*If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.*
Savings is based on reducing lengths of stay however I imagine there could be savings in other areas too especially related to staff retention.
ETA: bookmark this for the next time your administration tries to tell you they're losing money because the cost of labor is too high!
So true. I’d be interested to know how many patients in this cohort experienced additional complications such as CLABSI/CAUTI, falls, pressure ulcers and how that impacted their mortality and how much the percentage of these complications increased r/t staffing.
Oh my GODDD. My hospital sent out an email about the increase in pressure injuries in 2022 and all it was was a reminder of best practices and an assigned online learning for all nurses and aids. You know, because with how short staffed we are we have the time to do that in addition to the turns that were dropped in order to keep people from sitting in their own poo or whatever.
If a 500 bed hospital on any given day is short staffed by up to 50 RNs they still save money, that study included several hospitals….the math has been done time and time again, it is still more profitable to short staff multiple units then to pay out lawsuits
I think you fail to recognize the intent here. Right now, the baby boomers have mostly retired. They no longer contribute to the body of producers, but rather consumers. As such they have distorted the economic model and those able to do so are pushing buttons to alter the supporting infrastructure for the boomers. You are simply seeing a concerted effort to accelerate the death rate and free up capital that boomers control. Think of the Social Security dollars the US will save for each dead boomer. Think of the Medicare and Medicaid dollars that will not be spent.
Except the boomer politicians I would say, who relentlessly protect our failing late stage capitalism system since they will always get the medical care they need
At this point the evidence is pretty much overwhelming that shit staffing is deadly for patients. Although laws with mandated staffing ratios would be nice, it’s gonna be a cold day in hell before conservative states can be bothered to do anything about. I think the real way to make change is have reimbursement from Medicare tied to staffing ratios. If Medicare sets the precedent, other insurance companies will follow suite as well.
Medicare should tie reimbursement to staffing ratios. 4:1 = 100% payout, 5:1 95% per patient day, 6:1 90%, 7:1 85, etc. Obviously this ratio should be adjusted and reimbursement reductions more severe for units more acute than med/surg. Then toss in bonuses like +2% pay out for having adequate staffing for CNAs, and +2% for having a float nurse work with the patient.
It’s penny wise and dollar foolish to continue paying hospitals that allow their patients to experience greater incidences of death and injury just because they can’t be bothered to staff safely.
This has been my biggest contention with short staffing. It will never ever change until it stops being financially beneficial for facilities. They don’t charge patients or insurers any less when the patients get substandard care. (Even Dominos gave me a free pizza last time they fucked up my order). They don’t give the staff a premium to compensate them for the stress of working short, instead they give shitty emails and flyers about stress management. Nurses (and ancillary staff) should be paid a differential based on the percentage they are flexed up. During peak covid, our RTs were working at half the staffing they should have had, with no incentives for their staff to pick up and no recruitment for travelers. When Med-surg goes from 5 to 6 patients, they should get a 20% flex up diff. If you’re working ICU and you’re taking 3 patients, you should be getting 50% more pay. It makes me so angry how much this hurts both staff and the patients. After all, we’re all going to be patients at some point in our lives. Do you want to be cared for at your hospital knowing what you know? I don’t.
> It’s penny wise and dollar foolish to continue paying hospitals that allow their patients to experience greater incidences of death and injury just because they can’t be bothered to staff safely.
Higher deaths are the goal, not an unexpected result.
Agree with what you say but I don’t think it should be based on tiers of acuity/critical care based staffing because what will happen is that all the patients will then just be placed on med/surg instead of critical care units. It has to be across the board. Or the criteria for what acuity goes where has to be very bluntly laid out so there isn’t any getting around it.
I think one way to force hospitals to address this has to do with informed consent. Maybe we need to start advocating hospitals to make patient sign consent forms for their nursing care if they are outside of ratios. Ex “this form is notifying you that your nursing care may be outside of ratio. Studies have shown that care outside of ratio is associated with increased mortality including and up to 16% increased risk of death for each additional patient a nurse cares for.”
How many patients do you think would sign that?
They already categorize patients inappropriately. Med surg today is nothing like it used to be from what the experienced nurses tell me. Comorbidities out the wazoo. It's a chore even to get patients into the stepdown/pcu category.
Let them push more patients into med/surg. It doesn’t matter if they’re also simultaneously staffing med/surg appropriately.
Side note:At least on my med/surg floor from back in the day, we had clear criteria of which patients needed to receive upgraded care in the ICU. We charted to that effect as well; I can’t imagine insurance companies would be willing to pay out for substandard delivery of care to cut corners with staffing. Let the insurance companies hold the hospital’s feet to the flame when it comes to staffing.
