Local Matters
MONTPELIER -- Under federal food-labeling laws, grocery shoppers have a right to know how many grams of fat, sugar, sodium and carbohydrates are in a can of soup or frozen dinner they buy at the supermarket. Now, some health professionals and union activists want to give health-care consumers the same right to know the number of nurses and aides on duty during a given hospital shift, and require the hospitals to post those numbers daily where patients and visitors can see them.
Last week, the Vermont House of Representatives approved a bill that would require Vermont's 16 hospitals to disclose how many registered nurses, licensed practical nurses and licensed nurse assistants are staffing each hospital unit, as well as the maximum number of patients assigned to each staff person.
A chief sponsor of H.227, also known as the "Safe Staffing and Quality Patient Care" bill, is Anne Donahue (R-Northfield), a member of the House Human Services Committee, which reported it. The measure is backed by the Vermont Federation of Nurses and Health Professionals. Supporters contend that the provision will help the public make more informed decisions about where they seek medical care, and would pressure hospitals to be more competitive in their staff-to-patient ratios.
Opposing the bill is the Vermont Association of Hospital and Health Systems, which represents the state's hospitals. The group claims the measure will do little to improve patient outcomes or quality assurance. The organization adds that it will burden the hospitals with needless paperwork and drive up administrative costs, without providing the public with a meaningful way of gauging patient care.
A particularly controversial provision would have mandated specific staff-to-patient ratios for various hospital units. Those measures were removed from the bill following intense lobbying by the hospitals.
Jennifer Henry, a recovery nurse at Fletcher Allen Health Care and president of the nurses' union Local 5221, says this bill isn't meant to highlight what the hospitals are doing wrong or to pass judgment on their current staffing levels. Rather, she says, it's a way to provide the community with information that's already gathered by the hospitals but not made public. As she puts it, "It's a lot like knowing what's in your water or knowing about the background of the companies your money is invested in."
Henry points to a number of studies over the years that indicate a correlation between high patient-to-staff ratios and medical errors, infections, patient injuries and avoidable deaths. If Vermont's hospitals are forced to publicly divulge their staffing levels, Henry asserts, it will pressure them to do more to address the state's acute nursing shortage.
Henry cites an example from just last week, when she got a phone call at 11 p.m. from a nurse in Fletcher Allen's oncology unit who informed her there were 22 patients on the floor but only three nurses on duty. She suggests that if the hospital was required to post such information, "something would change." Henry adds that understaffing, long hours and burnout are driving nurses away from the profession in droves.
Fletcher Allen refers all questions about H.227 to Bea Grause, president and CEO of the Vermont Association of Hospitals and Health Systems. Grause says she supports one provision of the bill, which would allow nurses to sit on the committee that examines what performance data must be reported as part of the annual "hospital report card."
However, Grause is strongly opposed to the rest of the bill, and contends that it will do little or nothing to improve patient care or provide patients and their families with meaningful data. "You're taking numbers on a sheet and asking people to interpret whether this means good quality or bad quality," Grause says. "It just doesn't translate for them."
While Grause acknowledges several studies show a link between staffing and patient outcomes, she claims that, thus far, no one has been able to determine precisely what the best ratios are.
Jeanne Keller, a health-care policy analyst with the Burlington consulting firm Keller & Fuller, Inc., is skeptical that the bill would correct any of the problems its supporters claim it will. She says she's concerned that it will leave the hospitals "spinning their wheels when we really need them spending their time on more meaningful data."
Keller spent two years working on an advisory committee to the Vermont Department of Banking, Insurance, Securities and Health Care Administration. The committee's task was to come up with various measures for gauging hospital performance, such as post-surgical infection and pneumonia rates of patients on ventilators. Keller warns that nurse-to-patient ratios can be difficult to assess and the numbers can be massaged to show whatever interested parties want them to show.
She believes there are easier, cheaper and less controversial ways to improve patient outcomes. Keller points out that simply boosting the rate of hand washing among medical staff has been shown to dramatically reduce infection rates and lower complications. She also notes that when hospitals don't perform certain procedures frequently enough, hospital staff doesn't develop the proficiency to do them well. Keller adds that requiring hospitals to report these types of figures would more effectively lower health-care costs, and would give hospitals more bang for their administrative buck.
Supporters of H.227 acknowledge that the bill isn't a magic bullet for health-care reform, but they do call it a useful first step in bringing the issue to the public's attention. Representative Donahue asks, "What makes for good quality care and less expensive care?" Having fewer nurses so that costs go down, or having more nurses so that we have better outcomes and fewer side effects, infections and so forth that cost us a whole lot more?"
Donahue admits that no one has been able to adequately answer that question for her. However, she believes this bill is just one more "piece of the puzzle we get on the table so that people are more educated and informed."