The American Nurses Association has developed nursing sensitive indicators that capture outcomes most affected by nursing care. ANA is promoting, through its Nationwide State Legislative Agenda, state legislation that would require health care facilities to collect nursing sensitive indicator data and make it publicly available. The appropriate numbers and mix of nursing personnel (RN's LPN’s and Unlicensed Staff) are imperative for the delivery of safe, cost-effective quality care. Nurses are pushing for research projects that will collect data to establish the relationship between the right mix of staff and positive patient outcomes. Preliminary studies comparing staffing information and information on patient outcomes show that when there are more registered nurses, patients experience fewer complications, shorter lengths of stay, decreased mortality rates and even lower overall costs. However, a critical need remains for more definitive data to show the clear linkages between nursing interventions, staffing levels, and positive patient outcomes. On the federal level, ANA pushed for the enactment of SB 991, the Registered Nurse Safe Staffing Act of 2003 that calls for staffing plan evaluations to be based on nursing quality indicators. This bill was not enacted.
Activities / Actions
In 2005 and carried over into 2006, MA introduced legislation that requires health care institutions, organizations and corporations licensed or registered by the Department of Public Health to annually report appropriate data, including indicators of the nature and amount of nursing care directly provided by the licensed nurses. This bill requires that the data also include the average ratio of registered nurses to patients or residents and the average skill mix ratio of licensed and supervised unlicensed personnel to patients or residents, medication errors, number and grades of pressure sores, number of falls, number of injuries, number of nosocomial infections and number of preventable hospitalizations. NY introduced legislation requiring every facility to make available to the public information regarding nurse staffing and patient outcomes including the number of registered nurses providing direct care and the ratio of patients per registered nurse, the number of licensed practical nurses providing direct care and the number of unlicensed personnel utilized to provide direct patient care. The incidence of adverse patient care will also be reported including medication errors, patient injury, decubitus ulcers, and nosocomial infection. Not specific to nursing quality indicators, number of states enacted legislation in 2006, requiring monitoring and reporting of nosocomial infections.
In 2004, ME enacted legislation requiring minimum nurse to patient staffing ratios as outlined in law that will be increased as patient needs demand as determined by an established patient staffing system. The bill also directed the Maine Quality Forum Advisory Council to make recommendations to the legislature by January 2005 related to minimum staffing ratios. In their December 3, 2004 report, the Forum stated that there is no reliable scientific evidence that mandated registered nurse to patient staffing ratios are a guarantor of quality and safety of in-patient care. The Forum instead recommends the collection of 15 nurse-sensitive indicators to access the quality of care in ME in patient hospital settings.
In 2003, three states introduced nurse quality indicators legislation but none passed. A proposed MA bill would require all health care institutions to report annually on data collected such as: measures of severity, length of stay, rations including skill mix, medication errors, pain management, readmission rates, nurse education and length of employment and other parameters, to enable the public to make comparisons. NJ legislation would require hospitals and nursing homes to compile staffing and patient care incidents such as medication errors, patient injuries, decubitus ulcers and nonsocomial infections, posting such information daily in the patient care areas of each unit, providing monthly reports to the Commissioner of Health and Senior Services and making it available to the public on an annual basis. NY legislation would require facilities to disclose nursing quality indicators and directs the Commissioner of Health to adopt rules on the information to be disclosed.
Last year in 2002, legislation was passed in CT establishing a quality of care program within the Department of Public Health. The department is now required to develop standardized data sets to measure the clinical performance of health care facilities. New TX regulations require hospitals to develop nurse staffing systems and to measure patient outcomes through the collection of nursing quality indicators.
A study bill was enacted in FL in 1996. In 2000, legislation enacted in RI required an advisory council to consider nursing sensitive performance measures. Regulations were to be written in NJ regarding the mandatory collection and public disclosure of nursing quality indicators by health care facilities.