More than 150 Washington DC nurses, joined by patients and community leaders are filling the District of Columbia Council chambers today to demand the Council act to improve public safety and protect vulnerable hospital patients by enacting the Patient Protection Act.

A hearing is being held today on the proposed Act, introduced earlier this year by DC Council Chairman Phil Mendelson with 10 of the 13 council members as co-sponsors. The hearing is now underway in Room 500 of the John A. Wilson Building, 1350 Pennsylvania Avenue, N.W., Washington, DC. The hearing is being telecast at http://dccouncil.us/granicus (installation required).

The bill would set specific limits on the number of patients RNs can care for (nurse-to-patient ratios), with additional staffing required based on individual need, similar to limits on class sizes or minimum standards for clean air and water.

Patient Testimony About Short Staffing in DC Hospitals

Several community residents came to the hearing to support the bill, and relate their own experiences. “I am here because my mother is dead, and died in pain, as a result of the crisis in our city’s hospitals,” said Tina Trowell. She reported that her mother came to Washington Hospital Center “because of complications related to a urinary tract infection” where “she developed multiple pressure sores covering her entire backside.

“Pressure sores, which come from lying in the same position or having soiled dressings for too long, are completely preventable – but only when there are enough nurses to do their jobs,” said Trowell. “Instead, my mother suffered. There was no one to change her dressings when she was incontinent or apply antibiotics in a timely fashion or even give her regular pain medication when the pressure ulcers had grown out of control.”

Trowell emphasized she does not blame the nurses, “there were simply too few of them to care for the large number of patients, including my mother, in an optimal way. No mother should have to die in agony, covered in her own feces as mine did. Every patient deserves to live and die with dignity.”

Mary Neznek shared her experience as a patient at Sibley Memorial Hospital when she came for a hip replacement. “The real pain and problems didn’t come from my surgery as you might expect. They came in the hours and days after my surgery, and it was exacerbated because my nurses were so clearly over worked.”

“I could see that the nurses were running to get to all of their patients and I could tell they were trying their best, but it was also apparent that they could not do it all,” Neznek said. “No one should have additional pain inflicted on them because hospital management are cutting corners and understaffing nurses. No one in a hospital in the capital of the richest country in the world should have to endure unnecessary discomfort or be degraded because of short staffing.”

Rabbi Elizabeth Richman of Jews United for Justice in DC cited her own experience when giving birth at a city hospital noted, “my son developed feeding issues shortly after he was born. Overburdened staff would stop in and try to help me feed him as best they could, but mostly they told me there were too few of them working that day and everything would be okay tomorrow when staffing would be back to normal.”

“The staff was larger the next day, but 24 hours later it was just too late. My son’s feeding problems had snowballed. My husband and I spent the next four months spending money and time we didn’t have consulting with specialists to help our son. The specialists told us that if there had been people on staff in the first 24 hours to give our son the attention he needed, this would never have happened.”

Washington Hospital Center RN Lori Marlowe called the Patient Protection Act “the only solution to the chronic problem of understaffing in District hospitals. Bedside nurses such as myself are the only ones in minute-by-minute contact with patients and are thus the only ones who can accurately assess patient acuity and need.”

“I’ve been a patient in District hospitals myself and I’ve always taken an RN friend with me because I know the nurses will be understaffed,” said Brenda King, an RN who worked at Children’s National Medical Center for 42 years. “Several friends of mine have died from breast cancer over the last few years, and I’ve stayed with all of them while they were in the hospital so I could make sure they were getting the care they needed.”

The bill is modeled after a highly successful California law that since its implementation nine years ago has saved thousands of patient lives, promoted improved overall quality of care, and helped keep the state’s most experienced nurses at the bedside.

Forty-five community and labor organizations have endorsed the legislation. In addition, 43 community faith leaders have announced support for the bill and urged the Council to pass it.

The bill was prompted in part by a survey of DC area nurses last fall which found 57 percent of DC nurses say staffing is inadequate always or almost always and 87 percent say mandatory nurse-to-patient ratios, such as those in California, are needed in DC.

LaKisha Little, RN, noted that in the neonatal intensive care unit at Children’s, “the patient load has been increased by 50 percent on many occasions. If one of the nurses on the unit is able to take a break, then another nurse has to care for five, and sometimes six babies. These are dangerous conditions in any hospital unit, but especially in a neonatal intensive care unit where we have our youngest and most vulnerable patients.”

Judy Alba, RN at Medstar Washington Hospital cited a study in the current issue of the Journal of Patient Safety which says that each year between 210,000 and 440,000 patients “who go to the hospital for care suffer some type of preventable harm that contributes to their death. In terms of human lives, this part of our broken healthcare system represents the equivalent of 17 jumbo jets filled to full capacity crashing every week.”

“As direct care bedside nurses in our city’s hospitals,” said Alba, “we live this reality every day. Nurses are the most important line of defense against medical errors. But more and more, this important barrier of defense is being tampered with – by poor and unsafe staffing and overwhelming work loads.”

Studies by the nation’s most respected scientific and medical researchers affirm the significance of RN-to-patient ratios for patient safety.

A selection:

Each additional patient added to the work assignment of a pediatric RN increases the likelihood of an average child’s readmission to a hospital within 15-30 days by 11 percent. Each additional surgical child increases the likelihood of that readmission by 48 percent – “An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions,” BMJ Quality and Safety, September 2013

• Higher nurse workloads are associated with more patient deaths, complications, and medical errors – “State Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction,” Agency of Health Research and Quality, AHRQ Healthcare Innovations Exchange, September 26, 2012
• New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California’s 1:5 nurse-to-patient ratios in surgical units — Health Services Research Journal, August, 2010
• With improved nurse staffing levels, patient risk of hospital-acquired infections and hospital length of stay decrease, resulting in lives saved — Medical Care, Volume 47, Number 1, 2009
• Adding just one full-time RN on staff per day resulted in 9 percent fewer hospital-related deaths in intensive care units, 16 percent fewer in surgical patients and 6 percent fewer in medical patients — Healthcare Risk Management, February, 2008.
• Each additional patient assigned to an RN is associated with a 53 percent increase in respiratory failure, 7 percent increase in the risk of hospital-acquired pneumonia, and 17 percent risk in medical complications — AHRQ Publication No. 08-0043, 2008
• Cutting the number of patients per RN per shift in intensive care units from 3.3 patients to less than 1.6 reduces the odds of hospital-acquired sepsis (a severe blood infection that can lead to organ failure and death) – American Journal of Epidemiology, 2007
• Patients hospitalized for heart attacks, congestive heart failure, and pneumonia are more likely to receive high quality care in hospitals with better RN staffing ratios — Archives of Internal Medicine, December 11/25, 2006
• If all hospitals increased RN staffing to match the best staffed hospitals, more than 6,700 in-hospital patient deaths, and 60,000 adverse outcomes could be avoided — Health Affairs, January/February 2006.
• A study of 1,300 Texas patients undergoing surgery for bladder cancer documented a reduction in patient mortality rates of more than 50 percent in hospitals with better RN-to-patient ratios — Cancer, Journal of the American Cancer Society, September 2005.