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D.C. Hospitals And Nurses Fight Over Staffing Ratios

Hospital administrators in Washington, D.C., are furiously lobbying against a bill modeled on a California law that would require them to maintain a minimum nurse-to-patient ratio at all times.

Nursing unions say the proposed Patient Protection Act codifies into law minimum staffing levels that are needed to maintain patient safety, while hospitals say the cost of hiring new nurses to comply with the law would put them out of business.

The ratios called for in the bill vary depending on the hospital department. In a pediatrics unit, the bill would require no less than a 1-to-4 nurse-to-patient ratio. In the operating room, hospitals would have to maintain a 1-to-1 ratio — one nurse for every patient at all times.

Deidre Beckford, a nurse at MedStar Washington Hospital Center who has worked there for more than 20 years, says understaffing has forced her to take care of five to six patients at a time.

“There are times when I have to do the dressing on patients and I can’t get to it,” she said. “I have to put antibiotics on patients and they’re late. You have to turn patients every two hours and you can’t get to it. It infringes on their care.”

Washington Hospital Center didn’t respond to Beckford’s claims about infringed patient care, but its chief nursing executive, Sue Eckert, said in an email to KHN that the hospital manages its staffing levels collaboratively with nurses and that those levels can fluctuate depending on how many patients it has and how sick those patients are.

The nursing bill in D.C. would reduce some of this fluctuation. It’s modeled after a nearly identical law that took effect in 2004 in California, the only state to require minimum staffing ratios in its hospitals. So far, it’s unclear whether this requirement has had a positive or negative effect in California hospitals.

Studies have shown that the law has led to an increase in nurse hiring in California and a decrease in nurse turnover due to burnout. But researchers also found that the law put significant financial pressure on some hospitals.

When it comes to the ultimate question of whether this law reduced patient mortality, Teresa Serratt, a nursing professor at the University of Nevada, Reno, who has examined the effects of the California law, says the data are inconclusive.

“That’s the big question everyone wants an answer to,” she said.

Citing positive outcomes of the California law, the labor union National Nurses United is strongly pushing for the staffing ratio bill in D.C., which has been assigned to a committee but has no scheduled hearings as of yet. Nine of the Council’s 13 members signed on as co-introducers last week.

But the District of Columbia Hospital Association is waging an all-out campaign against it, supporting a competing bill that contains many of the same provisions as the Patient Protection Act but without the staffing ratio mandate. Robert Malson, the association’s president, says his organization is also scheduling individual meetings with every council member to try to persuade some of them to change their minds.

Malson said he’s been informing them of “exactly which hospitals would go out of business, and in which sequence” if the Patient Protection Act passes, though he wouldn’t share that information with KHN.

He said the bill is an attempt to get legislators involved in D.C. hospitals’ labor negotiations with its nurses, which have been far from harmonious in recent years. Almost two years ago, nurses at Washington Hospital Center staged a 24-hour strike a few months after voting overwhelmingly to join NNU, the largest nursing union in the country.

Serratt says the dueling bills are a sign that the relationship between hospitals and nurses in D.C. has grown dysfunctional.

“If you have really strong communication and good people on both sides of the table, we wouldn’t have the government getting in the middle of this kind of stuff,” she said.

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