through the mail.
In this issue of Roundup, we highlight our healthcare fair and neighborhood canvass in Pittsburgh, celebrate the first steps toward healthcare coverage for 520,000 Pennsylvanians and 275,000 Ohioans through Medicaid expansion. We also feature a study that shows the link between job stress and depression.
The Nurse Alliance of SEIU Healthcare will host its biennial conference, Quality Care: SEIU Nurses Leading the Way from the Bedside to the Community, in Pittsburgh, Pennsylvania October 16-17. We look forward to the opportunity to share the latest innovations, best practices, shared challenges and build our skills.
The Nurse Alliance of SEIU Healthcare advances and strengthens the voice of nurses on the local and national levels; trains and empowers nurse leaders in policy-making and politics; and promotes quality, affordable and accessible healthcare that enhances positive health outcomes using evidence-based best practices. Follow them on Twitter and Facebook.
If you’re interested in attending the Nurse Alliance meeting, please contact your union representative or the closest HCWI office.
Elections are too often a flurry of talking points based on focus group data that are short on the details. During the Republican National Convention this week, I expect to hear a lot of speeches that have a lot of rhetoric but not a lot of facts.
One major concern for me and every American is the future of our nation’s health care system. The quality of that system affects us all, and we need details about the candidates’ approach to health care, not high-level talking points.
I write this as a lifelong Republican and registered nurse. The foremost priority for me and my colleagues is providing the best care possible to our patients.
We are deeply concerned that Mitt Romney and his running mate, Rep. Paul Ryan, share a prescription for our nation’s health care system grounded in partisan politics that are holding our country back – instead of the reality nurses face in hospitals, clinics and emergency rooms across the country.
Earlier this year, Romney embraced Ryan’s budget proposal. This plan is very clear. It would end Medicare as we know it, drastically cut Medicaid – a lifeline for seniors, people with disabilities and children – and end the benefits and insurance protections of the Affordable Care Act.
Here is who the Romney-Ryan prescription would hurt: everyone who is counting on Medicare to be there when they retire,
seniorswho rely on nursing home care, people with disabilities, children living below the poverty line, working families struggling to afford health insurance, people with pre-existing conditions and the list goes on. In short, most of the patients my fellow nurses and I treat on a daily basis.
Romney and Ryan would replace Medicare with a private-market plan that gives seniors a voucher toward the cost of care. The really bad news is the value of the voucher would not increase with the cost of care, leaving seniors faced with mounting premiums.
Both Romney and Ryan have said they support repealing the Affordable Care Act. This means all of the ways the law is strengthening Medicare for the long haul and saving seniors money would be wiped out. The law is currently saving older Americans who fall into the Medicare Part D “doughnut hole” $635 a year.
Under Romney and Ryan, those savings would be gone. Smart investments in preventive care, including free annual wellness visits and screenings, also would be gone. Stopping waste, fraud and abuse among Medicare providers intent on swindling seniors – no more. And guaranteeing Medicare benefits to every American at age 65 – a thing of the past.
This is no small matter. These benefits already have changed the lives of patients I have treated, such as Tom, who had a mild heart attack and was diagnosed with diabetes. Doctors prescribed medication to control his high blood pressure and blood sugar. Tom initially skipped scheduled doctor appointments and rationed his medication because he simply couldn’t afford it.
Last year, thanks to the health care law, he had a free wellness visit and his prescriptions cost less. Today, Tom makes it to all of his appointments and takes his medication as prescribed. Medicare recipients such as Tom may not know that these improvements are due to the law, but nurses do know and it matters.
Romney and Ryan also would cut $810 billion from Medicaid and put the quality of health care of the very young and the very old at grave risk. Medicaid provides health care for many working families, and it pays for just under half of all births each year.
While Medicaid is often thought of as a program for the very poor, it funds health care for nearly two-thirds of all older Americans in nursing homes, including many elderly veterans. Cutting Medicaid so drastically would mean that many seniors would lose nursing home care or lose the choice to remain at home and receive care.
The presidential election should be filled with facts – especially when it comes to health care. Romney has embraced Ryan’s plan for our nation’s health care system, but nurses know firsthand it would leave patients with too few choices, greater risks and higher costs.
I would ask Romney and Ryan to think about the care nurses deliver and how wrong their prescription is for the health and future of America. Patients’ lives are at stake.
This week is Women’s Health Week, and thanks to the Affordable Care Act, women will be leading longer, healthier lives because they now have access to critical services like maternity care and preventive checkups. Women’s health is critical to our economy, family and community because they are mothers, senators, sisters, CEOs, aunts, nurses, wives and friends.
Today, because of the healthcare law, women have more freedom and control over their own healthcare choices. In 2011, 20.4 million women with private health insurance gained expanded preventive services with no cost sharing – including mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits. Young adults can now stay on their parents’ health insurance until they turn 26 years old, so an additional 1.1 million women of that age have health insurance. Additionally, 24.7 million women enrolled in Medicare have received preventive services without cost-sharing – including an annual wellness visit, a personalized prevention plan, mammograms, and bone mass measurement for women at risk of osteoporosis.
Young adults can now stay on their parents’ health insurance until they turn 26 years old, so an additional 1.1 million women of that age have health insurance. Additionally, 24.7 million women enrolled in Medicare received preventive services without cost-sharing – including an annual wellness visit, a personalized prevention plan, mammograms, and bone mass measurement for women at risk of osteoporosis.
The full benefits of the healthcare law are being phased in over the next several years. This August, women will be able to access additional preventive services with no cost-sharing including well-woman visits, screening for gestational diabetes, domestic violence screening, breastfeeding supplies and contraceptive services. (more…)
Nurses see it every day in their care settings—patients who have delayed treatment, who don’t know how to access care or whose lives are shorter and sicker because they don’t have healthcare. For the 99%, access to quality, affordable healthcare is a matter of life and death. The 1% live almost 5 years longer than the 99%, and extremists are doubling down to make sure that trend continues through their efforts to eliminate the President’s Affordable Care Act and their drastic proposals to cut healthcare funding, including state budgets, Medicaid, Medicare and the Children’s Health Insurance Program.
March 23rd marks the two year anniversary of the Affordable Care Act becoming law. The working women and men of SEIU fought for more than a decade to achieve more affordable, secure healthcare and better health for our patients, our communities, our colleagues, our families and ourselves. As the most trusted voice in healthcare, SEIU nurse were critical to the passage of the law.
SEIU Nurses have been invited to purple up and bring their scrubs to participate in several fun and important days of action over March 26-28. Here are some highlights: (more…)