Health care staffing crisis ailing rural hospitals

Everyone in Pennsylvania relies on and trusts our hospitals to keep us safe when we’re sick, but a catastrophic staffing crisis in healthcare is driving nurses away from the bedside and endangering patients.

If you’ve visited a friend or family member in a hospital recently, you probably noticed that their nurse didn’t have much time to stop and talk. That’s because nurses used to have four or maybe five patients but now care for seven or eight. That’s almost twice as many medications to deliver, treatments to provide, and call bells to answer. Our patients are paying the price of this crisis just as much as we are.

We know too well, from experience and from peer reviewed research, that nursing care suffers if nurses have too many patients. For every patient added over four patients per nurse, the risk of a surgical patient dying increases by 7%. Lower patient-to-nurse staffing ratios are also associated with significantly lower rates of cardiac arrest, hospital-acquired pneumonia, respiratory failure, patient falls, and pressure ulcers.

It’s tempting to blame this crisis on the pandemic, but the truth is that hospital executives put us on this path a long time ago. In pursuit of higher profit margins, hospitals cut back on staff and adopted management practices like “just in time” staffing that have put increasing pressure on nurses to do more with less. Now, nurses are fleeing the unsustainable and intolerable working conditions they’re facing day after day. In poll after poll, nurses say staffing is the number one issue affecting their ability to deliver safe and effective care, and it is also the top reason for job dissatisfaction.

There is no greater threat to our healthcare system right now than the staffing crisis, and legislation is required to fix it. Hospitals helped create this crisis, and they’ve had their opportunity to solve it. They haven’t. Yet as chair of the Health Committee in the Pennsylvania House, Representative Kathy Rapp has taken it upon herself to follow the lead of hospital lobbyists rather than nurses and block the most commonsense solution to the staffing crisis: safe staffing standards.

The Patient Safety Act, House Bill 106, would establish standards for how many patients a nurse should be assigned in every hospital in the state. Minimum staffing standards are not an unprecedented idea in Pennsylvania. When we drop our kids off at daycare, we can rest assured that the facility is legally required to limit the number of kids each childcare worker can have. Why should we accept less if our kids are in the hospital?

Every Pennsylvanian should get quality care at their hospital, regardless of what ZIP code it’s in. Better staffing has been shown to improve the financial performance of urban hospitals while having no negative impact on rural hospitals. Rep. Rapp, however, would rather peddle in fear by claiming that staffing mandates will close rural hospitals. California has had staffing standards in place for almost two decades and we have not seen any reports of hospitals closing as a result.

Safe staffing standards will also bring nurses back to the bedside. In a recent survey we conducted of nurses who left their jobs in the last two years, only one in 10 said they would consider taking a bedside nursing position in Pennsylvania in the future, but nearly half said they would consider it if the Patient Safety Act passes. Nurses want to work at the bedside, but only if it’s safe for them and their patients.

Improving working conditions for bedside nurses is also financially beneficial to hospitals. The cost of replacing a single burned-out nurse can cost as much as $80,000, and temporary staffing agencies are currently charging double or more the hourly wage rate of a staff nurse. Staffing standards will create a more stable workforce and more predictable costs for hospitals.

A bipartisan majority of representatives in the Pennsylvania House have co-sponsored the Patient Safety Act because they realize it’s good for nurses, good for patients, and can effectively address the staffing crisis in hospitals.

Representative Rapp’s arguments against the bill are wrong and she is wrong for standing between nurses and the safe staffing we need to bring nurses back to bedside and give every hospital patient in Pennsylvania the care they deserve. It’s time for her to move this bill.

Eileen Kelly, RN, Claudia Crane, RN, and Alex Rendina, RN, MSN, CMSRN are members of the Board of Directors of Nurses of Pennsylvania, an organization of, by and for nurses focused on improving the bedside care nurses provide with the goal of leading the state to a healthcare system that puts patients first.


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