Hospitals, Nurses, Legislators Unite to Support Evolving Health Care Workforce
Increasing the number of qualified health care workers and creating mechanisms for obtaining nurse input on how to best staff patient units are key issues to address in workforce policy and the Ohio House Health Committee this week is expected to accept substitute House Bill 346, which will give nurses more say on staffing decisions while protecting the flexibility needed to respond to patient needs.

Where does the health care workforce stand?
Hospitals are the buzzing hub of many communities, with hospitals statewide employing more than 250,000 people and 20 hospitals and health systems ranking among Ohio’s 100 largest employers. But hospitals still struggle to fill key vacancies and prepare for an impending one-two punch: the baby boomer generation’s retirement from the workforce and its growing need for hospital care. The statewide average hospital vacancy rate for pharmacists remains at nearly 20%, respiratory therapists at 12.5% and medical technologists at 9%.

Ohio hospitals have worked to combat shortages in registered nurses (RNs), adding nearly 9,000 more nurses to their staffs between 2002 and 2006. Even with these additions, the vacancy rate for RNs has remained relatively constant at around 5% over the past five years meaning hospitals still need over 3,000 full-time RNs. With the average age of Ohio’s RNs currently at about 47, the number of vacant RN positions is expected to skyrocket to almost 32,000 by the year 2020 as baby boomers retire – a 29% shortage.

And hospitals aren’t the only employers who need RNs. An Ohio Board of Nursing workforce survey showed 31% of employed nurses are not in positions where they provide direct care as a primary part of their job, which highlights nurses’ versatility and the need for nurses in settings such as nursing homes, outpatient/ambulatory care settings and home health agencies.

Ohio hospitals continue working with local high schools and other educational institutions to interest the upcoming generation in lucrative health care careers. One such program is Aultman Hospital’s Career Academy, which brings select high school students to the hospital four days a week during the school year to learn about health care, participate in clinical and non-clinical lessons, and earn class credit. Ohio hospitals also strive to establish outstanding and flexible work cultures that expand training for existing employees and draw high quality new employees. Twenty Ohio hospitals have earned Magnet Designation from the American Nurses Credentialing Center, the highest recognition of nursing excellence.

What are the dangers of mandated nurse-to-patient ratios
Within the hospital, an adequate number of nurses and other health care providers is essential to providing quality care. The Ohio Hospital Association (OHA) and the Ohio Organization for Nurse Executives (OONE) released a position statement on nurse staffing in 2007 noting: “Appropriate nurse staffing is critical to ensuring patient safety and quality outcomes for patients and their families as well as creating a positive work environment, maintaining staff satisfaction and retaining nurses and other health professionals.”

Currently there is a movement driven by the National Nurses Organizing Committee of the California Nurses Association to set mandatory RN-to-patient staffing ratios in Ohio – an approach with potentially devastating consequences for nurses, hospitals and ultimately patients. The American Organization of Nurse Executives, the American Nurses Association, the Ohio Nurses Association (ONA), OHA and other groups do not support mandatory ratios because they take flexibility and options away from the professional nurse managers most in tune with the many factors that impact their patients.

When the victims of a multi-car pileup are rushed to a hospital emergency department, nurse managers need the ability to pull nurses from other units based on the condition and number of patients in that specific hospital at that particular moment. Nurse staffing needs depend on a complex and fluid set of variables, including the education and experience of the staff, the severity of patient needs, the particular shift, the physical layout of the unit, and the availability of hospital resources and technology. Unpredictable by nature, patient care rarely fits neatly into static ratios. Furthermore, a mandated nurse to patient ratio might force the hospital to reduce the number of allied and assistive personnel at the bedside – respiratory care providers, pharmacists, physical and occupational therapists. Patient care would suffer without the vital input of these caregivers.

Why does a statewide nurse staffing plan make sense?
The nurse staffing legislation (HB 346) currently under consideration by the House Health Committee is an alternative to mandatory ratios. HB 346, supported by OHA, OONE and ONA, provides for greater nurse input in staffing decisions while maintaining the flexibility needed to appropriately respond to patient needs. It requires that hospitals create a hospital-wide nursing care committee charged with developing recommendations for a written nursing care staffing plan guiding the assignment of nurses. Direct care nurses representing all types of nursing services offered by the hospital will serve on the committee as will the hospital’s chief nursing officer. The bill also requires hospitals to create a staffing plan, giving significant regard to committee recommendations and remaining consistent with evidence-based governmental and private accreditation standards.

Simple and one-size-fits-all solutions often don’t fit the complex and changing needs of the health care workforce. HB 346 is a common-sense step in the right direction – a direct result of open communication and collaboration between Ohio’s nurses, hospitals and legislators. This cooperation creates an invaluable framework for responding to the evolving challenges of health care providers in the coming years and ensuring quality care for all Ohioans.