LEWISTOWN - A bill to establish safe nursing levels in Pennsylvania health care facilities was introduced last month, but Lewistown Hospital and Geisinger Health System have been following this practice for years, nursing staff from each of the facilities say.
The bill, HB 1033, or otherwise known as safe staffing legislation, "Encourages nurses and hospitals to work together to make sure the right number of nurses are there to provide the ... care that every patient deserves," according to a press release from the Pennsylvania State Nurses Association.
The legislation was introduced by Rep. William Adolph, (R-Delaware), to address the problem of inadequate nurse staffing, according to the release.
"HB 1033 calls on hospitals to establish safe nurse staffing levels for each of their inpatient units," the release states. "The legislation is geared towards patient safety and does not require hospitals to implement mandatory minimum ratios. Instead, each facility will tailor its staffing plan based on the unique factors of every inpatient unit."
Lewistown Hospital supports the legislation, and manages its staff by following a basic ongoing staffing plan, said Chris Mathews, vice president of nursing services at Lewistown Hospital. The plan involves reviewing staff daily based on inpatient census, staff skill level, and patient acuity, she said.
"We are already at or above the national norms for nursing coverage for all our patient units throughout the hospital," Mathews said.
Mathews said the hospital has been following safe staffing practices as the legislation develops.
"It's been circulating around the country as a concept for years," she said.
Patient care units that require nursing staff includes the operating room suite, which is mostly an outpatient facility; the ICCU, or intensive coronary care unit; IMCU, the immediate care unit; the pediatric surgery unit, the OBGYN unit, the med search unit, which contains chemotherapy and orthopedic care; inpatient psychiatry; and the outpatient IV therapy clinic, Mathews said.
The nurse to patient ratio for the critical care unit typically is 1 to 2, and the ratio for the med search units are between 1 to 5 and 1 to 4. The numbers are adjusted depending on what's going on, Mathews said.
"We do look at the admissions and discharges," she said.
Much of the hospital's nursing staff comes from Lewistown Hospital's School of Nursing. Some of the units are comprised of a mixture of more and less experienced nurses, Mathews said.
"We have to look at their skill level and experience," she said.
Mathews said the hospital is against mandatory minimum ratios because minimum ratios often become maximum ratios. It's more beneficial to have a plan that takes into account acuity and nursing skill level, and every hospital has their own way of doing this, she said.
"You can't just make a blanket statement," she said. "That's not the most effective."
Sue Hallick, executive vice president and chief nursing officer for Geisinger Health System, said Geisinger always has monitored nurse to patient ratios to provide the best possible care to patients. In addition, it has benchmarked ratios at a national level, she said.
Geisinger's Danville and Wilkes-Barre facilities have participated in The National Database of Nursing Quality Indicators for several years, which is a database for hospitals that have been designated as Magnet hospitals. In the database, hospitals contribute information on nurse to patient ratios, Hallick said.
Magnet status is an award given by the American Nurses' Credentialing Center, an affiliate of the American Nurses Association, to hospitals that satisfy a set of criteria designed to measure the strength and quality of their nursing, according to the Center for Nursing Advocacy's Web site.
Because Geisinger is a part of the database, the information it receives is from the "cream of the crop," Hallick said.
"That's the stance we've taken (regarding the legislation)," she said.
She added that safe staffing always has been something Geisinger has believed in to make sure "that we're staffing with a sound number of nurses to deliver the best possible care," she said.
Geisinger manages patient care by implementing a sound staffing ratio based on the database, building appropriate support teams, and addressing the ongoing education and competence of the nurses, she said.
Hallick said the thought behind the bill is correct, but there are certain issues with it. The bill fails to address other critical items that should be examined, such as nurses' education and competence, and teamwork.
"The bill needs to look at all of those items versus just a number," she said.