Campaign for Patient Safety Reform Anne Tan Piazza WSNA Assistant Executive Director Governmental Affairs & Operations Every nurse I know want to care for their patients, just as they would their own family.   Recently, it’s been tougher for nurses to do the job you love. Like so many nurses, your first response was to try harder. Nurses are struggling to work harder, faster, longer hours to try to make sure their patients have what they need. But nurses across the state are telling us the same thing over and over: it’s NOT nurses who are falling short. Hospital CEOs are rigging the system against nurses and our patients. They’re reducing staffing so much that nurses can’t do the jobs we love and our patients are suffering. We are already put our hearts, sweat and backs into this job. When our patients are at risk, nurses somehow find just a little bit more to give. But there has to be a limit to what hospital CEOs ask of us and our patients. It’s time to hold hospital CEOs accountable. We can take the strength and hard work and heart that we offer to our patients and, together, make real change happen. That’s why WSNA is proposing the Patient Safety Reform Package. Because nurses are the heart of patient safety and it’s time to stand up and take back our ability to do the jobs we love.

“It’s the staffing, stupid.” Judy Huntington, MN, RN

Mountain of Research

Safe RN Staffing = Safe Patient Care 98,000 preventable hospital deaths each year Registered nurses intercept 86% of medication errors before there is harm to the patient Higher levels of nursing skill and nurses providing more hours of care are correlated with better care, shorter hospital stays, fewer infections and lower rate of failure to rescue

Safe RN Staffing = Safe Patient Care By adding just one more full-time RN per day, hospitals decreased the number of deaths in ICU’s by 9% and in surgeries by 16%  A standard has already been implemented in California, and they’ve seen an 11-14% drop in postsurgical patient deaths

Safe Staffing = Cost Savings Hospital reimbursement models such as paying for performance and value based purchasing, the focus is on financial incentives for higher quality care. Same reimbursement for same surgery regardless of length of stay. CDC estimates 1.7 million hospital acquired infections each year costing the US healthcare system between 28 billion to 33 billion dollars.  The average cost of each healthcare acquired infection is estimated to be $43,000. In 2008, Medicare implemented a new payment policy of not paying hospitals for the cost of treating identified hospital-acquired conditions such as falls and hospital acquired infections. A hospital is often paid the same amount for a patient undergoing gallbladder surgery regardless of whether the patient remains in the hospital for two days or seven days.

Safe Staffing = Cost Savings New graduate nurse turnover in hospitals is estimated to be as high as 55%-61% with many nurses leaving their first hospital job after just one year. The cost for a hospital to replace a single nurse is $80,000 in recruitment, orientation and mentoring costs. Every percentage point increase in nurse turnover costs the average hospital $300,000 per year, and hospitals that have high nurse turnover spend about $3.6 million more than hospitals that have high retention of nurses. A hospital is often paid the same amount for a patient undergoing gallbladder surgery regardless of whether the patient remains in the hospital for two days or seven days.

"The idea of the mind as a cool calculator that makes decisions by weighing the evidence bears no relation to how the brain actually works." Dr. Drew Westen, The Political Brain

"In politics, when reason and emotion collide, emotion invariably wins Dr. Drew Westen, The Political Brain 

Nurses ARE Heroes Nurses intercept most medical errors before any harm is caused to a patient Nurses work harder, faster, longer hours to care for patients like their own families It is time to hold hospital CEOs accountable for putting patient care first, just like nurses do Different kind of patient care We have the power to make a change Every nurse I know want to care for their patients, just as they would their own family.   Recently, it’s been tougher for nurses to do the job you love. Like so many nurses, your first response was to try harder. Nurses are struggling to work harder, faster, longer hours to try to make sure their patients have what they need. But nurses across the state are telling us the same thing over and over: it’s NOT nurses who are falling short. Hospital CEOs are rigging the system against nurses and our patients. They’re reducing staffing so much that nurses can’t do the jobs we love and our patients are suffering. We are already put our hearts, sweat and backs into this job. When our patients are at risk, nurses somehow find just a little bit more to give. But there has to be a limit to what hospital CEOs ask of us and our patients. It’s time to hold hospital CEOs accountable. We can take the strength and hard work and heart that we offer to our patients and, together, make real change happen. That’s why WSNA is proposing the Patient Safety Reform Package. Because nurses are the heart of patient safety and it’s time to stand up and take back our ability to do the jobs we love.

