By Lena H. Sun and Mike DeBonis,
Feb 04, 2013 06:20 PM EST

The Washington Post Updated: Monday, February 4, 10:20 AM

The union representing nurses at six District hospitals says inadequate nurse staffing is putting patients at risk and is calling for legislation to establish minimum nurse-to-patient ratios.

D.C. Council Chairman Phil Mendelson (D) plans to introduce such a bill Tuesday, he announced at a news conference Monday, where nearly 200 nurses wearing red scrubs packed a room in the John A. Wilson Building as union leaders and local politicians led them in chants of “patients over profit.”

“I think this bill is today’s version of the eight-hour day — something that we will see business resist, but on the other hand makes good sense and leads to quality care,” Mendelson said.

Mendelson introduced similar legislation six years ago. He said he expects opposition from the hospitals because of the perceived increase in costs.

“But I’m not convinced it will increase costs,” he said in an interview before the press conference. Improved nurse staffing leads to better-quality care, which, in turn, means fewer errors and staff turnovers, which are also expensive, he said.

The “Patient Protection Act,” which also include a prohibition on mandatory overtime and whistleblower protections for nurses, has the early support of nine D.C. Council members — enough to guarantee passage.

Bonnie Linen-Carroll, an operating room nurse at MedStar Washington Hospital Center, described how patients are regularly wheeled into the hospital’s surgical unit uncleaned and unprepared for their procedures. “Because nurses in other units were short-staffed, they did not have time to properly prep these patients,” she said.

Some patients, she said, have been left to soil themselves because overworked nurses are unable to help them use the bathroom quickly enough.

Margaret Shanks, a transport nurse in the neonatal intensive care unit at Children’s National Medical Center, said nurses have been forced to care for too many patients on their shifts.

“There are simply not enough nurses at the bedside,” she said. “I have dealt with too many nurses in tears at the end of their shift because hospital management put them into impossible situations.”

In the Children’s Hospital NICU, she said, nurses regularly care for three patients each — two patients per nurse is standard, she said. Some very sick infants, Shanks said, should have a single nurse’s sole attention. But “that one-to-one attention is rarely authorized,” she said.

The ratio of nurses to patients was a concern during a labor dispute between the National Nurses United union and MedStar Washington Hospital Center. Several hundred nurses held a one-day strike in March 2011 before the two sides reached agreement.

Union officials said nurse staffing is a chronic problem. But the issue takes on greater importance, experts say, under the federal health-care overhaul. Hospitals are being rewarded or penalized on how they perform on many more quality measures. And experts say nurse staffing can help hospitals’ performances.

The union surveyed nurses at nine hospitals in the District last fall and found widespread concern about inadequate staffing. Of more than 800 nurses who responded, 60 percent say changes in their workload have led to worse outcomes for patients, according to the union. Nearly 90 percent of the nurses who responded said they have had to work through meal and rest breaks because there are not enough nurses.

Nurses worked at the following hospitals: MedStar Washington Hospital Center, MedStar Georgetown University Hospital, George Washington University Hospital, Howard University Hospital, Providence Hospital, Sibley Memorial Hospital, United Medical Center, Children’s National Medical Center and the Washington VA Medical Center.

National Nurses United, the country’s largest organization of nurses, represents about 1,700 nurses at the hospital center, the city’s largest private hospital, and about 2,300 nurses at Howard University, Children’s Hospital, United Medical Center, St. Elizabeths, the VA Medical Center and at some departments in the D.C. government.

The proposed ratios would vary by unit. In the operating room, the bill calls for a mandatory minimum of one nurse for every patient. In the intensive-care and neonatal intensive-care units, the proposal calls for one nurse for every two patients, and for non-trauma or noncritical care in the emergency room, the ratio would be one nurse for every four patients.

The D.C. Hospital Association, which represents many of the District’s hospitals, said such requirements are an oversimplified prescription for complex problems.

“There is no doubt that patient safety and enriching the professional lives of nurses are real issues,” said Amy Freeman, president of Providence Hospital and current chair of the association. But nurse staffing is only one variable in patient care. “Quotas don’t equal quality,” she said.

Every hospital has a methodology for nurse staffing that takes into account the number of patients, how ill the patients are and the experience of the staff, she said.

Nurses have complained for two decades that there are not enough nurses in hospitals to provide high-quality care. California implemented a minimum staffing law nine years ago.

One study in 2011 found that increased staffing in California hospitals was associated with better outcomes, compared with outcomes for patients treated in hospitals in states without a similar law. But the study said it remained to be determined whether the cost of increased staffing provided adequate returns compared with other initiatives to improve quality.

Barry Wolfman, chief executive at George Washington University Hospital, estimated that it would cost $10 million to $15 million a year to meet proposed staffing requirements. In his previous job, Wolfman was chief executive of a Los Angeles area hospital. The mandated nurse staffing ratios, he said, did not lead to overall improvements in patient care.