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Ohio nurses could get relief from some of their work force woes, if a recently introduced bill passes through the state’s legislative branch. Ohio House Bill 78, sponsored by Rep. Ann Womer Benjamin (R-District 75), would accomplish two much-needed goals, according to the Ohio Nurses’ Association (ONA):
1. require a health care facility to meet minimum staffing requirements based on a system that assesses patient health needs;
2. prohibit health care facilities from mandating that a nurse work overtime.
"This is not the first attempt to address staffing by any means, but it is the first comprehensive bill," says Peggy Noble, RN, government affairs specialist for the ONA. Other states, like California, have passed staffing laws to try to reduce the patient-nurse ratio. "We don’t think that’s so smart, really, because five patients may be all very critically ill and require constant nursing attention, or they may be all ready to go home and self-sufficient. Each day you need a different level of nursing, so a ratio is not the best approach," she says. "We want to make sure the staffing systems are valid and reliable, and they’re out there according to industry standards. And we want to have the hospital check every six months to make sure it works for them," she explains.
HB 78 has several components, including:
• A health care facility shall require each patient care unit in the facility to meet or exceed minimum staffing requirements established for each work shift by an assessment of patient health care needs conducted by an RN using the patient classification system. The staffing requirements shall be implemented through a staffing plan that is developed for each patient care unit.
• The staffing plan developed for each patient care unit for each work shift must be consistent with acceptable and prevailing standards of safe nursing care and with the American Nurses Association’s principles for nurse staffing.
• When comparing staffing requirements to other staffing requirements established under another provision of the Revised Code or an administrative rule, the facility shall comply with the more stringent staffing requirement.
• Each health care facility shall establish a committee, at least one-half comprised by RNs who provide direct care to patients, for the purpose of selecting the patient classification system to be used in establishing staffing requirements.
• Each health care facility’s patient classification committee shall develop an internal review mechanism. Not later than six months after the effective date of this section, each committee shall complete its development of the internal review mechanism and conduct an internal review of the patient classification system it has selected. Thereafter, the committee shall conduct an internal review of the system at least once each year.
• Notwithstanding any provision of state or federal law to the contrary, a health care facility shall not require an RN to work overtime.
In a report from the ONA, the nurse staffing situation was compared to the requirements for airline pilots and flight attendants, who are given a maximum amount of time each day they can work. Pilots are responsible for the safety of those under their watch, just as hospital patients are under the watch of hospital nurses. When they are overworked or overtired, safety is compromised. Noble notes, "A nurse in her 19th hour on the job may make a mistake in giving medication — and that mistake could be deadly."
Will case management feel the effects of this much talked about nursing shortage? Russell C. Coile Jr., MBA, a well-known health care futurist and author of the new book, Futurescan 2001: A Millennium Forecast of Healthcare Trends 2001-2005, says it’s a possibility. "There’s a shortage of everybody," he says. "If staffing shortages continue to get worse, eventually even the more attractive nursing positions [like case management] would feel some pinch, but I think they would out-compete many other nursing opportunities. Everyone is going to try to work toward retention strategies," he adds.
Noble agrees. "This bill [HB 78] is also a bill for retention, so that the nurses we have can count on a day soon when there’s no mandatory overtime and no unsafe staffing levels . . . so that they will stay the course. California’s retention is going up due to its bill, and I assume that ours would, too," she says. "You’ve got to retain; that’s the highest initiative."
[For more information, contact:
• Peggy Noble, RN, JD, Government Affairs Specialist, Ohio Nurses Association, 4000 E. Main St., Columbus, OH 43213. Telephone: (614) 237-5414.]