29% of those nurses saw a patient hurt by understaffing Nurses have seen understaffing harm or kill patients, and many see it as a chronic problem. 38% of nurses have witnessed patients being put at risk due to inadequate nurse staffing 29% of those nurses saw a patient hurt by understaffing 5% believe that patient’s death occurred as a result. Statewide independent survey of staffing nurses in Washington conducted in January 2013.

45% of nurses who have experienced understaffing threatening care say the problem occurs often 41% who have encountered the issue only once or twice

43% of these nurses experienced patients put at risk by understaffing Critical Care Units 43% of these nurses experienced patients put at risk by understaffing 9% of those saw patients die in that situation

ER and Psychology Units 46% of these nurses have had at least one situation where patients were put at risk by understaffing 41% of those had patients hurt or die in that situation

Nurses strongly support a law to set minimum staffing levels for patients. 82% of nurses favor “a proposed law that would set minimum nurse to patient staffing ratios in each hospital unit”

Patient Safety Standard Bill A standard keeps patients safe Hold Hospital CEOs Accountable Facts show that patient safety standards work The Patient Safety Standard Bill holds hospital CEOs accountable for having enough nurses per shift, so that patient care always comes before frivolous additions like fancy lobbies and inflated CEO salaries.   Here’s why the Patient Safety Standard Bill is part of the Patient Safety Reform Package: A standard keeps patients safe. We need a standard for the maximum number of patients per nurse. The “Patient Safety Standard” will be set for each unit so that Intensive Care is different than Radiology, but the standard will always make sure that the heart of patient safety – having enough nurses so that we can care for our patients – comes first. Hold Hospital CEOs Accountable. Each hospital already has a staffing committee, made up of a frontline team like nurses and managers. But under current law, CEOs can and do ignore the team on the front line and cut nurses in favor of fancy lobbies and inflated CEO salaries. This law would require CEOs to listen to their own staffing committee, and hold CEOs accountable so that the hospital’s staffing plan goes beyond the minimum when their staffing committee says that patient safety requires more. The Facts Show: Patient Safety Standards Work. · Every year, 98,000 patients die from preventable medical errors – as many as a plane crash every day. · By adding just one more full-time RN per day, hospitals decreased the number of deaths in ICU’s by 9% and in surgeries by 16%1. · A standard has already been implemented in California, and they’ve seen an 11-14% drop in post-surgical patient deaths2.

Patient Safety Standard Bill Safety Standards - Establishes minimum statewide staffing standards, maximum number of patients per nurse. Customization - Uses the current nurse staffing committees at each hospital to tailor staffing plans to the specific needs of each unit. Authority - Mandates that hospitals must implement the staffing plan approved by the nurse staffing committees above the minimum standard. Professional Judgment - Ensures that RNs are not assigned to other units without training and competency evaluation. Transparency - Collection and public disclosure of specific nursing sensitive patient outcomes data. Accountability - Prompt investigation of staffing complaints, corrective action required for violations with a potential civil penalty of $10,000 for violation.

44% of nurses say they very rarely or never get to take those breaks The vast majority of nurses are not getting the breaks they need, and they are being called in to work overtime to address chronic staff shortages. Only 9% of nurses say they always are able to take an uninterrupted 10-minute break every 4 hours and an uninterrupted 30-minute meal break. 44% of nurses say they very rarely or never get to take those breaks

Nurses are seeing lack of breaks and on-call abuse cause fatigue and jeopardize patient safety. 57% of nurses believe that lack of breaks, call requirements, and call back hours are causing nurse fatigue and jeopardizing patient safety at their hospital

Nurses are seeing lack of breaks and on-call abuse drive people out of nursing. 50% of nurses say that a lack of breaks and concern for patient safety has caused someone they know to leave their unit or profession, or it has caused them to consider doing so themselves

Nurses overwhelmingly support a law mandating an uninterrupted 10-minute break every 4 hours. 88% of nurses support “a law that required hospitals to give nurses at least a ten minute break for every four hours they worked, and required those breaks to be uninterrupted”

