The last of the scheduled bargaining sessions between Minnesota nurses and Twin Cities hospitals concluded Thursday without significant progress on the main issue that divides them: patient safety.
Nurses want hospitals to agree to limits on the number of patients that nurses must care for during their shifts. But Twin Cities Hospitals say the limits aren't necessary because they already provide some of the safest patient care in the nation. They also say the nurses' proposal is too expensive.
The bargaining impasse will come to a head Wednesday when nurses vote on whether to ratify the hospitals' contract offer, or reject it. Nursing leaders say their members are willing to walk off the job over the staffing issue.
It's hard to overstate the difference of opinion between hospitals and nurses when it comes to patient safety. Hospitals say their staffing practices have not compromised patient care at all. But nurses disagree.
"I can tell you that there are many situations that we know of where patients have been harmed, in fact where patients have died, and nurses have been left feeling guilt, wishing that there was something that they could have done," said Nellie Munn, a registered nurse who works at Children's Hospitals and Clinics of Minnesota in Minneapolis.
Federal health privacy laws prohibit her from disclosing the names of patients she thinks were harmed, so it's impossible to verify her claims.
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And Munn concedes that these cases aren't perfectly cut and dry because the patients involved were so sick.
"The situation didn't result specifically from an adverse event," she said. "It was because the patient's condition changed. And some nurses look at it as a situation that it was a failure to rescue."
That means nurses might have been too busy to notice subtle signs that their patients were declining.
Ginger Malone, chief nursing officer for Children's Hospitals of Minnesota, said Children's cannot defend itself against claims that it can't verify. But she said it's a documented fact that the hospital system has better than expected mortality rates. It ranks third best in the nation among 42 children's hospitals.
"Our mortality and morbidity rates are some of the best around the world," Malone said.
Children's also has very high staffing levels, measured in hours per patient day, she said.
A recent study suggests that top tier hospitals spend at least 9.1 hours on direct patient care per day. Malone said Children's rates range from 13 to 30 hours per patient per day depending on the intensity of the medical unit.
She said Children's also has a sophisticated computer system that helps it manage and track its staffing levels to make sure there are no gaps in care.
"We went out to Northwest Airlines and out to the airport and looked at a traffic control center and looked at what are the systems that are in place when planes come and go and you need to get crews to particular places," Malone said.
To outsiders, staffing disputes between nurses and hospitals are hard to sort out. That's because there's no easy way of monitoring how different hospitals assign nurses. But some states are starting to regulate how many patients nurses are assigned. Since 2005 California has mandated that hospitals have no more than five patients per nurse. And New Jersey now requires its hospitals to report their nurse-to-patient ratios publicly.
New Jersey's law allows patients to decide if a hospital is sufficiently staffed said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.
"If I was going to have general surgery, would I want my nurse to be taking care of ten or twelve other people? Or would I prefer to go to a hospital where my nurse is taking care of four other people beside me?," Aiken asked. "I mean if you saw that data, other things being equal, you would probably make a decision based upon it if you had to go to a hospital. So I think public information is good."
Aiken said many hospitals have voluntarily added more nurses because there is now a strong body of research showing that better staffing is associated with lower patient mortality and complications. Better staffed hospitals also have lower turnover rates because their nurses are more satisfied with their jobs, she said.