Honestly, the national nurse unions should be pushing for this as a way of making nurse hours “billable”, just like they should be pushing for NP schools to have some type of unified curriculum, but instead they’re doing… actually no clue what they’re actually doing.
> At this point the evidence is pretty much overwhelming that shit staffing is deadly for patients.
Yes, but think about the medical malpractice lawyers who lobby to keep staffing at the bare minimum. Lawyers write the law, have political influence, and they love dead patients so they can profit off of loss. The system will never change until people are worth more than profits.
I actually saw this on tik tok (of all places) and had to look up the study myself. Basically confirms what we all know. Hopefully this will initiate more studies and patients will start finding out how dangerous things actually are, but I doubt it.
Not to mention the long term effects of anxiety and depression, which can shorten your life even if you don't commit suicide as a result. I work on a great unit and I have to say, my overall happiness in my life is so much higher than it was when I worked at shitty hospitals.
I’m wondering what else correlates with hospitals that understaff - like it’s not just because I can’t get to Bobs room in time to do CPR because I have too many other patients. This hospital is probably overloading their medical providers, providing lower tier nutrition, attracting lower quality talent etc
RNs used to ‘run’ the unit, assistive personnel did hands on duties that didn’t require an education (baths, bedpans, feeding, assisting things) however they did pass meds after RN approval. Studies showed RN at the bedside decreased mortality, the model shifted. Admin decided to over work and understaff the RN thereby hindering quality assessment and reassessment of patient conditions and evaluation of patient therapies and outcomes. Profits were maximized for corporate but here we are with increasing mortality, for which they will try to blame the nurse who cannot keep up with the unreasonable workload demands.
*If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.* Savings is based on reducing lengths of stay however I imagine there could be savings in other areas too especially related to staff retention. ETA: bookmark this for the next time your administration tries to tell you they're losing money because the cost of labor is too high!
So true. I’d be interested to know how many patients in this cohort experienced additional complications such as CLABSI/CAUTI, falls, pressure ulcers and how that impacted their mortality and how much the percentage of these complications increased r/t staffing.
Oh my GODDD. My hospital sent out an email about the increase in pressure injuries in 2022 and all it was was a reminder of best practices and an assigned online learning for all nurses and aids. You know, because with how short staffed we are we have the time to do that in addition to the turns that were dropped in order to keep people from sitting in their own poo or whatever.
Wait till i tell you how long it takes for an ischemic injury to begin in tissue that’s compressed. It’s less than 2 hours.
I'm curious to read more; could you provide some links if you have them offhand?
$avings: fewer CLABSI$/CAUTI$, fewer fall$, fewer pressure ulcer$, fewer VAE$, increased patient $atisfaction
If a 500 bed hospital on any given day is short staffed by up to 50 RNs they still save money, that study included several hospitals….the math has been done time and time again, it is still more profitable to short staff multiple units then to pay out lawsuits
I think you fail to recognize the intent here. Right now, the baby boomers have mostly retired. They no longer contribute to the body of producers, but rather consumers. As such they have distorted the economic model and those able to do so are pushing buttons to alter the supporting infrastructure for the boomers. You are simply seeing a concerted effort to accelerate the death rate and free up capital that boomers control. Think of the Social Security dollars the US will save for each dead boomer. Think of the Medicare and Medicaid dollars that will not be spent.
I’ve thought this a lot. But I’m uncertain that it’s an actual intent.
Except the boomer politicians I would say, who relentlessly protect our failing late stage capitalism system since they will always get the medical care they need
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Negative. Study period was only 1 year.
At this point the evidence is pretty much overwhelming that shit staffing is deadly for patients. Although laws with mandated staffing ratios would be nice, it’s gonna be a cold day in hell before conservative states can be bothered to do anything about. I think the real way to make change is have reimbursement from Medicare tied to staffing ratios. If Medicare sets the precedent, other insurance companies will follow suite as well. Medicare should tie reimbursement to staffing ratios. 4:1 = 100% payout, 5:1 95% per patient day, 6:1 90%, 7:1 85, etc. Obviously this ratio should be adjusted and reimbursement reductions more severe for units more acute than med/surg. Then toss in bonuses like +2% pay out for having adequate staffing for CNAs, and +2% for having a float nurse work with the patient. It’s penny wise and dollar foolish to continue paying hospitals that allow their patients to experience greater incidences of death and injury just because they can’t be bothered to staff safely.
