Has nurse staffing in New Jersey really improved? | Opinion

The fact that Rutgers University conducted a study that deals with safe staffing ratios for nurses shows how important this issue is in New Jersey. The study, Effects of Public Reporting Legislation of Nurse Staffing: A Trend Analysis, claims hospital reporting of staffing numbers has led to better nurse staffing ratios – that nurses are handling fewer patients. 

Public reporting of staffing statistics is a good thing. However, JNESO, the professional healthcare union that serves some 5,000 nurses and techs in New Jersey and Pennsylvania, would argue the study does not tell the whole story.

While transparency is vital to ensure patient safety, hospital reporting is based on incomplete data that does not provide the public with true daily staffing numbers, patient volume, or patient acuity that all impact a safe patient care environment. 

General hospitals licensed in accordance with the Health Care Facilities Planning Act (P.L. 1971, c136 codified at N.J.S.A.26:2H-1 et seq.) are required to publicly disclose direct care staffing levels within the facilities and to report staffing level information to the N.J. Department of Health and Senior Services.

The problem: Not everything is reported to clearly describe what happens daily in these facilities. 

The reporting process:

• The Department of Health (DOH) combines the reported monthly averages into a quarterly report
• DOH posts direct patient care staffing levels
• Each inpatient unit: required to count the number of patients and the number of staff -- based on hours worked for each category of direct patient care staff, excluding other licensed health care professionals, one hour before the end of each shift on each day of each month.
• Each emergency department: required to count the number of patients registered during the shift and the number of staff -- based on hours worked for each category of direct patient care staff, excluding other licensed health care professionals, one hour before the end of the shift on each day of each month.

What is NOT reported:

• Not reported or shown in Average Daily Ratios is the actual number of staff and patients.
• Daily staff numbers are only cited for Emergency Departments (ED) and Post Anesthesia Care Unit/Recovery Room (PACU) not for all other hospital units.

We contend that you can’t compare apples to apples because the information required to be reported is not standardized. In addition, public reporting should be changed because including other licensed healthcare professions such as supervisors, charge nurses, unit clerks, and techs who do not necessarily handle direct patient care can lead to misleading results.

If we want to keep the nursing profession vital and be able to solve problems such as short staffing and poor nurse-to-patient staffing ratios, we need more nurses to stay working as nurses. 

According to data posted by the DOH, JNESO lost numerous bedside registered nurse positions in four of our represented hospitals between Sept. 2008 (when reporting was initiated) and Dec. 2018. This affected staffing in Psychiatric, Medical/Surgical, Pediatrics, ED, PACU, Nursery and Obstetrics units.

The largest staff losses came from:

• ED -- patient volume increased while staff decreased
• Medical/Surgical Units -- no Daily Staff numbers or number of patients

Nurses are obligated to report unsafe patient care environments. The tool JNESO members utilize to report unsafe conditions is Short Staffing Forms. JNESO has seen a dramatic increase in the number of forms submitted by nurses providing direct patient care:

• 2016 to 2017: 42% increase in forms submitted
• 2017 to 2018: 40% increase in forms submitted

Patient acuity measures are also left out of the equation when looking at the Rutgers study results and the information reported to DOH. Patient acuity measurement of the intensity of nursing care required by a patient based on the actual needs of the patient.  Providing patient care in a safe environment is critical to the well-being of all patients and requires a staffing plan that includes the number of patients each nurse cares for and considers acuity.  Surprisingly, while current Hospital Licensing Standards call for the use of acuity tools (N.J.A.C. Hospital Licensing Standards 8:43G-17.1, 3ii), few hospitals implement them and assign staffing based on the number of patients instead.

JNESO has supported and fought for safe staffing legislation in both New Jersey and Pennsylvania for years. We understand the importance of protecting our nurse’s licenses from jeopardy when errors or injuries result from under staffing. We also need to protect patients, who entrust their lives to the belief that a hospital is a safe place, which it should be.

In addition to requiring hospitals to publicly disclose staffing levels, we still need to enact safe staffing legislation to guarantee that minimum staffing levels and nurse-to-patient ratios are set throughout the state -- to protect our nurses and ensure patient safety.

Douglas Placa is the Executive Director of JNESO, the professional healthcare union that serves some 5,000 nurses and techs in 19 facilities across New Jersey and Pennsylvania.