Necessity of nursing: fixing staffing issues

Posted Nov. 01, 2010, at 7:55 p.m.

As the chief nursing officer and vice president for patient care at Eastern Maine Medical Center, it is my responsibility to ensure the high quality and safety of the nursing care at EMMC. It is a job I love, and one that I take very seriously.

I have been a full-time nurse at EMMC for more than 28 years, having started my career at the bedside. I can still remember the names and faces of many patients for whom I cared. Nursing has changed a lot during those years, but nurses still are among the most caring professionals I know, and at EMMC we have the best.

On Oct. 20, Judith Brown, an EMMC nurse and president of EMMC’s nursing union — the Maine State Nurses Association-National Nurse Organizing Committee-National Nurses United — shared her thoughts on the ongoing contract negotiations between the union and EMMC through a column in the Bangor Daily News, “Keeping patient-to-nurse ratios low.” Most of what she said is factual, though there is information missing and some significant differences of philosophy that need to be addressed.

Nurse staffing decisions are among the most important we make at EMMC. Nurses are the core of the care team and we take many factors into consideration in determining optimal staffing.

For many years, Eastern Maine Medical Center has staffed to the recommendations of the New England Journal of Medicine article to which Brown refers. In fact, the article recommends 9.1 nursing hours per patient day, and EMMC is currently staffing at 9.8 hours, more than the article suggests.

In addition, we have nursing technicians, certified nurses’ aides, who help the nurses, one technician to every two nurses. While the study Brown quotes does not include nursing technicians in the equation, these caregivers are just as proud of the quality of the care they give to patients as our nurses. They are compassionate, caring and thoroughly trained, as are the respiratory and physical therapists, the dietary staff, housekeepers and others who come into contact with patients and help meet their needs.

Staffing to meet the needs of patients in a medical center of our size is not a simple proposition, and certainly not one to be dictated within the small scope of a contract for one group of caregivers. My responsibility, and the responsibility of the nurse managers who supervise the patient care areas, is to consider the patient needs, the blend of nursing expertise, the rate of admission and discharge activity and many other variables to come up with the right staffing on a daily basis.

Collectively, we have hundreds of years of nursing experience behind making those decisions, and our results speak for themselves. Our patient care quality is recognized nationally and our results are among the top hospitals in the country.

Brown touts the staffing ratios in California as a model to follow, yet fails to acknowledge that several research studies reveal that Maine’s hospital care ranks among the top performing states in the nation, while California’s is ranked among the lowest.

Brown refers to burnout and job dissatisfaction without mentioning that EMMC’s nurse retention rate is more than 94 percent, compared with national rates of about 82 percent. While Ms. Brown and the union leadership refer to tired, overworked nurses, EMMC’s overtime rate hovers at around 1.7 percent of total hours, well under national guidelines of 2 percent to 4 percent.

In terms of quality and safety, Brown failed to mention that nurses helped design the electronic documentation system, which is reducing error rates and improving patient safety at EMMC. She also failed to acknowledge that EMMC is one of just 16 hospitals in the country that has received a national grant for this work from the Robert Wood Johnson Foundation.

This grant, called Transforming Care at the Bedside, is a three-year project and is driven by staff nurses. The goal of this project is to improve the patient experience, increase staff nurse time at the bedside and to focus on the work of medical-surgical nurses. To date, we have had great success and have increased the nurses’ time at the bedside from a national average of about 30 percent to 47 percent. Again, all of this work has been done by staff nurses and is greatly supported by nursing administration.

The voice and contributions of nurses abound at EMMC. This labor union, representing 150,000 nurses nationwide, does not have an exclusive lock on the issue of patient care quality and safety. There are more than 3,000 of us at EMMC — nurses and others, union and nonunion — who are equally passionate and committed to the quality of care at EMMC and deliver on that commitment every day.

Lorraine Rodgerson, RN, is vice president of patient care services and chief nursing officer at Eastern Maine Medical Center in Bangor.

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