JCAHO's nurse staffing standards questioned
Nursing suit says regs are not stringent enough
The American Nurses Association, the New York State Nurses Association, and the Washington State Nurses Association filed a lawsuit against the Department of Health and Human Services (HHS), claiming that HHS allows hospitals that fail to meet federal nurse staffing requirements to participate in Medicare, thereby endangering patients. The groups wants to prevent HHS from allowing the Joint Commission to use its own standards for nurse staffing in its accreditation of hospitals, as opposed to standards set by HHS for participation in Medicare. The groups want to require that the Joint Commission use standards that are "at least equivalent" to HHS standards.
Although HHS and Joint Commission guidelines both include requirements for nurse supervisory personnel, HHS requirements also call for nurse staffing levels that ensure the "immediate availability" of a registered nurse for the bedside care of any patient, and staffing schedules that are reviewed and revised to meet patient care needs and make adjustments for nursing staff absenteeism.
The Joint Commission says its standards meet or exceed HHS requirements. In a prepared statement, the Joint Commission pointed to its "longstanding commitment to nursing issues" including creation of a Nursing Advisory Council in 2003, and its sharing of solutions to address the nursing shortage through the publication of "Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis." The Joint Commission also says that its new survey process "pays particular attention to the important role of nurses." In addition, the Joint Commission says its "cutting-edge staffing standards create a framework for measuring and improving nursing care."
Since the HHS regulations don't have a specific staffing standard, it's hard to determine that the JCAHO requirements are really much different from what Medicare requires, says Patrice Spath, RHIT, a health care quality specialist with Forest Grove, OR-based Brown-Spath & Associates.
"It is unfortunate that some groups feel they must turn to the courts to answer the question of what is adequate staffing, since there are so many variables that impact this answer," she adds.
Quality and process improvement initiatives and the policies and procedures generated from these initiatives are heavily influenced by the decision support data that are collected, says Diana Contino, RN, MBA, CEN. FAEN, manager of public services/healthcare for McLean, VA-based BearingPoint, which provides consulting, application services, and technology solutions.
"The challenge with RN and LPN staffing is 'What data are collected, and how do we rank or assign the type of nursing care individual patients require or request?'" says Contino.
Progressive quality managers are looking at turnover rates in conjunction with staffing patterns and trends, says Contino. "It has been my experience that departments with high levels of unfilled vacant shifts due to absenteeism or unfilled positions have higher rates of turnover," she says.
If a department has one to two sick calls per day, contingency plans should be developed or staffing increased to accommodate these sick call trends, Contino says. "As the nursing population ages, we will continue to see increased use of sick time," she says. "As our workforce changes, we need to respond with system changes that meet the needs of employees if we are going to attract and retain employees."
For quality professionals, the most important lesson to be learned is that adequacy of staffing is a factor that should be part of any root-cause analysis or proactive risk assessment, says Spath.
"Setting specific staffing numbers is difficult due to the variations in patient populations and resultant workload," Spath says. "However, it behooves all health care organizations to recognize the patient safety implications of under-staffing in any clinical area, and adjust staffing levels or job requirements to ensure that a safety environment is maintained."
[For more information, contact:
Diana Contino, RN, MBA, CEN. FAEN, Manager, Public Services – Healthcare, BearingPoint, 600 Anton Blvd, Plaza Tower #700, Costa Mesa, CA 92626. Telephone: (949) 683-0117. Fax: (949) 861-6426. E-mail: [email protected].
Patrice L. Spath, BA, RHIT, Health Care Quality Specialist, Brown-Spath & Associates, P.O. Box 721, Forest Grove, OR 97116. Phone: (503) 357-9185. E-mail: [email protected]. Web: www.brownspath.com.]
The American Nurses Association, the New York State Nurses Association, and the Washington State Nurses Association filed a lawsuit against the Department of Health and Human Services (HHS), claiming that HHS allows hospitals that fail to meet federal nurse staffing requirements to participate in Medicare, thereby endangering patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content