During the pandemic, anecdotes have surfaced from frontline nurses – especially nurses – about unsafe conditions for patients.
One example is Crystal Johnson, an emergency room nurse at Emanate Health Inter-Community Hospital in Covina, California.
The hospital saw an increase in COVID-19 during the holiday season and in the weeks thereafter. Speaking to Modern Healthcare last month, Johnson called for a state waiver that would allow hospitals to introduce higher nurse staffing rates, resulting in below-average patient care.
"They prioritize your care based on current needs," she said. "It's completely unsafe."
California is one of two states with mandatory nurse quotas. However, when there was a surge in COVID-19 in December, Governor Gavin Newsom introduced a waiver for the second time since the pandemic began, which allowed hospitals to increase nurse staffing rates when they see a spate of cases through one accelerated process. The exemptions allowed ED nurses to care for up to six out of four patients at a time.
In a statement, Rob Curry, CEO of Emanate Health, said the waiver was a necessary and temporary measure. He also said he was proud of the response from his staff as the pandemic is nearly a year old. "Since the beginning of the COVID-19 pandemic, maintaining the safety and health of our patients and employees has been our top priority."
California this month suspended all current exemptions, along with declines in COVID cases, except in "unprecedented circumstances," the state said.
But Johnson described a challenging experience. "You don't know what to expect and you don't know if you can provide the care they need to the patients who come to your emergency room. It's very stressful," she said at the time.
Nurses usually point out poor staffing when they talk about underperforming patient care. The American Nurses Association calls it the biggest problem nurses face right now, according to Katie Boston-Leary, director of the association's nursing programs.
Nursing staff has become more of a challenge during the pandemic for a variety of reasons, including an overburdened healthcare system, nursing care, or temporary or permanent staff resignations.
And the shortage of nurses could be an even bigger problem in the future as nurses are reported to be leaving the profession. When New York was hit by its first COVID spike in the spring, elderly nurses decided to take early retirement, said Judy Sheridan-Gonzalez, an ED nurse at Montefiore Medical Center and president of the New York State Nurses Association.
The ANA is concerned that more nurses are leaving the workforce after COVID, Boston-Leary added.
There is some research that shows that better nurse staffing rates lead to better patient care. A study published last year in the American Journal of Infection Control found that an additional patient with sepsis assigned to a nurse was associated with higher mortality rates, 60-day readmission, and longer length of stay. The study used data from 116 New York hospitals.
"This type of chronic understaffing of nurses is not just a public health problem where patients are more likely to die. … But in the long run it is a money-losing strategy for hospitals because we show in our research that things like shorter stays (and the avoidance of readmission) could result in significant cost savings, ”said Karen Lasater, lead author of the study and assistant professor of nursing at the University of Pennsylvania.
In California, where care quotas have been mandated for over two decades, the impact on quality is less clear. A study from 2012 shows mixed results on the quality of care since the Relationship Act came into force.
The American Nurses Association is not advocating mandatory staff quotas, but advocating a transparent approach by hospitals, in which management actively collects feedback from nurses and other frontline staff and then responds to their concerns.
The association cites St. Peter & # 39; s University Hospital in New Brunswick, New Jersey as an example of maintaining an adequate workforce with no mandatory quotas.
The 478-bed teaching hospital is part of a project by the New Jersey Nursing Leaders nonprofit that is focused on establishing councils in hospitals across the state. The councils include frontline nurses and leaders who work together to address staffing issues in their facility.
St. Peter upheld the advice even during the spring surge in COVID patients, said Linda Carroll, the hospital's chief nursing officer.
Some nurses have been on leave due to childcare responsibilities, but none of the nurses have left St. Peter due to poor or unsafe working conditions, and staffing rates have not been impacted, Carroll said. The hospital was very busy throughout the COVID-19 team as it worked regularly with staff and implemented proposed solutions.
“Our employees are our greatest voice. They know what's needed on the bed, ”said Carroll.