Urgent action alert: Support federal proposal on nurse staffing transparency

Make your voice heard today in support of safe hospitals! Deadline for comments is June 13th.

Federal Government Proposes Adopting New Consumers Tool Increasing Transparency on the Critical Role of Nurses in Measuring Patient Outcomes

Nurses are critical to patient safety in hospital settings and are the most trusted providers on the health care delivery team. In fact, there is a direct correlation between nurse staffing, patient satisfaction, readmissions, and adverse events. Currently patients and their families compare hospitals on a number of factors through a website called “Hospital Compare” but they are unable to access information on how many nurses are staffing the unit to which they may be admitted and the staff skill mix, both of which ultimately impact outcomes. Skill mix is part of the formula for appropriate staffing. Proper use of support personnel improves nurses’ workflow, permitting nurses to fully apply their professional knowledge and skill.

To help consumers make informed choices, the Centers for Medicare & Medicaid Services (CMS) proposes public reporting of two quality measures that are very powerful tools to compare nurse staffing and skill mix in hospitals. These measures have already been adopted by more than 2,000 hospitals in the US. This proposed requirement for public reporting of all hospitals allows patients and their families to make more informed decisions.

The Proposed New Tool for Consumers

• CMS has proposed the public reporting of two nurse staffing quality measures to help consumers compare hospitals based on the level of nurse staffing and staff skill mix. The measures were included in the proposed FY 2018 Inpatient Prospective Payment System (IPPS) rule, which was released in April 2017; the comment period ends June 13th and the final rule would be published in late summer 2017.
• This data will be available on Hospital Compare, a consumer-oriented website that provides information on how comparable hospitals are prepared to provide high quality and safe care. These new requirements increase the transparency of care provided and will improve patient safety.
• The American Nurses Association (ANA) first championed these nursing-sensitive quality measures in 1994 and continues to stand behind these measures. They are a mechanism to demonstrate the impact that appropriate nurse staffing levels plays in patient safety—and a growing body of research demonstrates the link between nurse staffing and patient safety and outcomes.
• Studies continue to find that inadequate registered nurse staffing is associated with increased mortality and multiple types of avoidable adverse events causing patient harm, reinforcing the need to match staffing and skill mix to patient’s need for nursing care.
• WSNA and ANA strongly supports the inclusion of both measures in the final hospital payment rule.

About the Proposed Nursing Quality Measures

• If finalized, the proposed rule will require hospitals to collect and report data on the following quality measures on nursing for inclusion in CMS’ quality reporting program:
  • Nurse staffing; and
  • Staff skill mix, which refers to the combination or grouping of different categories of workers providing patient care.
• Both measures are fully endorsed as a priority for Hospital Compare by the National Quality Forum (NQF), a non-partisan organization that endorses valid, evidence-based quality measures. This is the gold-star seal of approval for quality measures.
• The proposed measures represent key indicators of patient safety in a hospital, not just another piece of data to collect. Reporting these data is not a paperwork burden to hospitals, nurses or other clinicians. In fact, in hospital settings, this information is not necessarily being newly collected but rather, newly reported—the measures collect electronic data already included in hospital databases. Transparent access to this data contributes to safer, more effective interdisciplinary teams across the hospital.
• While hospitals share a commitment to patient safety, they want flexibility in how they staff their hospitals. Nothing in these measures will require hospitals to have rigid staffing patterns. The data will inform safe, appropriate care that meets the needs of their patient acuity. Nor will Hospital Compare reveal a hospital’s individual staffing pattern. Instead, it will highlight which hospitals have lower staffing and skill mix patterns so that consumers can make an informed choice.

Why These Measures are Important

• Nurse staffing data gives consumers tools to make informed decision when selecting from comparable hospitals. There is currently a wide variation in nurse staffing and staff skill mix in hospitals across the country. Patients should demand to know that there is a nurse at the other end of the call button. Transparency empowers patients and their families with information to understand the staffing levels compared to other similar hospitals, providing essential information to decisions makers.
• Research shows that appropriate nurse staffing is key in improving a range of patient outcomes, including:
  
  • Improving patient satisfaction and health-related quality of life;
  • Reducing medical and medication errors, Higher RN staffing levels have been shown to decrease avoidable Hospital-Acquired Conditions (HACs);
  • Reducing patient mortality, hospital readmissions, and length of stay; as well as patient care costs through avoidance of unplanned readmissions;
  • Decreasing the number of preventable events such as patient falls, pressure ulcers, central line infections, healthcare-associated infections (HAIs), and other complications related to hospitalizations; and
  • Preventing nurse fatigue, thus promoting nursing safety, nurse retention, and job satisfaction - all contributors safer patient care and nurse retention.
• Hospitals which invest in appropriate nurse staffing and skill mix to meet the needs of their patients will receive higher ratings. Hospital Compare generally ranks hospitals using the data from these measures to award up to 5 stars. A hospital with strong nurse staffing and skill mix level will receive a higher star rating—and will stand out strongly in an apples-to-apples comparison with hospitals who are not investing in appropriate nurse staffing.

Take Action. Make your voice heard today in support of safe hospitals! Deadline for comments is June 13th.