Safety in Numbers

Suzanne Gordon, John Buchanan, Tanya Bretherton

Description

Legally mandated nurse-to-patient ratios are one of the most controversial topics in health care today. Ratio advocates believe that minimum staffing levels are essential for quality care, better working conditions, and higher rates of RN recruitment and retention that would alleviate the current global nursing shortage. Opponents claim that ratios will unfairly burden hospital budgets, while reducing management flexibility in addressing patient needs. Safety in Numbers is the first book to examine the arguments for and against ratios. Utilizing survey data, interviews, and other original research, Suzanne Gordon, John Buchanan, and Tanya Bretherton weigh the cost, benefits, and effectiveness of ratios in California and the state of Victoria in Australia, the two places where RN staffing levels have been mandated the longest. They show how hospital cost cutting and layoffs in the 1990s created larger workloads and deteriorating conditions for both nurses and their patients-leading nursing organizations to embrace staffing level regulation. The authors provide an in-depth account of the difficult but ultimately successful campaigns waged by nurses and their allies to win mandated ratios. Safety in Numbers then reports on how nurses, hospital administrators, and health care policymakers handled ratio implementation.With at least fourteen states in the United States and several other countries now considering staffing level regulation, this balanced assessment of the impact of ratios on patient outcomes and RN job performance and satisfaction could not be timelier. The authors' history and analysis of the nurse-to-patient ratios debate will be welcomed as an invaluable guide for patient advocates, nurses, health care managers, public officials, and anyone else concerned about the quality of patient care in the United States and the world.

Sujets

• Médecine
• Nursing
• Nurse
• California
• Victoria

Informations

• Publié par: Cornell University Press
• Date de parution: 15 octobre 2012
• Nombre de lectures: 0
• EAN13: 9780801464935
• Langue: English

Extrait

Safety in Numbers

A VOLUME IN THE SERIES

The Culture and Politics of Health Care Work Edited bySuzanne Gordon and Sioban Nelson

The Caregiver: A Life with Alzheimer’s By Aaron Alterra Assisted Living for Our Parents: A Son’s Journey By Daniel Jay Baum From Silence to Voice: What Nurses Know and Must Communicate to the Public, Second Edition By Bernice Buresh and Suzanne Gordon Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France By Paul V. Dutton Nobody’s Home: Candid Reflections of a Nursing Home Aide By Thomas Edward Gass Life Support: Three Nurses on the Front Lines By Suzanne Gordon Nursing against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care By Suzanne Gordon Nurses on the Move: Migration and the Global Health Care Economy By Mireille Kingma The Complexities of Care: Nursing Reconsidered Edited by Sioban Nelson and Suzanne Gordon Code Green: Money-Driven Hospitals and the Dismantling of Nursing By Dana Beth Weinberg

Safety in Numbers

NURSETOPATIENT RATIOS AND THE FUTURE OF HEALTH CARE

Suzanne Gordon,

John Buchanan, and

Tanya Bretherton

ILR Press AN IMPRINT OF CORNELL UNIVERSITY PRESS ITHACA AND LONDON

Copyright © 2008 by Suzanne Gordon, John Buchanan, and Tanya Bretherton

All rights reserved. Except for brief quotations in a review, this book, or parts thereof, must not be reproduced in any form without permission in writing from the publisher. For information, address Cornell University Press, Sage House, 512 East State Street, Ithaca, New York 14850.

First published 2008 by Cornell University Press

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data

Gordon, Suzanne, 1945– Safety in numbers : nursetopatient ratios and the future of health care / Suzanne Gordon, John Buchanan, and Tanya Bretherton. p. cm. — (The culture and politics of health care work) Includes bibliographical references and index. ISBN 9780801446832 (cloth : alk. paper) 1. Nursing services—Standards—California. 2. Nursing services—Standards—Australia— Victoria. 3. Nursing services—California—Personnel management—Statistical methods. 4. Nursing services—Australia—Victoria—Personnel management—Statistical methods. 5. Hospitals—California—Administration—Statistical methods. 6. Hospitals—Australia— Victoria—Administration—Statistical methods. 7. Ratio analysis. I. Buchanan, John. II. Bretherton, Tanya. III. Title. IV. Series. RT85.5.G67 2008 362,17'30683—dc22 2007045442

Cornell University Press strives to use environmentally responsible suppliers and materials to the fullest extent possible in the publishing of its books. Such materials include vegetablebased, lowVOC inks and acidfree papers that are recycled, totally chlorinefree, or partly composed of nonwood fibers. For further information, visit our website at www.cornellpress.cornell.edu.

