The Honorable Congressman John W. Olver

February 10, 2012

The Honorable Congressman John W. Olver 1111 Longworth House Office Building United States House of Representatives Washington, DC 20515

Dear Representative Olver:

My name is , I am writing to you as your constituent in the first congressional district of Massachusetts. As a certified critical care registered nurse (CCRN) and as a member of both the Massachusetts Nurses Association (MNA) and the American Nurses Association (ANA) I am deeply concerned about being able to practice in a safe environment that supports quality patient care. The purpose of this letter is to inform you of my personal support for the Registered Nurse Safe Staffing Act of 2011 (H.R. 876/S. 58) that is currently before the House of Representatives Subcommittee on Health. I urge you to endorse the proposed legislation that would make hospitals liable for constructing and enacting specific unit-by-unit core nurse staffing plans that are based on acuity and the individual needs of the unit, and not just standardized nurse-to-patient ratios.

My years of experience as a seasoned intensive care (ICU) nurse and my newest endeavor as a nursing student enrolled in an on-line acute care nurse practitioner (ACNP) program through the University of South Alabama (USA) have provided me with invaluable insight into the importance of championing for legislation that promotes positive patient outcomes as H.R. 876/ S. 58 would inevitably do. This is the first bill of its kind that acknowledges the worth of utilizing input from bedside registered nurses (RNs) in conjunction with nursing leadership in formulating realistic staffing plans.

Unfortunately, as a direct care giver I have had no voice in how our unit is staffed. The set staffing ratio is one RN for two patients. The ICU is a fast paced incredibly stressful environment. We are expected to manage competing priorities, be fiscally prudent, meet all Medicare guidelines, while providing outstanding patient care. When the acuity level of one patient far exceeds the combined set staffing ratio our stress levels are exponentially compounded, patient care suffers, and deleterious outcomes can ensue. Health care facilities that lack appropriate nurse staffing have statistically higher death rates, hospital acquired infections (HAIs), failure-to-rescue percentages, and longer hospital stays (Blegen, Goode, Spetz, Vaughn, & Park, 2011). It is an indescribable feeling when you go home at the end of a nonstop 12 hour shift and despite trying your best, you know that your patients did not receive the care that they deserved and you simply thank God that no one died.

In such a pressure driven atmosphere it becomes harder and harder for direct care nurses to have a sense of pride and accomplishment in their vocation. In a 2010 ANA poll, 53.6% of nurses responded that they were contemplating leaving their present RN positions because of unsafe staffing issues. Can we really afford to lose our veteran nurses? Job satisfaction is directly associated with decreased morbidity and mortality rates in hospitalized patients. According to a research study conducted by Kane, Shamliyan, Mueller, Duval, and Wilt (2006) there is a 15% decrease in patient mortality rates in nurses who voice being satisfied in their present jobs.

Multiple studies including a recent one published in the New England Journal of Medicine (Needleman et al., 2011) displayed that increased patient mortality and poor patient outcomes were directly linked to decreased RN staffing levels. A study by Kutney-Lee et al. (2009) showed that a reduction in the nurse-to-patient workload correlated with increased patient satisfaction and a significant improvement in the quality of care given. Additionally, the U.S. is facing a national health care crisis, with experts predicting RN shortages that range from 340,000 to greater than one million by 2020 (Ellenbecker, 2010). According to the Health Resources and Services Administration (2006) report, the demand for full time equivalent RNs in MA will increase by an estimated 29% from 2000 to 2020. Safe staffing is the fundamental factor in promoting positive patient experiences and outcomes, while simultaneously providing nurses with the encouragement they need to remain at the bedside. Appropriate staffing based on patient care levels versus set ratios enhance the nurse's ability to aggressively respond to signals that a patient's health status is deteriorating.

There are a multitude of major health care issues that are addressed by the Registered Nurse Safe Staffing Act of 2011. The most compelling issues are how the bill will increase safe patient care, decrease patient morbidity and mortality rates, and assist in retention and recruitment of competent bedside RNs. What's more, acuity based staffing will assist hospitals in meeting Medicare bundle payment requirements. The above cited issues reinforce the need to correlate RN staffing plans with the complexity of patient care needs. Passage of the Act would provide nurses with the opportunity for increased autonomy and self governance as it relates to improving patient outcomes. Please refer to the

Talking Points that highlight the rationales as to why the bill is essential on a national level and on a state level as it pertains to MA.

Nurses in conjunction with the health care industry have to ensure proper staffing that allows RNs to provide superior patient care. The key to promoting optimal patient outcomes is through the use of nurse acuity staffing practices that uphold healthy work environments. For the sake of our patients and your constituents I urge you to endorse the Registered Nurse Safe Staffing Act of 2011 (H.R. 876/S.58).

Thank you for your consideration regarding this critical legislation. I look forward to your reply.

Respectfully,

Talking Points

The Registered Nurse Safe Staffing Act of 2011 (H.R. 876/S. 58) before the 112 Congress would make Medicare participating hospitals legally responsible for the formulation and execution of safe nurse staffing plans. Staffing would be based on critical factors that account for patient acuity, qualifications of the nursing staff and ancillary support, and the individual needs of the unit.

 The bill will significantly impact nurses and patients on a national and state level. In the U.S. there are 2.6 million nurses currently employed in health care, with 60% of those working in hospital settings. Patient admissions to registered hospitals tally 36,915,331 per year (Bureau of Labor