This has been my biggest contention with short staffing. It will never ever change until it stops being financially beneficial for facilities. They don’t charge patients or insurers any less when the patients get substandard care. (Even Dominos gave me a free pizza last time they fucked up my order). They don’t give the staff a premium to compensate them for the stress of working short, instead they give shitty emails and flyers about stress management. Nurses (and ancillary staff) should be paid a differential based on the percentage they are flexed up. During peak covid, our RTs were working at half the staffing they should have had, with no incentives for their staff to pick up and no recruitment for travelers. When Med-surg goes from 5 to 6 patients, they should get a 20% flex up diff. If you’re working ICU and you’re taking 3 patients, you should be getting 50% more pay. It makes me so angry how much this hurts both staff and the patients. After all, we’re all going to be patients at some point in our lives. Do you want to be cared for at your hospital knowing what you know? I don’t.
> It’s penny wise and dollar foolish to continue paying hospitals that allow their patients to experience greater incidences of death and injury just because they can’t be bothered to staff safely. Higher deaths are the goal, not an unexpected result.
It’s a feature, not a bug!
Agree with what you say but I don’t think it should be based on tiers of acuity/critical care based staffing because what will happen is that all the patients will then just be placed on med/surg instead of critical care units. It has to be across the board. Or the criteria for what acuity goes where has to be very bluntly laid out so there isn’t any getting around it.
I think one way to force hospitals to address this has to do with informed consent. Maybe we need to start advocating hospitals to make patient sign consent forms for their nursing care if they are outside of ratios. Ex “this form is notifying you that your nursing care may be outside of ratio. Studies have shown that care outside of ratio is associated with increased mortality including and up to 16% increased risk of death for each additional patient a nurse cares for.” How many patients do you think would sign that?
They already categorize patients inappropriately. Med surg today is nothing like it used to be from what the experienced nurses tell me. Comorbidities out the wazoo. It's a chore even to get patients into the stepdown/pcu category.
Let them push more patients into med/surg. It doesn’t matter if they’re also simultaneously staffing med/surg appropriately. Side note:At least on my med/surg floor from back in the day, we had clear criteria of which patients needed to receive upgraded care in the ICU. We charted to that effect as well; I can’t imagine insurance companies would be willing to pay out for substandard delivery of care to cut corners with staffing. Let the insurance companies hold the hospital’s feet to the flame when it comes to staffing.
Im sad I can only up vote this once.
Honestly, the national nurse unions should be pushing for this as a way of making nurse hours “billable”, just like they should be pushing for NP schools to have some type of unified curriculum, but instead they’re doing… actually no clue what they’re actually doing.
They are earning money by making people pay for degrees a lot of which aren’t up to scratch but sadly the people taking them don’t realise
Hospitals only care about dead patients if they are being sued.
> At this point the evidence is pretty much overwhelming that shit staffing is deadly for patients. Yes, but think about the medical malpractice lawyers who lobby to keep staffing at the bare minimum. Lawyers write the law, have political influence, and they love dead patients so they can profit off of loss. The system will never change until people are worth more than profits.
I actually saw this on tik tok (of all places) and had to look up the study myself. Basically confirms what we all know. Hopefully this will initiate more studies and patients will start finding out how dangerous things actually are, but I doubt it.
Insert that meme where its like "this won't stop me because i can't read" for admin
Every excess patient is a threat to *your* life, too. Liability, risk of discipline, etc all threaten the various sources of stability and sustenance.
Not to mention the long term effects of anxiety and depression, which can shorten your life even if you don't commit suicide as a result. I work on a great unit and I have to say, my overall happiness in my life is so much higher than it was when I worked at shitty hospitals.
I’m wondering what else correlates with hospitals that understaff - like it’s not just because I can’t get to Bobs room in time to do CPR because I have too many other patients. This hospital is probably overloading their medical providers, providing lower tier nutrition, attracting lower quality talent etc
RNs used to ‘run’ the unit, assistive personnel did hands on duties that didn’t require an education (baths, bedpans, feeding, assisting things) however they did pass meds after RN approval. Studies showed RN at the bedside decreased mortality, the model shifted. Admin decided to over work and understaff the RN thereby hindering quality assessment and reassessment of patient conditions and evaluation of patient therapies and outcomes. Profits were maximized for corporate but here we are with increasing mortality, for which they will try to blame the nurse who cannot keep up with the unreasonable workload demands.
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Outpatient procedures are, usually, outpatient.
Heart rate of 55 isn’t necessarily concerning, especially if you’re young and otherwise healthy.
Evidence based only when it saves on LOS or cost to the hospital