From bad to worse

Nursing bill does nothing to solve the shortage

Published February 6, 2007 at midnight

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Well-run hospitals obviously should have a staffing plan for nurses that tries to meet the needs of patients, and probably nurses themselves should help develop it. But a state mandate to draft a particular type of plan, backed up by threats of a $5,000 fine per day for each violation aside from limited exemptions for emergencies? We certainly hope not.

According to its summary, Senate Bill 10, sponsored by Sen. Lois Tochtrop, D-Thornton, would require every hospital to adopt a staffing plan that "sets forth the minimum number of registered nurses, licensed practical nurses, and other personnel providing direct patient care required in each patient care unit in the hospital."

Hospitals would also have to keep detailed records - for every shift in every patient care unit - of the number of patients, admissions, discharges and transfers, and the mix of nursing personnel available to care for them.

Can you say "mountain of administrative paperwork"? As if that requirement weren't burdensome enough, the data would have to be reported to the state twice a year and made available to members of the public on request.

Yes, there is a genuine staffing issue: a shortage of nurses who want to practice in hospitals, and a shortage of nursing faculty to train people who want to be nurses.

Understaffing may, as advocates of the bill claim, be one of the factors that cause nurses to leave the profession. But it's a stretch to think this bill would bring them back through the very indirect mechanism of public disclosure leading patients to choose hospitals with higher staffing ratios. Other indicators of good care - patient outcomes, for instance - are of much greater concern, and staffing levels, by themselves, are not particularly informative to prospective patients who are in no position to know how to interpret them.

The estimated cost to the state is almost $100,000 a year, although legislative analysts still project the state will have to investigate more than 200 complaints a year and impose five penalties annually.

But the cost to the hospitals will be much greater, not only for the administrative paperwork, but for undergoing these investigations. The bill provides that hospitals are prohibited from retaliating or intimidating an employee who reports a staffing violation to the state, but says nothing about what happens if the report proves to be frivolous or even malicious.

Last year the legislature passed a measure establishing a hospital report card, to be issued starting in November. Before starting to tinker with it, as this bill does, legislators should wait to see how it works out.

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