WHEREAS: Medical errors are the third leading cause of death in the U.S: It
has been estimated that as many as 400,000 patients die each year as a result
of preventable medical errors. Tragically, very little progress has been made
in improving conditions since the Institute of Medicine’s 1999 report, “To Err
is Human,” first brought the problem to national attention; and

WHEREAS: Hospital patients are also at risk for preventable infections and
unnecessary complications that may prolong their stay and threaten their
recovery; and

WHEREAS: Many patients are discharged without adequate education on
their medicines and treatment protocols, which may lead to unnecessary
readmissions; and

WHEREAS: The Patient Protection and Affordable Care Act (ACA) attempts to
fix these problems by creating payment systems that reward or punish
hospitals based on readmissions, hospital-acquired infections, mortality,
patient satisfaction and other quality indicators; and

WHEREAS: Decades of research have established the relationship between
nurse staffing and factors such as:

  • Patient Deaths: A one-patient increase in a nurse’s workload increased the
    likelihood of an in-patient death within 30 days of admission by 7 percent.
    Mortality risk decreases by 9 percent for ICU patients and 16 percent for
    surgery patients with the increase of one full-time equivalent RN per
    patient day. Nurse staffing shortages are a factor in one of every four
    unexpected hospital deaths or injuries caused by errors.
  • Medical Errors: A study of medication errors in two hospitals found that
    nurses were responsible for intercepting 87 percent of all medication
    errors made by physicians, pharmacists and others before the error
    reached the patient.
  •  Complications and Infections: Facilities with nurse staffing levels in the
    bottom 30 percent were more likely to be among the worst 10 percent for
    heart failure, electrolyte imbalances, sepsis, respiratory infection and
    urinary tract infections. Lower nurse staffing levels led to higher rates of
    blood infections, ventilator associated pneumonia, 30-day mortality,
    urinary tract infections and pressure ulcers. Large patient loads and high
    levels of exhaustion among nurses were associated with greater rates of
    urinary tract and surgical-site infections. As nurse staffing levels increase,
    patient risk of hospital-acquired complications and hospital length of stay
    decrease, resulting in medical cost savings, improved national productivity,
    and lives saved.
  • Readmissions: Reducing readmissions is a significant goal of the ACA. Each
    one-patient increase in a hospital’s average staffing ratio increased the
    odds of a medical patient’s readmission within 15-30 days by 11 percent
    and a surgical patient’s readmission by 48 percent.
  • Patient Satisfaction: Patients on units characterized as having adequate
    staff were more than twice as likely to report high satisfaction with their
    care, and their nurses reported significantly lower burnout. Patient
    satisfaction scores were significantly higher in hospitals with better nurse-
    to-patient ratios. There was a 10-point difference in the percentage of
    patients who would definitely recommend the hospitals— depending on
    whether patients were in a hospital with a good work environment for
  • Burnout and turnover: In August 2012, approximately one-third of nurses
    reported an emotional exhaustion score of 27 or greater, considered by
    medical standards to be “high burnout.” Each additional patient per nurse
    (above four) is associated with a 23 percent increase in the odds of nurse
  • Lower costs: A 2009 study found that adding 133,000 RNs to the U.S.
    hospital workforce would produce medical savings estimated at $6.1
    billion in reduced patient care costs:

THEREFORE BE IT RESOLVED: That the Ohio AFL-CIO will support state and
federal laws to set minimum standards related to the number of patients
assigned to registered nurses for each hospital unit and shift, with the ability
to make upward adjustments based on a plan that takes into account factors
like acuity, skill mix, department layout and patient population. Such plans
should be established by a nurse staffing committee in each hospital.

BE IT FURTHER RESOLVED: The Ohio AFL-CIO will support laws that require
hospitals to establish nurse staffing committees that will be empowered to
research, establish, implement and review factors appropriate for increasing
nurse staffing levels above the minimum levels established by law; and review
of proper staffing levels for other health professionals and ancillary staff as

BE IT FURTHER RESOLVED: The Ohio AFL-CIO will advocate for and support
laws that require healthcare providers to employ a sufficient number of
registered nurses, with knowledge and expertise in the areas for which
patients are admitted, to provide safe, high-quality care and prevent adverse
events and readmissions among the patients they serve.

BE IT FINALLY RESOLVED: The Ohio AFL-CIO will work with other
healthcare unions to help develop resources for locals designed to empower
nurses serving on staffing committees through education about healthcare
payment systems and other business factors that impact staffing, economic
implications for staffing profiles, and evidence-based research linking nurse
staffing to quality outcomes.

Submitted by: Ohio Nurses Association / Ohio Federation of Teachers