Urgent action alert: Support federal proposal on nurse staffing transparency

Make your voice heard today in support of safe hospi­tals! Deadline for comments is June 13th.

Federal Government Proposes Adopting New Consumers Tool Increasing Transparency on the Critical Role of Nurses in Measuring Patient Outcomes #

Nurses are critical to patient safety in hospital settings and are the most trusted providers on the health care delivery team. In fact, there is a direct corre­la­tion between nurse staffing, patient satis­fac­tion, readmis­sions, and adverse events. Currently patients and their families compare hospi­tals on a number of factors through a website called Hospital Compare” but they are unable to access infor­ma­tion on how many nurses are staffing the unit to which they may be admitted and the staff skill mix, both of which ultimately impact outcomes. Skill mix is part of the formula for appro­priate staffing. Proper use of support personnel improves nurses’ workflow, permit­ting nurses to fully apply their profes­sional knowl­edge and skill.

To help consumers make informed choices, the Centers for Medicare & Medicaid Services (CMS) proposes public reporting of two quality measures that are very powerful tools to compare nurse staffing and skill mix in hospi­tals. These measures have already been adopted by more than 2,000 hospi­tals in the US. This proposed require­ment for public reporting of all hospi­tals allows patients and their families to make more informed decisions.

The Proposed New Tool for Consumers
  • CMS has proposed the public reporting of two nurse staffing quality measures to help consumers compare hospi­tals based on the level of nurse staffing and staff skill mix. The measures were included in the proposed FY 2018 Inpatient Prospec­tive Payment System (IPPS) rule, which was released in April 2017; the comment period ends June 13th and the final rule would be published in late summer 2017.
  • This data will be avail­able on Hospital Compare, a consumer-oriented website that provides infor­ma­tion on how compa­rable hospi­tals are prepared to provide high quality and safe care. These new require­ments increase the trans­parency of care provided and will improve patient safety.
  • The American Nurses Associ­a­tion (ANA) first champi­oned these nursing-sensi­tive quality measures in 1994 and continues to stand behind these measures. They are a mecha­nism to demon­strate the impact that appro­priate nurse staffing levels plays in patient safety — and a growing body of research demon­strates the link between nurse staffing and patient safety and outcomes.
  • Studies continue to find that inade­quate regis­tered nurse staffing is associ­ated with increased mortality and multiple types of avoid­able adverse events causing patient harm, reinforcing the need to match staffing and skill mix to patient’s need for nursing care.
  • WSNA and ANA strongly supports the inclu­sion of both measures in the final hospital payment rule.
About the Proposed Nursing Quality Measures
  • If final­ized, the proposed rule will require hospi­tals to collect and report data on the following quality measures on nursing for inclu­sion in CMS’ quality reporting program:
    • Nurse staffing; and
    • Staff skill mix, which refers to the combi­na­tion or grouping of different categories of workers providing patient care.
  • Both measures are fully endorsed as a priority for Hospital Compare by the National Quality Forum (NQF), a non-partisan organi­za­tion that endorses valid, evidence-based quality measures. This is the gold-star seal of approval for quality measures.
  • The proposed measures repre­sent key indica­tors of patient safety in a hospital, not just another piece of data to collect. Reporting these data is not a paper­work burden to hospi­tals, nurses or other clini­cians. In fact, in hospital settings, this infor­ma­tion is not neces­sarily being newly collected but rather, newly reported — the measures collect electronic data already included in hospital databases. Trans­parent access to this data contributes to safer, more effec­tive inter­dis­ci­pli­nary teams across the hospital.
  • While hospi­tals share a commit­ment to patient safety, they want flexi­bility in how they staff their hospi­tals. Nothing in these measures will require hospi­tals to have rigid staffing patterns. The data will inform safe, appro­priate care that meets the needs of their patient acuity. Nor will Hospital Compare reveal a hospital’s individual staffing pattern. Instead, it will highlight which hospi­tals have lower staffing and skill mix patterns so that consumers can make an informed choice.

Why These Measures are Important
  • Nurse staffing data gives consumers tools to make informed decision when selecting from compa­rable hospi­tals. There is currently a wide varia­tion in nurse staffing and staff skill mix in hospi­tals across the country. Patients should demand to know that there is a nurse at the other end of the call button. Trans­parency empowers patients and their families with infor­ma­tion to under­stand the staffing levels compared to other similar hospi­tals, providing essen­tial infor­ma­tion to decisions makers.
  • Research shows that appro­priate nurse staffing is key in improving a range of patient outcomes, including:
    • Improving patient satis­fac­tion and health-related quality of life;
    • Reducing medical and medica­tion errors, Higher RN staffing levels have been shown to decrease avoid­able Hospital-Acquired Condi­tions (HACs);
    • Reducing patient mortality, hospital readmis­sions, and length of stay; as well as patient care costs through avoid­ance of unplanned readmissions;
    • Decreasing the number of preventable events such as patient falls, pressure ulcers, central line infec­tions, health­care-associ­ated infec­tions (HAIs), and other compli­ca­tions related to hospi­tal­iza­tions; and
    • Preventing nurse fatigue, thus promoting nursing safety, nurse reten­tion, and job satis­fac­tion — all contrib­u­tors safer patient care and nurse retention.
  • Hospi­tals which invest in appro­priate nurse staffing and skill mix to meet the needs of their patients will receive higher ratings. Hospital Compare gener­ally ranks hospi­tals using the data from these measures to award up to 5 stars. A hospital with strong nurse staffing and skill mix level will receive a higher star rating — and will stand out strongly in an apples-to-apples compar­ison with hospi­tals who are not investing in appro­priate nurse staffing.
Take Action. Make your voice heard today in support of safe hospitals! Deadline for comments is June 13th.