Differing Approaches in Florida Bills Aimed at Improving Patient Care and Relieving the Nursing Shortage
For more than a decade, studies have supported the positive impact of adequate hospital nurse staffing on reducing patient complications and mortality, promoting safe work environments, and improving job satisfaction and retention among nurses. There seems to be little doubt that safe staffing is essential to promoting patient safety and quality health care. However, there has been much discussion in the health care community as to the best way to improve conditions and outcomes for patients in hospitals and to alleviate the nursing shortage.
Two versions of health care bills introduced in the Florida Legislature take different approaches to staffing and are supported by different nursing organizations. One pair of bills, filed as HB 1283 and SB 2316, has been referred to as the Florida Hospital Patient Protection Act of 2010 (Act). The Acts authors, Oscar Braynon and Senator Tony Hill, believe that optimal patient care and nursing staffing can be achieved by setting fixed nurse-to-patient ratios by law. For example, the Act would require that the direct care registered nurse-to-patient ratio for critical care patients in the emergency department shall be 1 to 2 or fewer at all times.
The primary advocates of the Bills are the nurses of NNOC-Florida, which is the state chapter of the National Nurses Organizing Committee (NNOC). NNOC is affiliated with National Nurses United, the new national union of registered nurses. They are joined in supporting the Act by SEIU Healthcare Florida and SEIU 1991, another professional association and union for registered nurses and healthcare workers.
Senator Dave Aronberg and Representative Ronald Brisé, propose another solution to the patient care and nursing shortage issue in SB 114 and HB 377 (Bills). The Bills would require that nursing staffing plans be established according to patient acuity, nurse experience level, nurse educational level, skill mix of staff on the unit, and other specific unit-level circumstances. Instead of a “one-size-fits-all” model, the Bills plan-based approach enables direct-care nurses to actively participate in developing safe staffing systems within their work settings. These plans would be based on each units needs and characteristics. A hospital would also be required to review the staffing plan with the hospitals nurses on an annual basis and provide the staffing plan to the public, upon request.
The Florida Nurses Association supports the Bills, which the association believes would hold hospitals accountable for establishing valid, reliable, unit-level nurse staffing plans consistent with the American Nurses Associations Principles for Nurse Staffing.
With research demonstrating that a primary cause of medical errors and sentinel events in hospitals is nurse under-staffing, the issue is ripe for resolution. What is not obvious, however, is the best way to improve the situation. The Bills and the Act are currently being reviewed in committee at the Florida Legislature with no clear indication at this time which approach will prevail.
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