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Contents

Acknowledgments

Introduction

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vii

Part ICalifornia: Managed Care, Hospital Restructuring, and the Ratio Response 1Hospital Restructuring and the Erosion of Nursing Care in California and the United States25 2Not Out of Thin Air47 3The Hospital Industry Response58 4Ratios Redux70

Part IIAustralia: Nurses and Work Intensification in Public Hospitals in Victoria—Context, Response, and Legacies 5Working Life for Nurses in the Late 1990s in Australia: A Snapshot 95 6How Did It Come to This? The Factors Driving the Intensification of Nursing Work103 7Winning Ratios in Victoria115 8Evaluating the Impact of Ratios: An Imperfect Experiment148

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Contents

Part III Arguments and Alternatives 9What We Know about Nurse Staffing181 10Arguments against and Alternatives to Ratios

Conclusion: Ratios and Beyond

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198

Appendix:Decision of the Australian Industrial Relations Commission on NursetoPatient Ratios239

Notes Index

247 263

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Acknowledgments

This book has been a transcontinental collaboration that has required con tact and communication across time zones, oceans, and land masses, as well as family ties and friendships. As we’ve hashed out ideas, discussed, and refined, our communication have been structured by the fact that John and Tanya are either just waking up when Suzanne is going to sleep or just going to sleep when Suzanne is yawning and struggling to get up. Even in the age of the In ternet getting Sydney and Boston together is a feat that requires as much strategic planning as patience. This collaboration would never have happened without the assistance of a grant from the Australian Nursing Federation’s Victorian Branch and the support of Lisa Fitzpatrick, its secretary. Although the ANF gave us the seed money to embark on this book, we accepted it only with the understanding that we were doing an objective analysis of ratios—warts and all. We believe that the result shows not only the benefits of ratios but also the problems and limitations associated with them. We would also like to acknowledge the help of Vicki Bermudez of the Cali fornia Nurses Association. Vicki provided us with a great deal of documenta tion that has helped us grasp the complexity of the California story. We are grateful to the comments and insights of Sean Clarke and Sioban Nelson. Holly Bailey offered us invaluable editorial assistance. We are also deeply grateful to Kristin Elifson for her help in compiling, analyzing, and drafting material on the many studies that have been done on nurse staffing, nursing and patient outcomes, and nurses’ health. Our analysis of the experience of nursepatient ratios in Victoria, Australia, has only been possible because of the generous cooperation of many individ uals. Prime among these are the members and job representatives of the Vic

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Acknowledgments

torian Branch of the Australian Nursing Federation. Since 1999 they have contributed to countless focus groups, filled in questionnaires, and provided important insights through extended, semistructured interviews. Many nurs ing managers and directors of nursing also helped us understand the impact of ratios. There are hundreds, indeed thousands, of nurses who have agreed to give so openly to help us (as health industry outsiders) understand the complex workload issues faced by nurses. There are too many people to name individually, and in many cases we have agreed to use pseudonyms to preserve the confidentiality of the nurses who agreed to participate. We ex tend our personal thanks and appreciation to these nurses, who often agreed to give up their own personal time to be interviewed before or after long and stressful shifts (in some cases at dawn, or very late in the evening). Important information about the origins and development of the ratios has been pro vided by Belinda Morieson, Lisa Fitzpatrick, Yvonne Kelly, Bob Burrows, and Nick Blake. Special thanks also to Terese Garreffa and Robyn Asbury for help in locating resources and contacts in the industry. Commissioner Wayne Blair of the Australian Industrial Relations Commission (AIRC) provided particularly important insights that only an arbitrator can provide. The regis trar of the AIRC was very cooperative in making full transcripts of all arbitral proceedings available to the research team. Our analysis of the experience in Victoria has benefited from research and advice from our colleagues at the Workplace Research Centre (formerly ACCIRT) at the University of Sydney. Jill Considine assisted in the design and analysis of the first two evaluation surveys and Sarah Wise helped on the most recent ones. At various times over the years Sue Bearfield, Stephen Jackson, and Nick Harrington have contributed to the analysis that is contained in this book. We also want to thank our families for putting up with the demands of the in ternational effort. Suzanne would like to thank her husband, Steve Early, for his help in illuminating issues of labor law and for his many editorial suggestions. John owes his wife, Kylie Nomchong (and their children, Ben and Isobel) a huge debt for giving up their claims on his “free” time to get his sections of the manu script finished. Tanya extends thanks to family—Jason, Clare, and Laura Anderson—for their patience and support. Both Tanya and John have [SG1]only been able to work on this project because of support provided by their col leagues at the Workplace Research Centre. Finally, we would like to thank Fran Benson for supporting this project and for her patience as we extended deadlines and begged once and again for just that extra time that turned not only into weeks but months. We also want to thank Katy Meigs for her editorial help and many, many thanks go to Ange RomeoHall for her vigilance and polish and for tolerating the authors’ many last minute changes and delays. We would also like to add a note about citations, names, and spelling. Because

Acknowledgments

ix

this book is published by an American press, we have used American spelling and idioms rather than Australian in the sections on Australia. We trust that Aus tralian readers will not be offended by this choice. When quotations are used but not followed by an endnote it means that, following a more journalistic practice, this material is taken from interviews that the authors conducted. In some cases, we have used pseudonyms indicated by asterisks to protect the anonymity of our sources. This interview protocol allowed participants to speak frankly and openly to us about their experiences, without fear of retribution by managers. Because we want to reach the widest possible audience on this important subject, we have attempted to write in a journalistic rather than traditional academic style while not compromising scholarly standards. We hope readers both inside and outside the academy will appreciate our mission to be more inclusive and that this book will help all concerned with the future of nursing and health care to understand the conditions and dilemmas nurses face as they do their critical work.