Real Breaks Keep Patients Safe Bill Nurses intercept 86% of medication errors before there is harm to patients Real breaks mean better care We can still put our patients first Real Breaks Keep Patients Safe Bill   Nurses are heroes; we intercept 86% of medication errors before there is harm to patients and we seem to always find a little more to give when our patients need us. But it’s not good for us or for our patients when we are forced to work 10, 12 or even more hours in a row without breaks because hospital CEOs didn’t staff enough nurses. Nurses often work 10, 12 or more hours, but they have to be sharp 100% of the time. Having uninterrupted breaks to refocus and recharge can literally be a lifesaver, but breaks don’t happen unless there are enough nurses on the shift. This bill requires that hospitals give nurses the uninterrupted breaks that we need to take care of our patients. We can still put our patients first. No nurse would ever abandon a patient while providing critical patient care or in the midst of surgery. There are times when a particular nurse is the only one who has the specific skills or expertise to help a patient, or there are times when local or national emergencies mean that all bets are off. The law makes sure that hospitals provide uninterrupted breaks while ensuring flexibility in circumstances where we need to be at a patient’s side.

Real Breaks Keep Patients Safe Bill Requires hospitals to provide uninterrupted meal and rest breaks. Preserves the nurse’s professional judgment by allowing breaks to be interrupted or delayed when the nurse on, or scheduled for, a break determines a clinical circumstance could lead to patient harm without his/her skill, expertise, or knowledge. Provides flexibility by allowing the rest break to be taken at any time during each 4 hour period. Hospitals are free to determine how to provide the breaks by working with the staff nurses in each unit in the development and implementation of mechanisms to ensure breaks.

On-Call Nurses are for Emergencies Bill CEOs are using a loophole to rig the system against nurses and our patients Forced overtime isn’t safe On-C all Nurses are for Emergencies Bill   It used to be that on-call nurses were our back-up plan, the ones that we called when a major accident happened. Now, the on-call nurses are more like a band-aid than a back-up, filling in for chronic shortages because some hospital CEOs just don’t hire enough nurses to cover a shift. We end up with a few overworked nurses and no back-up plan in an emergency. The On-Call Nurses are for Emergencies Bill says that on-call nurses are for emergencies, not chronic staff shortages. Here’s why this provision is part of the Patient Safety Reform Package: CEOs are using a loophole to rig the system against nurses and our patients. The On-Call Nurses are for Emergencies Bill closes a loophole in the Mandatory Overtime Law that some hospital CEOs are using to rig the system. They hire too few nurses, then use the on-call nurses to fill the gap. This provision requires that on-call nurses are preserved for emergencies, so we’ll have enough nurses when an emergency comes. Forced overtime isn’t safe. We want to work hard, but not be forced to do so when it’s unsafe. Nurses intercept 86% of medical errors before there is harm to patients, but we know that nurses who work shifts of 12.5 hours or longer are three times more likely to miss things. This bill says that overtime is voluntary, that on-call nurses should be for emergencies only and prevents hospitals from scheduling non-emergency procedures that require forced overtime.

On-Call Nurses are for Emergencies Bill On-call nurses should be for emergencies only and prevents hospitals from scheduling non-emergency procedures that require forced overtime Limits the use of prescheduled on-call for immediate and unanticipated patient care emergencies instead of chronic and foreseeable staff shortages Prohibits the scheduling of nonemergency procedures that would require overtime

Member Outreach Unprecedented effort including: RN Heroes Handbook Webpage info Webinars Phone calls Targeted local unit activities Advocacy Camp Lobby Days

Grassroots Action E-mails to Legislators 1000+ unique people used capwiz 3000+ individual emails sent Hand-written Letters 500+ handwritten letters collected and mailed to Legislators Advocacy Camp & Legislative Day 800+ attendees

Nurses are heroes, but we can’t do it alone!

Almost 2/3 of voters believe nurses are definitely or probably overworked

70% support a law to "set a maximum number of patients each nurse could care for in a hospital unit"

87% of voters favor a law that “requires hospitals to give nurses at least a ten minute break for every four hours they worked, and requires those breaks to be uninterrupted

Next Steps Public Outreach Member/RN Outreach Policymaker Engagement Community Partners Engagement Plans for 2013 and beyond

Our Representatives should work for us   We can make sure that our representatives work for “we the people.” Over and over, we have seen how even a small group of people can make a difference in this country - that is part of the promise of democracy and what has made America great. And nurses are not a small group. We number in the millions nationally, we are the most trusted professionals and our representatives know it. If we stand up, if we speak together, nothing can stop us. Our representatives need to hear us say that enough is enough. Patient care must come first and nurses are the heart of patient safety.